Search

Purpose: To assess indications, safety, and effectiveness of percutaneous adrenal mass biopsy in contemporary practice. Methods: This institutional review board-approved, retrospective study included all patients undergoing percutaneous image-guided adrenal mass biopsies at an academic health system from January 6, 2015, to January 6, 2023. Patient demographics, biopsy indications, mass size, laboratory data, pathology results, and complications were recorded. Final diagnoses were based on pathology or ≥ 1 year of imaging follow-up when biopsy specimens did not yield malignant tissue. Test performance calculations excluded repeat biopsies. Continuous variables were compared with Student's t test, dichotomous variables with chi-squared test. Results: A total of 160 patients underwent 186 biopsies. Biopsies were indicated to diagnose metastatic disease (139/186; 74.7%), for oncologic research only (27/186; 14.5%), diagnose metastatic disease and oncologic research (15/186; 8%), and diagnose an incidental adrenal mass (5/186; 2.7%). Biopsy specimens were diagnostic in 154 patients (96.3%) and non-diagnostic in 6 (3.8%). Diagnostic biopsies yielded malignant tissue (n = 136), benign adrenal tissue (n = 12), and benign adrenal neoplasms (n = 6) with sensitivity = 98.6% (136/138), specificity = 100% (16/16), positive predictive value = 100% (136/136), and negative predictive value = 88.9% (16/18). Adverse events followed 11/186 procedures (5.9%) and most minor (7/11, 63.6%). The adverse event rate was similar whether tissue was obtained for clinical or research purposes (10/144; 6.9% vs. 1/42; 2.4%, p = 0.27), despite more specimens obtained for research (5.8 vs. 3.7, p < 0.001). Conclusion: Percutaneous adrenal mass biopsy is safe, accurate, and utilized almost exclusively to diagnose metastatic disease or for oncologic research. The negative predictive value is high when diagnostic tissue samples are obtained. Obtaining specimens for research does not increase adverse event risk. [ABSTRACT FROM AUTHOR]

• Core biopsies (bx) for research vs clinical do not have an increased risk of AEs. • A non-lung parenchymal target may be preferred for research biopsies. • Lung bx have pneumothorax risk; suggest multi-D patient/lesion selection discussion. A common opportunity to collect research samples is during image-guided percutaneous core needle biopsies (CNBs) performed when clinically indicated or for assessing clinical trial eligibility. The relative safety of extra CNBs collected for research is undefined. Patients who underwent CNB for research purposes only [RO], as clinically indicated [CI], or as part of a clinical trial [CT] were identified. 30-day post-procedure adverse events (AEs) among the cohorts were examined and compared to the 2020 Society of Interventional Radiology QI guidelines. 236 patients with thoracic cancers (90 % NSCLC, 5 % SCLC, 4 % mesothelioma, and 1 % thymic) had 292 CNBs (63 RO, 229 CI + CT). AEs occurred in 13 % of both the RO and CI + CT groups. Compared to the CI + CT group, the RO group did not have a higher pneumothorax incidence (RO: 5/29 [17 %], CI + CT: 18/114 [16 %], p = 0.79); both were below the suggested QI threshold of 45 % for pneumothorax. There was a negative association between number of cores obtained and risk of AE (AE vs no AE mean cores = 3.5 vs 4.8). After adjusting for the number of cores and smoking history, RO vs CI + CT lung biopsies had a higher risk of AEs (adjusted relative risk [aRR] = 2.44, 1.08–5.55, p = 0.03 vs non-lung aRR = 0.86, 0.10–7.09, p = 0.89). CNBs performed for research purposes do not have a significantly increased risk of AEs when compared to those performed for clinical trials and/or when clinically indicated. However, AEs were most frequent in lung biopsies. When performing research biopsies, a target other than lung may be preferred when clinically appropriate. [ABSTRACT FROM AUTHOR]

Earlier work has raised the potential importance of nebular emission in the derivation of the physical characteristics of high-redshift Lyman break galaxies. Within certain redshift ranges, and especially at z ≃ 6-7, such lines may be strong enough to reduce estimates of the stellar masses and ages of galaxies compared with those derived assuming the broadband photometry represents stellar light alone. To test this hypothesis at the highest redshifts where such lines can be probed with ground-based facilities, we examine the near-infrared spectra of a representative sample of 28 3.0 < z < 3.8 Lyman break galaxies using the newly commissioned MOSFIRE near-infrared spectrograph at the Keck I telescope. We use these data to derive the rest-frame equivalent widths (EWs) of [O III] emission and show that these are comparable with estimates derived using the spectral energy distribution (SED) fitting technique introduced for sources of known redshift by Stark et al. Although our current sample is modest, its [O III] EW distribution is consistent with that inferred for Hα based on SED fitting of Stark et al.'s larger sample of 3.8 < z < 5 galaxies. For a subset of survey galaxies, we use the combination of optical and near-infrared spectroscopy to quantify kinematics of outflows in z ≃ 3.5 star-forming galaxies and discuss the implications for reionization measurements. The trends we uncover underline the dangers of relying purely on broadband photometry to estimate the physical properties of high-redshift galaxies and emphasize the important role of diagnostic spectroscopy. [ABSTRACT FROM AUTHOR]

