Multifocal High-Grade Pancreatic Precursor Lesions: A Case Series and Management Recommendations

Background: The risk of developing invasive cancer in the remnant pancreas after resection of multifocal high-grade pancreatic precursor lesions is not well known. We report three patients who were followed up after resection of multifocal high-grade pancreatic intraepithelial neoplasia (PanIN)-3 or intraductal papillary mucinous neoplasia (IPMN), two of whom eventually developed invasive carcinoma. Presentation: 1) 68-year-old woman who had a laparoscopic distal pancreatectomy for multifocal mixed-type IPMN, identified as high-grade on final pathology, with negative surgical margins. During semiannual monitoring, eight years from the first surgery, the patient developed suspicious features prompting surgical resection of the body with final pathology revealing invasive ductal adenocarcinoma in the setting of IPMN. 2) 48-year-old woman who had a distal pancreatectomy for severe acute/chronic symptomatic pancreatitis, with final pathology revealing multifocal high-grade PanIN-3, with negative surgical margins. Despite semiannual monitoring, two years from the first surgery, the patient developed pancreatic adenocarcinoma with liver metastasis. 3) 55-year-old woman who had a Whipple procedure for symptomatic chronic pancreatitis, with multifocal PanIN-3 on final pathology. The patient underwent completion pancreatectomy due to symptomatology and her high-risk profile, with final pathology confirming multifocal PanIN-3. Conclusion: Multifocal high-grade dysplastic lesions of the pancreas might benefit from surgical resection

The Black Hole-Bulge Relationship in Luminous Broad-Line Active Galactic Nuclei and Host Galaxies

We have measured the stellar velocity dispersions (\sigma_*) and estimated the central black hole (BH) masses for over 900 broad-line active galactic nuclei (AGNs) observed with the Sloan Digital Sky Survey. The sample includes objects which have redshifts up to z=0.452, high quality spectra, and host galaxy spectra dominated by an early-type (bulge) component. The AGN and host galaxy spectral components were decomposed using an eigenspectrum technique. The BH masses (M_BH) were estimated from the AGN broad-line widths, and the velocity dispersions were measured from the stellar absorption spectra of the host galaxies. The range of black hole masses covered by the sample is approximately 10^6 < M_BH < 10^9 M_Sun. The host galaxy luminosity-velocity dispersion relationship follows the well-known Faber-Jackson relation for early-type galaxies, with a power-law slope 4.33+-0.21. The estimated BH masses are correlated with both the host luminosities (L_{H}) and the stellar velocity dispersions (\sigma_*), similar to the relationships found for low-redshift, bulge-dominated galaxies. The intrinsic scatter in the correlations are large (~0.4 dex), but the very large sample size allows tight constraints to be placed on the mean relationships: M_BH ~ L_H^{0.73+-0.05} and M_BH ~ \sigma_*^{3.34+-0.24}. The amplitude of the M_BH-\sigma_* relation depends on the estimated Eddington ratio, such that objects with larger Eddington ratios have smaller black hole masses than expected at a given velocity dispersion.Comment: Accepted for publication in A

Spectral Classification of Quasars in the Sloan Digital Sky Survey: Eigenspectra; Redshift and Luminosity Effects

We study 16,707 quasar spectra from the SDSS using the Karhunen-Lo\`eve (KL) transform (or Principal Component Analysis, PCA). The quasar eigenspectra of the full catalog reveal the following: 1st order - the mean spectrum; 2nd order - a host-galaxy component; 3rd order - the UV-optical continuum slope; 4th order - the correlations of Balmer emission lines. We find that the spectral classification of quasars is redshift and luminosity dependent, as such there does not exist a compact set (< 10 modes) of eigenspectra (covering 900 to 8000 angstrom) which can describe most variations (> 95%) of the entire catalog. We therefore construct several sets of eigenspectra in different redshift and luminosity bins. From these eigenspectra we find that quasar spectra can be classified (by the first two eigenspectra) into a sequence that is defined by a simple progression in the steepness of the slope of the continuum. We also find a dependence on redshift and luminosity in the eigencoefficients. The dominant redshift effect is a result of the evolution of the blended FeII emission (optical) and the Balmer continuum (the ``small bump''). A luminosity dependence is also present in the eigencoefficients and is related to the Baldwin effect. The eigenspectra constructed from the wavelength-selected SDSS spectra are found to agree with the principal components by Francis et al. (1992) and the well-known ``Eigenvector-1'' (Boroson and Green 1992). (Abridged)Comment: AJ accepted. 65 pages, 27 figures, 9 tables. Resolutions of some figures are lowere

