Previous clinical trials have suggested that carotid-artery stenting with a device to capture and remove emboli ("embolic protection") is an effective alternative to carotid endarterectomy in ...patients at average or high risk for surgical complications.
In this trial, we compared carotid-artery stenting with embolic protection and carotid endarterectomy in patients 79 years of age or younger who had severe carotid stenosis and were asymptomatic (i.e., had not had a stroke, transient ischemic attack, or amaurosis fugax in the 180 days before enrollment) and were not considered to be at high risk for surgical complications. The trial was designed to enroll 1658 patients but was halted early, after 1453 patients underwent randomization, because of slow enrollment. Patients were followed for up to 5 years. The primary composite end point of death, stroke, or myocardial infarction within 30 days after the procedure or ipsilateral stroke within 1 year was tested at a noninferiority margin of 3 percentage points.
Stenting was noninferior to endarterectomy with regard to the primary composite end point (event rate, 3.8% and 3.4%, respectively; P=0.01 for noninferiority). The rate of stroke or death within 30 days was 2.9% in the stenting group and 1.7% in the endarterectomy group (P=0.33). From 30 days to 5 years after the procedure, the rate of freedom from ipsilateral stroke was 97.8% in the stenting group and 97.3% in the endarterectomy group (P=0.51), and the overall survival rates were 87.1% and 89.4%, respectively (P=0.21). The cumulative 5-year rate of stroke-free survival was 93.1% in the stenting group and 94.7% in the endarterectomy group (P=0.44).
In this trial involving asymptomatic patients with severe carotid stenosis who were not at high risk for surgical complications, stenting was noninferior to endarterectomy with regard to the rate of the primary composite end point at 1 year. In analyses that included up to 5 years of follow-up, there were no significant differences between the study groups in the rates of non-procedure-related stroke, all stroke, and survival. (Funded by Abbott Vascular; ACT I ClinicalTrials.gov number, NCT00106938.).
ABSTRACT
The characterization of exoplanets is critical to understanding planet diversity and formation, their atmospheric composition, and the potential for life. This endeavour is greatly enhanced ...when light from the planet can be spatially separated from that of the host star. One potential method is nulling interferometry, where the contaminating starlight is removed via destructive interference. The GLINT instrument is a photonic nulling interferometer with novel capabilities that has now been demonstrated in on-sky testing. The instrument fragments the telescope pupil into sub-apertures that are injected into waveguides within a single-mode photonic chip. Here, all requisite beam splitting, routing, and recombination are performed using integrated photonic components. We describe the design, construction, and laboratory testing of our GLINT pathfinder instrument. We then demonstrate the efficacy of this method on sky at the Subaru Telescope, achieving a null-depth precision on sky of ∼10−4 and successfully determining the angular diameter of stars (via their null-depth measurements) to milliarcsecond accuracy. A statistical method for analysing such data is described, along with an outline of the next steps required to deploy this technique for cutting-edge science.
Abstract
The fraction of galaxies supported by internal rotation compared to galaxies stabilized by internal pressure provides a strong constraint on galaxy formation models. In integral field ...spectroscopy surveys, this fraction is biased because survey instruments typically only trace the inner parts of the most massive galaxies. We present aperture corrections for the two most widely used stellar kinematic quantities V/σ and λR (spin parameter proxy). Our demonstration involves integral field data from the SAMI (Sydney-AAO Multi-object Integral-field spectrograph) Galaxy Survey and the ATLAS3D survey. We find a tight relation for both V/σ and λR when measured in different apertures that can be used as a linear transformation as a function of radius, i.e. a first-order aperture correction. In degraded seeing, however, the aperture corrections are more significant as the steeper inner profile is more strongly affected by the point spread function than the outskirts. We find that V/σ and λR radial growth curves are well approximated by second-order polynomials. By only fitting the inner profile (0.5Re), we successfully recover the profile out to one Re if a constraint between the linear and quadratic parameter in the fit is applied. However, the aperture corrections for V/σ and λR derived by extrapolating the profiles perform as well as applying a first-order correction. With our aperture-corrected λR measurements, we find that the fraction of slow rotating galaxies increases with stellar mass. For galaxies with log M*/M⊙ > 11, the fraction of slow rotators is 35.9 ± 4.3 per cent, but is underestimated if galaxies without coverage beyond one Re are not included in the sample (24.2 ± 5.3 per cent). With measurements out to the largest aperture radius, the slow rotator fraction is similar as compared to using aperture-corrected values (38.3 ± 4.4 per cent). Thus, aperture effects can significantly bias stellar kinematic integral field spectrograph studies, but this bias can now be removed with the method outlined here.