We present a catalog of high-redshift star-forming galaxies selected to lie within the redshift range z ≃ 7-8 using the Ultra Deep Field 2012 (UDF12), the deepest near-infrared (near-IR) exposures yet taken with the Hubble Space Telescope (HST). As a result of the increased near-IR exposure time compared to previous HST imaging in this field, we probe ~0.65 (0.25) mag fainter in absolute UV magnitude, at z ~ 7 (8), which increases confidence in a measurement of the faint end slope of the galaxy luminosity function. Through a 0.7 mag deeper limit in the key F105W filter that encompasses or lies just longward of the Lyman break, we also achieve a much-refined color-color selection that balances high redshift completeness and a low expected contamination fraction. We improve the number of dropout-selected UDF sources to 47 at z ~ 7 and 27 at z ~ 8. Incorporating brighter archival and ground-based samples, we measure the z ≃ 7 UV luminosity function to an absolute magnitude limit of MUV = -17 and find a faint end Schechter slope of α = -1.87+0.18-0.17. Using a similar color-color selection at z ≃ 8 that takes our newly added imaging in the F140W filter into account, and incorporating archival data from the HIPPIES and BoRG campaigns, we provide a robust estimate of the faint end slope at z ≃ 8, α = -1.94+0.21-0.24. We briefly discuss our results in the context of earlier work and that derived using the same UDF12 data but with an independent photometric redshift technique. [ABSTRACT FROM AUTHOR]

Using deep Keck spectroscopy of Lyman break galaxies selected from infrared imaging data taken with the Wide Field Camera 3 on board the Hubble Space Telescope, we present new evidence for a reversal in the redshift-dependent fraction of star-forming galaxies with detectable Lyman alpha (Lyα) emission in the redshift range 6.3 < z < 8.8. Our earlier surveys with the DEIMOS spectrograph demonstrated a significant increase with redshift in the fraction of line emitting galaxies over the interval 4 < z < 6, particularly for intrinsically faint systems which dominate the luminosity density. Using the longer wavelength sensitivities of Low Resolution Imaging Spectrometer and NIRSPEC, we have targeted 19 Lyman break galaxies selected using recent WFC3/IR data whose photometric redshifts are in the range 6.3 < z < 8.8 and which span a wide range of intrinsic luminosities. Our spectroscopic exposures typically reach a 5σ sensitivity of <50 Å for the rest-frame equivalent width (EW) of Lyα emission. Despite the high fraction of emitters seen only a few hundred million years later, we find only two convincing and one possible line emitter in our more distant sample. Combining with published data on a further seven sources obtained using FORS2 on the ESO Very Large Telescope, and assuming continuity in the trends found at lower redshift, we discuss the significance of this apparent reversal in the redshift-dependent Lyα fraction in the context of our range in continuum luminosity. Assuming all the targeted sources are at their photometric redshift and our assumptions about the Lyα EW distribution are correct, we would expect to find so few emitters in less than 1% of the realizations drawn from our lower redshift samples. Our new results provide further support for the suggestion that, at the redshifts now being probed spectroscopically, we are entering the era where the intergalactic medium is partially neutral. With the arrival of more sensitive multi-slit infrared spectrographs, the prospects for improving the statistical validity of this result are promising. [ABSTRACT FROM AUTHOR]

The redshift-dependent fraction of color-selected galaxies revealing Lyman alpha (Lyα) emission, xLyα has become the most valuable constraint on the evolving neutrality of the early intergalactic medium. However, in addition to resonant scattering by neutral gas, the visibility of Lyα is also dependent on the intrinsic properties of the host galaxy, including its stellar population, dust content, and the nature of outflowing gas. Taking advantage of significant progress we have made in determining the line-emitting properties of z ≃ 4-6 galaxies, we propose an improved method, based on using the measured slopes of the rest-frame ultraviolet continua of galaxies, to interpret the growing body of near-infrared spectra of z > 7 galaxies in order to take into account these host galaxy dependencies. In a first application of our new method, we demonstrate its potential via a new spectroscopic survey of 7 < z < 8 galaxies undertaken with the Keck MOSFIRE spectrograph. Together with earlier published data, our data provide improved estimates of the evolving visibility of Lyα, particularly at redshift z ≃ 8. As a by-product, we also present a promising new line-emitting galaxy candidate, detected at 4.0σ at redshift z = 7.62. We discuss the improving constraints on the evolving neutral fraction over 6 < z < 8 and the implications for cosmic reionization. [ABSTRACT FROM AUTHOR]

