False-negative upper extremity ultrasound in the initial evaluation of patients with suspected subclavian vein thrombosis due to thoracic outlet syndrome (Paget-Schroetter syndrome)

OBJECTIVE: To assess the utilization and consequences of upper extremity Duplex ultrasound in the initial diagnostic evaluation of patients with suspected subclavian vein (SCV) thrombosis and venous thoracic outlet syndrome (VTOS). METHODS: A retrospective single-center review was conducted for patients that underwent primary surgical treatment for VTOS between 2008 and 2017, in whom an upper extremity ultrasound had been performed as the initial diagnostic test (n = 214). Clinical and treatment characteristics were compared between patients with positive and false-negative ultrasound studies. RESULTS: There were 122 men (57%) and 92 women (43%) that had presented with spontaneous idiopathic arm swelling, including 28 (13%) with proven pulmonary embolism, at a mean age of 30.7 ± 0.8 years (range 14-69). Upper extremity ultrasound had been performed 23.8 ± 12.2 days after the onset of symptoms, with confirmation of axillary-SCV thrombosis in 169 patients (79%) and negative results in 45 (21%). Of the false-negative ultrasound study reports, only 8 (18%) acknowledged limitations in visualizing the central SCV. Definitive diagnostic imaging (DDI) had been obtained by upper extremity venography in 175 (82%), computed tomography angiography in 24 (11%), and magnetic resonance angiography in 15 (7%), with 142 (66%) undergoing catheter-directed axillary-SCV thrombolysis. The mean interval between initial ultrasound and DDI was 48.9 ± 14.2 days with no significant difference between groups, but patients with a positive ultrasound were more likely to have DDI within 48 hours than those with a false-negative ultrasound (44% vs 24%; P = .02). At the time of surgical treatment, the SCV was widely patent following paraclavicular decompression and external venolysis alone in 74 patients (35%). Patch angioplasty was performed for focal SCV stenosis in 76 (36%) and bypass graft reconstruction for long-segment axillary-SCV occlusion in 63 (29%). Patients with false-negative initial ultrasound studies were significantly more likely to require SCV bypass reconstruction than those with a positive ultrasound (44% vs 25%; P = .02). CONCLUSIONS: Duplex ultrasound has significant limitations in the initial evaluation of patients with suspected SCV thrombosis, with false-negative results in 21% of patients with proven VTOS. This is rarely acknowledged in ultrasound reports, but false-negative ultrasound studies have the potential to delay definitive imaging, thrombolysis, and further treatment for VTOS. Initial false-negative ultrasound results are associated with progressive thrombus extension and a more frequent need for SCV bypass reconstruction at the time of surgical treatment

Spitzer reveals what's behind Orion's Bar

We present Spitzer Space Telescope observations of 11 regions SE of the Bright Bar in the Orion Nebula, along a radial from the exciting star theta1OriC, extending from 2.6 to 12.1'. Our Cycle 5 programme obtained deep spectra with matching IRS short-high (SH) and long-high (LH) aperture grid patterns. Most previous IR missions observed only the inner few arcmin. Orion is the benchmark for studies of the ISM particularly for elemental abundances. Spitzer observations provide a unique perspective on the Ne and S abundances by virtue of observing the dominant ionization states of Ne (Ne+, Ne++) and S (S++, S3+) in Orion and H II regions in general. The Ne/H abundance ratio is especially well determined, with a value of (1.01+/-0.08)E-4. We obtained corresponding new ground-based spectra at CTIO. These optical data are used to estimate the electron temperature, electron density, optical extinction, and the S+/S++ ratio at each of our Spitzer positions. That permits an adjustment for the total gas-phase S abundance because no S+ line is observed by Spitzer. The gas-phase S/H abundance ratio is (7.68+/-0.30)E-6. The Ne/S abundance ratio may be determined even when the weaker hydrogen line, H(7-6) here, is not measured. The mean value, adjusted for the optical S+/S++ ratio, is Ne/S = 13.0+/-0.6. We derive the electron density versus distance from theta1OriC for [S III] and [S II]. Both distributions are for the most part decreasing with increasing distance. A dramatic find is the presence of high-ionization Ne++ all the way to the outer optical boundary ~12' from theta1OriC. This IR result is robust, whereas the optical evidence from observations of high-ionization species (e.g. O++) at the outer optical boundary suffers uncertainty because of scattering of emission from the much brighter inner Huygens Region.Comment: 60 pages, 16 figures, 10 tables. MNRAS accepte

Dissecting the Gaseous Halos of z~2 Damped Lyα\alpha Systems with Close Quasar Pairs