Muon-Spin Rotation Measurements of the Magnetic Field Dependence of the Vortex-Core Radius and Magnetic Penetration Depth in NbSe2

Muon-spin rotation spectroscopy has been used to measure the internal magnetic field distribution in NbSe2 for Hc1 << H < 0.25 Hc2. The deduced profiles of the supercurrent density indicate that the vortex-core radius in the bulk decreases sharply with increasing magnetic field. This effect, which is attributed to increased vortex-vortex interactions, does not agree with the dirty-limit microscopic theory. A simple phenomenological equation in which the core radius depends on the intervortex spacing is used to model this behaviour. In addition, we find for the first time that the in-plane magnetic penetration depth increases linearly with H in the vortex state of a conventional superconductor.Comment: 4 pages, RevTeX, 4 encapsulated postscript figures, (to appear in Phys. Rev. Lett. 25Aug97 issue

An SU(N) Mott insulator of an atomic Fermi gas realized by large-spin Pomeranchuk cooling

The Hubbard model, containing only the minimum ingredients of nearest neighbor hopping and on-site interaction for correlated electrons, has succeeded in accounting for diverse phenomena observed in solid-state materials. One of the interesting extensions is to enlarge its spin symmetry to SU(N>2), which is closely related to systems with orbital degeneracy. Here we report a successful formation of the SU(6) symmetric Mott insulator state with an atomic Fermi gas of ytterbium (173Yb) in a three-dimensional optical lattice. Besides the suppression of compressibility and the existence of charge excitation gap which characterize a Mott insulating phase, we reveal an important difference between the cases of SU(6) and SU(2) in the achievable temperature as the consequence of different entropy carried by an isolated spin. This is analogous to Pomeranchuk cooling in solid 3He and will be helpful for investigating exotic quantum phases of SU(N) Hubbard system at extremely low temperatures.Comment: 20 pages, 6 figures, to appear in Nature Physic

NTT and NOT spectroscopy of SDSS-II supernovae

Context. The SDSS-II Supernova Survey, conducted between 2005 and 2007, was designed to detect a large number of Type Ia supernovae (SNe Ia) around z~0.2, the redshift "gap" between low-z and high-z SN searches. The survey has provided multi-band photometric lightcurves for variable targets, and SN candidates were scheduled for spectroscopic observations, primarily to provide SN classification and accurate redshifts. We present SN spectra obtained in 2006 and 2007 using the NTT and the NOT. Aims. We provide an atlas of SN spectra in the range z =0.03-0.32 that complements the well-sampled lightcurves from SDSS-II in the forthcoming three-year SDSS SN cosmology analysis. The sample can, for example, be used for spectral studies of SNe Ia, which are critical for understanding potential systematic effects when SNe are used to determine cosmological distances. Methods. The spectra were reduced in a uniform manner, and special care was taken in estimating the uncertainties for the different processing steps. Host-galaxy light was subtracted when possible and the SN type fitted using the SuperNova IDentification code (SNID). We also present comparisons between spectral and photometric dating using SALT lightcurve fits to the photometry from SDSS-II, as well as the global distribution of our sample in terms of the lightcurve parameters: stretch and colour. Results. We report new spectroscopic data from 141 SNe Ia, mainly between -9 and +15 days from lightcurve maximum, including a few cases of multi-epoch observations. This homogeneous, host-galaxy subtracted, SN Ia spectroscopic sample is among the largest such data sets and unique in its redshift interval. The sample includes two potential SN 1991T-like SNe (SN 2006on and SN 2007ni) and one potential SN 2002cx-like SN (SN 2007ie). In addition, the new compilation includes spectra from 23 confirmed Type II and 8 Type Ib/c SNe.Comment: Accepted for publication in A&

Routine Gastric Decompression after Pancreatoduodenectomy: Treating the Surgeon?