The fraction of ionizing photons that escape from young star-forming galaxies is one of the largest uncertainties in determining the role of galaxies in cosmic reionization. Yet traditional techniques for measuring this fraction are inapplicable at the redshifts of interest due to foreground screening by the Lyα forest. In an earlier study, we demonstrated a reduction in the equivalent width of low-ionization absorption lines in composite spectra of Lyman break galaxies at z ≃ 4 compared to similar measures at z ≃ 3. This might imply a lower covering fraction of neutral gas and hence an increase with redshift in the escape fraction of ionizing photons. However, our spectral resolution was inadequate to differentiate between several alternative explanations, including changes with redshift in the outflow kinematics. Here we present higher quality spectra of three gravitationally lensed Lyman break galaxies at z ≃ 4 with a spectral resolution sufficient to break this degeneracy of interpretation. We present a method for deriving the covering fraction of low-ionization gas as a function of outflow velocity and compare the results with similar quality data taken for galaxies at lower redshift. We find an interesting but tentative trend of lower covering fractions of low-ionization gas for galaxies with strong Lyα emission. In combination with the demographic trends of Lyα emission with redshift from our earlier work, our results provide new evidence for a reduction in the average H I covering fraction, and hence an increase in the escape fraction of ionizing radiation from Lyman break galaxies, with redshift. [ABSTRACT FROM AUTHOR]

Interventions designed to limit the spread of coronavirus disease 2019 (COVID-19) are having profound effects on the delivery of health care, but data showing the impact on oncology clinical trial enrollment, treatment, and monitoring are limited. We prospectively tracked relevant data from oncology clinical trials at Dana-Farber Cancer Institute from January 1, 2018, to June 30, 2020, including the number of open trials, new patient enrollments, in-person and virtual patient visits, dispensed investigational infusions, dispensed or shipped oral investigational agents, research biopsies, and blood samples. We ascertained why patients came off trials and determined on-site clinical research staffing levels. We used 2-sided Wilcoxon rank sum tests to assess the statistical significance of the reported changes. Nearly all patients on interventional treatment trials were maintained, and new enrollments continued at just under one-half the prepandemic rate. The median number of investigational prescriptions shipped to patients increased from 0 to 74 (range = 22-107) per week from March to June 2020. The median number of telemedicine appointments increased from 0 to 107 (range = 33-267) per week from March to June 2020. Research biopsies and blood collections decreased dramatically after Dana-Farber Cancer Institute implemented COVID-19-related policies in March 2020. The number of research nurses and clinical research coordinators on site also decreased after March 2020. Substantial changes were required to safely continue clinical research during the pandemic, yet we observed no increases in serious adverse events or major violations related to drug dosing. Lessons learned from adapting research practices during COVID-19 can inform industry sponsors and governmental agencies to consider altering practices to increase operational efficiency and convenience for patients. [ABSTRACT FROM AUTHOR]

Malignant obstruction of the IVC can cause severe morbidity and impairment of quality of life in end-stage oncology patients. However, medical literature regarding minimally-invasive palliation using large diameter percutaneous stents, particularly the Gianturco-Rosch-Z (GRZ) stent is limited. A retrospective review from January 2004 to February 2017, revealed 17 subjects with malignant obstruction of the IVC who were treated with a total of 34 GRZ stents. Pre- and post-stent pressure gradients were measured in 10. Available data regarding clinical presentation and follow-up were recorded. Technical success for stent deployment was 100%. A median of 2 stents (range 1 to 5) were deployed per patient, with median stent diameter 20 mm (range 15 to 30 mm). The median pre-treatment pressure gradient of 17.5 mmHg (range 9–31 mmHg) decreased to a median of 4.5 mmHg (range 0–21 mmHg, p <.0004) after stent placement. One subject developed recurrent stent occlusion due to disease progression requiring additional intervention, for a primary patency rate of 94%. Lower extremity edema improved or resolved in 58% of those for whom follow-up data was recorded. Median survival after treatment was only 28 days (range 5 to 607 days). There were no procedural complications. Endovascular treatment of malignant IVC obstruction can be safely performed with GRZ stents. Although overall survival is poor, this technique can effectively palliate lower extremity edema symptoms. • Report the patency and clinical outcomes of using the Gianturco-Rosch-Z (GRZ) stent in patients with malignant venous obstruction • GRZ stents offer a high level of stent patency and are effective at palliating symptoms of lower extremity edema in patients with malignant compression of the IVC [ABSTRACT FROM AUTHOR]