We use spectroscopy of close pairs of quasars to study diffuse gas in the circumgalactic medium (CGM) surrounding a sample of 40 Damped Lya systems (DLAs). The primary sightline in each quasar pair probes an intervening DLA in the redshift range 1.6 < z_DLA < 3.6, such that the second quasar sightline then probes Lya, CII, SiII, and CIV absorption in the CGM transverse to the DLA to projected distances $R_{\perp} < 300$ kpc. Analysis of the Lya profiles in these CGM sightlines constrains the covering fraction (f_C) of optically thick HI (having column density N_HI > 10^17.2 cm^-2) to be greater than ~30% within $R_{\perp} < 200$ kpc of DLAs. Strong SiII 1526 absorption with equivalent width W_1526 > 0.2 Ang occurs with an incidence f_C (W_1526 > 0.2 Ang) = 20(+12/-8)% within $R_{\perp}<100$ kpc, indicating that low-ionization metal absorption associated with DLAs probes material at a physical distance R_3D < 30 kpc. However, we find that strong CIV 1548 absorption is ubiquitous in these environments (f_C (W_1548 > 0.2 Ang) = 57(+12/-13)% within $R_{\perp} < 100$ kpc), and in addition exhibits a high degree of kinematic coherence on scales up to ~175 kpc. We infer that this high-ionization material arises predominantly in large, quiescent structures extending beyond the scale of the DLA host dark matter halos rather than in ongoing galactic winds. The Lya equivalent width in the DLA-CGM is anticorrelated with $R_{\perp}$ at >98% confidence, suggesting that DLAs arise close to the centers of their host halos rather than on their outskirts. Finally, the average Lya, CII and CIV equivalent widths are consistent with those measured around z~2 Lyman Break Galaxies. Assuming that DLAs trace a galaxy population with lower masses and luminosities, this finding implies that the absorption strength of cool circumgalactic material has a weak dependence on dark matter halo mass for M_h < 10^12 M_sun.Comment: Submitted to ApJ. 30 pages, 13 figures, 3 tables, 1 appendix. Uses emulateapj forma

Assessing the Risk of 100-year Freshwater Floods in the Lamprey River Watershed of New Hampshire Resulting from Changes in Climate and Land Use

What is the coastal resource issue the project sought to address? Both the magnitude and frequency of freshwater flooding is on the rise in seacoast NH and around much of New England. In the Great Bay watershed, this is the result of two primary causes: 1) increases in impervious surface stemming from a three-to-four fold increase in developed land since 1962; and 2) changing rainfall patterns in part exemplified by a doubling in the frequency of extreme weather events that drop more than 4 inches of precipitation in less than 48 hours (Wake et al., 2011) over the same time period. Moreover, the size of the 100-year precipitation event in this region has increased 26% from 6.3 inches to 8.5 inches from the mid 1950’s to 2010 (NRCC and NRCS, 2012). One consequence is the occurrence of three 100-year floods measured on the Lamprey River at Packers Falls since 1987, and a fourth if the three days of flooding in March of 2010 had occurred instead in two days (Figure 1). Flooding events are expected to continue to increase in magnitude and frequency as land in the watershed is further developed and climate continues to change in response to anthropogenic forcing (e.g., Hayhoe et el., 2007; IPCC, 2007; Karl et al., 2009). Land use management strategies, in particular low impact development (LID) zoning requirements, are one strategy that communities can employ for increased resiliency to flooding with the greatest influence in urban environments

Spitzer observations of extragalactic H II regions - III. NGC 6822 and the hot star, H II region connection

Using the short-high module of the Infrared Spectrograph on the Spitzer Space Telescope, we have measured the [S IV] 10.51, [Ne II] 12.81, [Ne III] 15.56, and [S III] 18.71-micron emission lines in nine H II regions in the dwarf irregular galaxy NGC 6822. These lines arise from the dominant ionization states of the elements neon (Ne$^{++}$, Ne$^+$) and sulphur (S$^{3+}$, S$^{++}$), thereby allowing an analysis of the neon to sulphur abundance ratio as well as the ionic abundance ratios Ne$^+$/Ne$^{++}$ and S$^{3+}$/S$^{++}$. By extending our studies of H II regions in M83 and M33 to the lower metallicity NGC 6822, we increase the reliability of the estimated Ne/S ratio. We find that the Ne/S ratio appears to be fairly universal, with not much variation about the ratio found for NGC 6822: the median (average) Ne/S ratio equals 11.6 (12.2$\pm$0.8). This value is in contrast to Asplund et al.'s currently best estimated value for the Sun: Ne/S = 6.5. In addition, we continue to test the predicted ionizing spectral energy distributions (SEDs) from various stellar atmosphere models by comparing model nebulae computed with these SEDs as inputs to our observational data, changing just the stellar atmosphere model abundances. Here we employ a new grid of SEDs computed with different metallicities: Solar, 0.4 Solar, and 0.1 Solar. As expected, these changes to the SED show similar trends to those seen upon changing just the nebular gas metallicities in our plasma simulations: lower metallicity results in higher ionization. This trend agrees with the observations.Comment: 22 pages, 13 figures. To be published in MNRAS. reference added and typos fixed. arXiv admin note: text overlap with arXiv:0804.0828, which is paper II by Rubin et al. (2008