Background The decision to routinely leave a nasogastric tube after pancreatoduodenectomy remains controversial. We sought to determine the impact of immediate nasogastric tube removal versus early nasogastric tube removal (<24 h) on postoperative outcomes. Methods A retrospective review of our institution’s prospective ACS-NSQIP database identified patients that underwent pancreatoduodenectomy from 2015 to 2018. Outcomes were compared among patients with immediate nasogastric tube removal versus early nasogastric tube removal. Results A total of 365 patients were included in primary analysis (no nasogastric tube, n = 99; nasogastric tube removed 0.05). Incidence of delayed gastric emptying (11.1 versus 13.2%) was similar between groups. Patients with no nasogastric tube less frequently required nasogastric tube reinsertion (n = 4, 4%) compared to patients with NGT <24 h (n = 39, 15%) (OR = 3.83, 95% CI [1.39-10.58]; P = 0.009). Conclusion Routine gastric decompression can be safely avoided after uneventful pancreaticoduodenectomy

Global protease activity profiling provides differential diagnosis of pancreatic cysts

Purpose: Pancreatic cysts are estimated to be present in 2%-3% of the adult population. Unfortunately, current diagnostics do not accurately distinguish benign cysts from those that can progress into invasive cancer. Misregulated pericellular proteolysis is a hallmark of malignancy, and therefore, we used a global approach to discover protease activities that differentiate benign nonmucinous cysts from premalignant mucinous cysts.Experimental Design: We employed an unbiased and global protease profiling approach to discover protease activities in 23 cyst fluid samples. The distinguishing activities of select proteases was confirmed in 110 samples using specific fluorogenic substrates and required less than 5 μL of cyst fluid.Results: We determined that the activities of the aspartyl proteases gastricsin and cathepsin E are highly increased in fluid from mucinous cysts. IHC analysis revealed that gastricsin expression was associated with regions of low-grade dysplasia, whereas cathepsin E expression was independent of dysplasia grade. Gastricsin activity differentiated mucinous from nonmucinous cysts with a specificity of 100% and a sensitivity of 93%, whereas cathepsin E activity was 92% specific and 70% sensitive. Gastricsin significantly outperformed the most widely used molecular biomarker, carcinoembryonic antigen (CEA), which demonstrated 94% specificity and 65% sensitivity. Combined analysis of gastricsin and CEA resulted in a near perfect classifier with 100% specificity and 98% sensitivity.Conclusions: Quantitation of gastricsin and cathepsin E activities accurately distinguished mucinous from nonmucinous pancreatic cysts and has the potential to replace current diagnostics for analysis of these highly prevalent lesions. Clin Cancer Res; 23(16); 4865-74. ©2017 AACR

Unification of Luminous Type 1 Quasars through CIV Emission

Using a sample of 30,000 quasars from SDSS-DR7, we explore the range of properties exhibited by high-ionization, broad emission lines, such as CIV 1549. Specifically we investigate the anti-correlation between L_UV and emission line EQW (the Baldwin Effect) and the "blueshifting" of high-ionization emission lines. The blueshift of the CIV emission line is nearly ubiquitous, with a mean shift of 810 km/s for radio-quiet (RQ) quasars and 360 km/s for radio-loud (RL) quasars, and the Baldwin Effect is present in both RQ and RL samples. Composite spectra are constructed as a function of CIV emission line properties in attempt to reveal empirical relationships between different line species and the SED. Within a two-component disk+wind model of the broad emission line region (BELR), where the wind filters the continuum seen by the disk component, we find that RL quasars are consistent with being dominated by the disk component, while BALQSOs are consistent with being dominated by the wind component. Some RQ objects have emission line features similar to RL quasars; they may simply have insufficient black hole (BH) spin to form radio jets. Our results suggest that there could be significant systematic errors in the determination of L_bol and BH mass that make it difficult to place these findings in a more physical context. However, it is possible to classify quasars in a paradigm where the diversity of BELR parameters are due to differences in an accretion disk wind between quasars (and over time); these differences are underlain primarily by the SED, which ultimately must be tied to BH mass and accretion rate.Comment: 51 pages, 18 figures, accepted by AJ, revised version includes various modifications based on the referee's comment