We presentKeck/MOSFIRE observations of UV metal emission lines in four bright (H=23.9. 25.4) gravitationally lensed z ≃ 6-8 galaxies behind the cluster Abell 1703. The spectrum of A1703-zd6, a highly magnified star-forming galaxy with a Lyα redshift of z = 7.045, reveals a confident detection of the nebular CIV λ1548 emission line (unresolved with full width at halfmaximum< 125 km s-1). UV metal emission lines are not detected in the three other galaxies. At z ≃ 2.3, nebular CIV emission is observed in just 1 per cent of UV-selected galaxies. The presence of strong C IV emission in one of the small sample of galaxies targeted in this paper may indicate that hard ionizing spectra are more common at z ≃ 7. The total estimated rest-frame equivalent width of the CIV doublet and CIV/Lyƒα flux ratio are comparable to measurements of narrow-lined AGNs. Photoionization models show that the nebular C IV line can also be reproduced by a young stellar population, with very hot metal-poor stars dominating the photon flux responsible for triply ionizing carbon. Regardless of the origin of the CIV, we show that the ionizing spectrum of A1703-zd6 is different from that of typical galaxies at z2, producing more H ionizing photons per unit 1500 Å luminosity (log(Eion/erg-1 Hz) = 25.68) and a larger flux density at 30.50 eV. If such extreme radiation fields are typical in UV-selected systems at z ≳ 7, it would indicate that reionization-era galaxies are more efficient ionizing agents than previously thought. Alternatively, we suggest that the small sample of Lyα emitters at z ≳ 7 may trace a rare population with intense radiation fields capable of ionizing their surrounding hydrogen distribution. Additional constraints on high-ionization emission lines in galaxies with and without Lyα detections will help clarify whether hard ionizing spectra are common in the reionization era. [ABSTRACT FROM AUTHOR]

Deep spectroscopic observations of z ≳ 6.5 galaxies have revealed a marked decline with increasing redshift in the detectability of Ly α emission. While this may offer valuable insight into the end of the reionization process, it presents a challenge to the detailed spectroscopic study of bright photometrically-selected distant sources now being found via deep Hubble Space Telescope imaging, and particularly those highly magnified sources viewed through foreground lensing clusters. In this paper, we demonstrate the validity of a new way forward via the detection of an alternative diagnostic line, C III] λ1909 Å, seen in spectroscopic exposures of a star-forming galaxy at zLyα = 6.029. We also report tentative detection of C III] λ1909 Å in a galaxy at zLyα = 7.213. The former 3.3σ detection is based on a 3.5 h XShooter spectrum of a bright (J125 = 25.2) gravitationally-lensed galaxy behind the cluster Abell 383. The latter 2.8σ detection is based on a 4.2 h MOSFIRE spectra of one of the most distant spectroscopically confirmed galaxies, GN-108036, with J140 = 25.2. Both targets were chosen for their continuum brightness and previously-known redshift (based on Ly α), ensuring that any C III] emission would be located in a favourable portion of the near-infrared sky spectrum. Since the availability of secure Ly α redshifts significantly narrows the wavelength range where C III] is sought, this increases confidence in these, otherwise, low-signal-to-noise ratio detections. We compare our C III] and Ly α equivalent widths in the context of those found at z ≃ 2 from earlier work and discuss the motivation for using lines other than Ly α to study galaxies in the reionization era. [ABSTRACT FROM AUTHOR]