The Quandary of Serving Multiple Masters: An Institutional Exploratory Analysis of Publishing in Business Law

Notwithstanding published articles on the nature and quality of research and scholarship in practically every other business discipline, to date there has been little systematic evaluation of relevant journals in the business law discipline. This deficiency is due, in part, to the fact that business law may still be described as a developing discipline. Thus, the focus of this article is on delineating the nature of research and scholarship within the business law discipline. Specifically, the publishing practices of business law faculty from academic institutions that were members of the Association to Advance Collegiate Schools of Business (AACSB International), the premier international accrediting body for schools of business, were examined. The comparative perspective developed in this study provides a wide-ranging view of factors related to both the qualitative and quantitative aspects of research and scholarship among business law scholars

Impact of the SPOP Mutant Subtype on the Interpretation of Clinical Parameters in Prostate Cancer.

Purpose: Molecular characterization of prostate cancer, including The Cancer Genome Atlas, has revealed distinct subtypes with underlying genomic alterations. One of these core subtypes, SPOP (speckle-type POZ protein) mutant prostate cancer, has previously only been identifiable via DNA sequencing, which has made the impact on prognosis and routinely used risk stratification parameters unclear. Methods: We have developed a novel gene expression signature, classifier (Subclass Predictor Based on Transcriptional Data), and decision tree to predict the SPOP mutant subclass from RNA gene expression data and classify common prostate cancer molecular subtypes. We then validated and further interrogated the association of prostate cancer molecular subtypes with pathologic and clinical outcomes in retrospective and prospective cohorts of 8,158 patients. Results: The subclass predictor based on transcriptional data model showed high sensitivity and specificity in multiple cohorts across both RNA sequencing and microarray gene expression platforms. We predicted approximately 8% to 9% of cases to be SPOP mutant from both retrospective and prospective cohorts. We found that the SPOP mutant subclass was associated with lower frequency of positive margins, extraprostatic extension, and seminal vesicle invasion at prostatectomy; however, SPOP mutant cancers were associated with higher pretreatment serum prostate-specific antigen (PSA). The association between SPOP mutant status and higher PSA level was validated in three independent cohorts. Despite high pretreatment PSA, the SPOP mutant subtype was associated with a favorable prognosis with improved metastasis-free survival, particularly in patients with high-risk preoperative PSA levels. Conclusion: Using a novel gene expression model and a decision tree algorithm to define prostate cancer molecular subclasses, we found that the SPOP mutant subclass is associated with higher preoperative PSA, less adverse pathologic features, and favorable prognosis. These findings suggest a paradigm in which the interpretation of common risk stratification parameters, particularly PSA, may be influenced by the underlying molecular subtype of prostate cancer

Human prostate sphere-forming cells represent a subset of basal epithelial cells capable of glandular regeneration in vivo.

BackgroundProstate stem/progenitor cells function in glandular development and maintenance. They may be targets for tumor initiation, so characterization of these cells may have therapeutic implications. Cells from dissociated tissues that form spheres in vitro often represent stem/progenitor cells. A subset of human prostate cells that form prostaspheres were evaluated for self-renewal and tissue regeneration capability in the present study.MethodsProstaspheres were generated from 59 prostatectomy specimens. Lineage marker expression and TMPRSS-ERG status was determined via immunohistochemistry and fluorescence in situ hybridization (FISH). Subpopulations of prostate epithelial cells were isolated by cell sorting and interrogated for sphere-forming activity. Tissue regeneration potential was assessed by combining sphere-forming cells with rat urogenital sinus mesenchyme (rUGSM) subcutaneously in immunocompromised mice.ResultsProstate tissue specimens were heterogeneous, containing both benign and malignant (Gleason 3-5) glands. TMPRSS-ERG fusion was found in approximately 70% of cancers examined. Prostaspheres developed from single cells at a variable rate (0.5-4%) and could be serially passaged. A basal phenotype (CD44+CD49f+CK5+p63+CK8-AR-PSA-) was observed among sphere-forming cells. Subpopulations of prostate cells expressing tumor-associated calcium signal transducer 2 (Trop2), CD44, and CD49f preferentially formed spheres. In vivo implantation of sphere-forming cells and rUGSM regenerated tubular structures containing discreet basal and luminal layers. The TMPRSS-ERG fusion was absent in prostaspheres derived from fusion-positive tumor tissue, suggesting a survival/growth advantage of benign prostate epithelial cells.ConclusionHuman prostate sphere-forming cells self-renew, have tissue regeneration capability, and represent a subpopulation of basal cells