We demonstrate the feasibility and potential of using large integral field spectroscopic surveys to investigate the prevalence of galactic-scale outflows in the local Universe. Using integral field ...data from the Sydney-AAO Multi-object Integral field spectrograph (SAMI) and the Wide Field Spectrograph, we study the nature of an isolated disc galaxy, SDSS J090005.05+000446.7 (z = 0.053 86). In the integral field data sets, the galaxy presents skewed line profiles changing with position in the galaxy. The skewed line profiles are caused by different kinematic components overlapping in the line-of-sight direction. We perform spectral decomposition to separate the line profiles in each spatial pixel as combinations of (1) a narrow kinematic component consistent with H ii regions, (2) a broad kinematic component consistent with shock excitation, and (3) an intermediate component consistent with shock excitation and photoionization mixing. The three kinematic components have distinctly different velocity fields, velocity dispersions, line ratios, and electron densities. We model the line ratios, velocity dispersions, and electron densities with our mappings iv shock and photoionization models, and we reach remarkable agreement between the data and the models. The models demonstrate that the different emission line properties are caused by major galactic outflows that introduce shock excitation in addition to photoionization by star-forming activities. Interstellar shocks embedded in the outflows shock-excite and compress the gas, causing the elevated line ratios, velocity dispersions, and electron densities observed in the broad kinematic component. We argue from energy considerations that, with the lack of a powerful active galactic nucleus, the outflows are likely to be driven by starburst activities. Our results set a benchmark of the type of analysis that can be achieved by the SAMI Galaxy Survey on large numbers of galaxies.
Detection of persistent circulating tumor DNA (ctDNA) after curative-intent surgery can identify patients with minimal residual disease (MRD) who will ultimately recur. Most ctDNA MRD assays require ...tumor sequencing to identify tumor-derived mutations to facilitate ctDNA detection, requiring tumor and blood. We evaluated a plasma-only ctDNA assay integrating genomic and epigenomic cancer signatures to enable tumor-uninformed MRD detection.
A total of 252 prospective serial plasma specimens from 103 patients with colorectal cancer undergoing curative-intent surgery were analyzed and correlated with recurrence.
Of 103 patients, 84 stage I (9.5%), II (23.8%), III (47.6%), IV (19%) had evaluable plasma drawn after completion of definitive therapy, defined as surgery only (
= 39) or completion of adjuvant therapy (
= 45). In "landmark" plasma drawn 1-month (median, 31.5 days) after definitive therapy and >1 year follow-up, 15 patients had detectable ctDNA, and all 15 recurred positive predictive value (PPV), 100%; HR, 11.28 (
< 0.0001). Of 49 patients without detectable ctDNA at the landmark timepoint, 12 (24.5%) recurred. Landmark recurrence sensitivity and specificity were 55.6% and 100%. Incorporating serial longitudinal and surveillance (drawn within 4 months of recurrence) samples, sensitivity improved to 69% and 91%. Integrating epigenomic signatures increased sensitivity by 25%-36% versus genomic alterations alone. Notably, standard serum carcinoembryonic antigen levels did not predict recurrence HR, 1.84 (
= 0.18); PPV = 53.9%.
Plasma-only MRD detection demonstrated favorable sensitivity and specificity for recurrence, comparable with tumor-informed approaches. Integrating analysis of epigenomic and genomic alterations enhanced sensitivity. These findings support the potential clinical utility of plasma-only ctDNA MRD detection.