We analyze the redshift- and luminosity-dependent sizes of dropout galaxy candidates in the redshift range z ∼ 7-12 using deep images from the 2012 Hubble Ultra Deep Field (UDF12) campaign, which offers two advantages over that used in earlier work. First, we utilize the increased signal-to-noise ratio offered by the UDF12 imaging to provide improved measurements for known galaxies at z ≃ 6.5-8 in the HUDF. Second, because the UDF12 data have allowed the construction of the first robust galaxy sample in the HUDF at z > 8, we have been able to extend the measurement of average galaxy size out to higher redshifts. Restricting our measurements to sources detected at >15σ, we confirm earlier indications that the average half-light radii of z ∼ 7-12 galaxies are extremely small, 0.3-0.4 kpc, comparable to the sizes of giant molecular associations in local star-forming galaxies. We also confirm that there is a clear trend of decreasing half-light radius with increasing redshift, and provide the first evidence that this trend continues beyond z ≃ 8. Modeling the evolution of the average half-light radius as a power law, ∝(1 + z)s, we obtain a best-fit index of over z ∼ 4-12. A clear size-luminosity relation is evident in our dropout samples. This relation can be interpreted in terms of a constant surface density of star formation over a range in luminosity of . The average star formation surface density in dropout galaxies is 2-3 orders of magnitude lower than that found in extreme starburst galaxies, but is comparable to that seen today in the centers of normal disk galaxies. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia is a rare disease associated with high morbidity and mortality. Acute mesenteric ischemia is most commonly secondary to embolism followed by arterial thrombosis, nonocclusive ischemia, and less commonly venous thrombosis. Chronic mesenteric ischemia is almost always caused by atherosclerotic disease, with rare causes including fibromuscular dysplasia and vasculitis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Patients with mesenteric ischemia usually present with nonspecific abdominal symptoms and laboratory findings. This document evaluates and rates the appropriateness of imaging to evaluate patients with clinically suspected mesenteric ischemia. While catheter-based angiography has been considered the reference standard and enables diagnosis and treatment, advances in computed tomography have made it a first-line test in many patients because it is a fast, widely available, and noninvasive study. Abdominal radiographs and ultrasound have a limited role in diagnosing mesenteric ischemia but are commonly the first ordered tests in patients with abdominal pain and may diagnose more common pathologies. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia is a rare disease associated with high morbidity and mortality. Acute mesenteric ischemia is most commonly secondary to embolism followed by arterial thrombosis, nonocclusive ischemia, and less commonly venous thrombosis. Chronic mesenteric ischemia is almost always caused by atherosclerotic disease, with rare causes including fibromuscular dysplasia and vasculitis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Patients with mesenteric ischemia usually present with nonspecific abdominal symptoms and laboratory findings. This document evaluates and rates the appropriateness of imaging to evaluate patients with clinically suspected mesenteric ischemia. While catheter-based angiography has been considered the reference standard and enables diagnosis and treatment, advances in computed tomography have made it a first-line test in many patients because it is a fast, widely available, and noninvasive study. Abdominal radiographs and ultrasound have a limited role in diagnosing mesenteric ischemia but are commonly the first ordered tests in patients with abdominal pain and may diagnose more common pathologies. [ABSTRACT FROM AUTHOR]

Understanding cosmic reionization requires the identification and characterization of early sources of hydrogenionizing photons. The 2012 Hubble Ultra Deep Field (UDF12) campaign has acquired the deepest infrared images with the Wide Field Camera 3 aboard Hubble Space Telescope and, for the first time, systematically explored the galaxy population deep into the era when cosmic microwave background (CMB) data indicate reionization was underway. The UDF12 campaign thus provides the best constraints to date on the abundance, luminosity distribution, and spectral properties of early star-forming galaxies. We synthesize the new UDF12 results with the most recent constraints from CMB observations to infer redshift-dependent ultraviolet (UV) luminosity densities, reionization histories, and electron scattering optical depth evolution consistent with the available data. Under reasonable assumptions about the escape fraction of hydrogen-ionizing photons and the intergalactic medium clumping factor, we find that to fully reionize the universe by redshift z ~ 6 the population of star-forming galaxies at redshifts z ~ 7-9 likely must extend in luminosity below the UDF12 limits to absolute UV magnitudes of MUV ~ -13 or fainter. Moreover, low levels of star formation extending to redshifts z ~ 15-25, as suggested by the normal UV colors of z≃7-8 galaxies and the smooth decline in abundance with redshift observed by UDF12 to z ≃ 10, are additionally likely required to reproduce the optical depth to electron scattering inferred from CMB observations. [ABSTRACT FROM AUTHOR]

The purpose of these guidelines is to recommend appropriate imaging for patients with blunt chest trauma. These patients are most often imaged in the emergency room, and thus emergency radiologists play a substantial role in prompt, accurate diagnoses that, in turn, can lead to life-saving interventions. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Imaging largely focuses on the detection and exclusion of traumatic aortic injury; a large proportion of patients are victims of motor vehicle accidents. For those patients who survive the injury and come to emergency radiology, rapid, appropriate assessment of patients who require surgery is paramount. [ABSTRACT FROM AUTHOR]