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Characterisation of exoplanets is key to understanding their formation, composition and potential for life. Nulling interferometry, combined with extreme adaptive optics, is among the most promising ...techniques to advance this goal. We present an integrated-optic nuller whose design is directly scalable to future science-ready interferometric nullers: the Guided-Light Interferometric Nulling Technology, deployed at the Subaru Telescope. It combines four beams and delivers spatial and spectral information. We demonstrate the capability of the instrument, achieving a null depth better than 10
with a precision of 10
for all baselines, in laboratory conditions with simulated seeing applied. On sky, the instrument delivered angular diameter measurements of stars that were 2.5 times smaller than the diffraction limit of the telescope. These successes pave the way for future design enhancements: scaling to more baselines, improved photonic component and handling low-order atmospheric aberration within the instrument, all of which will contribute to enhance sensitivity and precision.
Cosmological hydrodynamical simulations are rich tools to understand the build-up of stellar mass and angular momentum in galaxies, but require some level of calibration to observations. We compare ...predictions at |$z$| ∼ 0 from the eagle, hydrangea, horizon-agn, and magneticum simulations with integral field spectroscopic (IFS) data from the SAMI (Sydney-AAO Multi-object Integral field spectrograph) Galaxy Survey, ATLAS^3D, CALIFA (Calar Alto Legacy Integral Field Area), and MASSIVE surveys. The main goal of this work is to simultaneously compare structural, dynamical, and stellar population measurements in order to identify key areas of success and tension. We have taken great care to ensure that our simulated measurement methods match the observational methods as closely as possible, and we construct samples that match the observed stellar mass distribution for the combined IFS sample. We find that the eagle and hydrangea simulations reproduce many galaxy relations but with some offsets at high stellar masses. There are moderate mismatches in R_e (+), ε (−), σ_e (−), and mean stellar age (+), where a plus sign indicates that quantities are too high on average, and minus sign too low. The horizon-agn simulations qualitatively reproduce several galaxy relations, but there are a number of properties where we find a quantitative offset to observations. Massive galaxies are better matched to observations than galaxies at low and intermediate masses. Overall, we find mismatches in R_e (+), ε (−), σ_e (−), and (V/σ)_e (−). magneticum matches observations well: this is the only simulation where we find ellipticities typical for disc galaxies, but there are moderate differences in σ_e (−), (V/σ)_e (−), and mean stellar age (+). Our comparison between simulations and observational data has highlighted several areas for improvement, such as the need for improved modelling resulting in a better vertical disc structure, yet our results demonstrate the vast improvement of cosmological simulations in recent years.
Abstract
We investigate the energy sources of random turbulent motions of ionized gas from H α emission in eight local star-forming galaxies from the Sydney-AAO Multi-object Integral field ...spectrograph (SAMI) Galaxy Survey. These galaxies satisfy strict pure star-forming selection criteria to avoid contamination from active galactic nuclei (AGNs) or strong shocks/outflows. Using the relatively high spatial and spectral resolution of SAMI, we find that – on sub-kpc scales, our galaxies display a flat distribution of ionized gas velocity dispersion as a function of star formation rate (SFR) surface density. A major fraction of our SAMI galaxies shows higher velocity dispersion than predictions by feedback-driven models, especially at the low SFR surface density end. Our results suggest that additional sources beyond star formation feedback contribute to driving random motions of the interstellar medium in star-forming galaxies. We speculate that gravity, galactic shear and/or magnetorotational instability may be additional driving sources of turbulence in these galaxies.
We demonstrate a novel technology that combines the power of the multi-object spectrograph with the spatial multiplex advantage of an integral field spectrograph (IFS). The Sydney-AAO (Australian ...Astronomical Observatory) Multi-object IFS (SAMI) is a prototype wide-field system at the Anglo-Australian Telescope (AAT) that allows 13 imaging fibre bundles ('hexabundles') to be deployed over a 1-degree diameter field of view. Each hexabundle comprises 61 lightly fused multi-mode fibres with reduced cladding and yields a 75 per cent filling factor. Each fibre core diameter subtends 1.6 arcsec on the sky and each hexabundle has a field of view of 15 arcsec diameter. The fibres are fed to the flexible AAOmega double-beam spectrograph, which can be used at a range of spectral resolutions (R=λ/δλ≈ 1700-13 000) over the optical spectrum (3700-9500 Å). We present the first spectroscopic results obtained with SAMI for a sample of galaxies at z≈ 0.05. We discuss the prospects of implementing hexabundles at a much higher multiplex over wider fields of view in order to carry out spatially resolved spectroscopic surveys of 104-105 galaxies.
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