Primary Masses Research Articles

3-OGC: Catalog of Gravitational Waves from Compact-binary Mergers

Abstract We present the third open gravitational-wave catalog (3-OGC) of compact-binary coalescences, based on the analysis of the public LIGO and Virgo data from 2015 through 2019 (O1, O2, O3a). Our updated catalog includes a population of 57 observations, including 4 binary black hole mergers that had not been previously reported. This consists of 55 binary black hole mergers and the 2 binary neutron star mergers, GW170817 and GW190425. We find no additional significant binary neutron star or neutron star–black hole merger events. The most confident new detection is the binary black hole merger GW190925_232845, which was observed by the LIGO–Hanford and Virgo observatories with  astro > 0.99 ; its primary and secondary component masses are 20.2 − 2.5 + 3.9 M ⊙ and 15.6 − 2.6 + 2.1 M ⊙ , respectively. We estimate the parameters of all binary black hole events using an up-to-date waveform model that includes both subdominant harmonics and precession effects. To enable deep follow up as our understanding of the underlying populations evolves, we make available our comprehensive catalog of events, including the subthreshold population of candidates, and the posterior samples of our source parameter estimates.

Detecting gravitational waves with disparate detector responses: Two new binary black hole mergers

We introduce a new technique to search for gravitational wave events from compact binary mergers that produce a clear signal only in a single gravitational wave detector, and marginal signals in other detectors. Such a situation can arise when the detectors in a network have different sensitivities, or when sources have unfavorable sky locations or orientations. We start with a short list of loud single-detector triggers from regions of parameter space that are empirically unaffected by glitches (after applying signal-quality vetoes). For each of these triggers, we compute evidence for astrophysical origin from the rest of the detector network by coherently combining the likelihoods from all detectors and marginalizing over extrinsic geometric parameters. We report the discovery of two new binary black hole (BBH) mergers in the second observing run of Advanced LIGO and Virgo (O2), in addition to the ones that were reported in [B. P. Abbott et al. (LIGO Scientific and Virgo Collaborations), Phys. Rev. X 9, 031040 (2019) and [T. Venumadhav et al., Phys. Rev. D 101, 083030 (2020)]. We estimate that the two events have false alarm rates of one in 19 years (60 O2) and one in 11 years (36 O2). One of the events, GW170817A, has primary and secondary masses ${m}_{1}^{\mathrm{src}}=5{6}_{\ensuremath{-}10}^{+16}\text{ }\text{ }{M}_{\ensuremath{\bigodot}}$ and ${m}_{2}^{\mathrm{src}}=4{0}_{\ensuremath{-}11}^{+10}\text{ }\text{ }{M}_{\ensuremath{\bigodot}}$ in the source frame. The existence of GW170817A should be very informative about the theoretically predicted upper mass gap for stellar mass black holes. Its effective spin parameter is measured to be ${\ensuremath{\chi}}_{\mathrm{eff}}=0.5\ifmmode\pm\else\textpm\fi{}0.2$, which is consistent with the tendency of the heavier detected BBH systems to have large and positive effective spin parameters. The other event, GWC170402, will be discussed thoroughly in future work.

MP49-16 COMPARISON OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY AND PERCUTANEOUS ABLATION FOR CT1 RENAL MASSES: MID TERM OUTCOME ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-16 COMPARISON OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY AND PERCUTANEOUS ABLATION FOR CT1 RENAL MASSES: MID TERM OUTCOME ANALYSIS Umberto Carbonara, Alp Tuna Beksac, Alessandro Larcher, Fabio Crocerossa, Lance Hampton, Ithaar Derweesh, Umberto Capitanio, Francesco Montorsi, Jihad Kaouk, and Riccardo Autorino Umberto CarbonaraUmberto Carbonara More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Fabio CrocerossaFabio Crocerossa More articles by this author , Lance HamptonLance Hampton More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , and Riccardo AutorinoRiccardo Autorino More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is one of the established treatment for cT1 renal masses. With the rapid dissemination of robotic surgery in the past ten years, RAPN has become “de facto” the new gold-standard for nephron-sparing surgery. In this scenario, percutaneous thermal ablation (PTA) represents a valid alternative to the nephron-sparing option. We aim to compare oncological outcomes of patients with cT1 renal mass undergoing RAPN vs. PTA. METHODS: Overall, a total of 1767 patients with primary cT1N0M0 renal masses treated between 2006 and 2019 were identified from a multicenter dataset. Data collected included baseline, pathological, perioperative, and postoperative features. The RAPN data were compared with those of PTA. Local recurrence-free, metastases-free, and overall survival rates were estimated using the Kaplan-Meier method and compared with log-rank tests. RESULTS: Of the 1767 patients, 1039 and 728 underwent RRAPN and PTA, respectively. In our cohort, patients who underwent RAPN reported a lower median age (58 vs. 64 years, p=0.005) as well as lower Charlson comorbidity scores. The mean tumor size was 3 and 4cm in PTA and RAPN, respectively. Median follow up was similar among the groups (45 vs. 48months, p=0.1). Local recurrence-free survival was similar among the treatments (p=0.38). Metastases-free survival was significantly better after RAPN (p=0.001). Overall survival was high for RAPN patients (p<0.001). CONCLUSIONS: In a large cohort of cT1 renal masses, we observed that recurrence-free survival was similar for RAPN and percutaneous ablation patients. Metastases-free survival was superior for RAPN patients, as well as overall survival. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e882-e882 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Carbonara More articles by this author Alp Tuna Beksac More articles by this author Alessandro Larcher More articles by this author Fabio Crocerossa More articles by this author Lance Hampton More articles by this author Ithaar Derweesh More articles by this author Umberto Capitanio More articles by this author Francesco Montorsi More articles by this author Jihad Kaouk More articles by this author Riccardo Autorino More articles by this author Expand All Advertisement Loading ...

English

BACKGROUND The primary lung masses (tumours) are those that originate from the lung tissue. Although most primary pulmonary tumours are carcinomas, a large histological spectrum of benign and malignant tumours of the lung exists. Although chest xray is still considered to be the primary imaging modality of lungs, computed tomography (CT) not only shows the segments that are involved but also the extent of involvement. We wanted to study the sensitivity and specificity of CT in the diagnosis of primary neoplastic lesions of lung, study the CT patterns of different histological variants of bronchogenic carcinoma, and correlate CT findings with CT guided fine needle aspiration and cytology (FNAC) findings. METHODS The present descriptive cross-sectional study was conducted among 34 patients suspected clinically of having lung neoplasms, in Gauhati Medical College and Hospital, Guwahati, Assam from December 2010 to November 2011. RESULTS Considering FNAC / histopathological examination (HPE) as the gold standard, the positive predictive value and false negative value of CT scan for diagnosis of neoplastic lesions of lung were 97 % and 3 % respectively, in our study. Among our study population, mean age with lung tumours was 61 years, highest number of cases was seen in the age group of 51 - 60 years (35 %); Males and females affected were 27 (79.41 %), and 7 in number (20.59 %), respectively. CONCLUSIONS CT is more sensitive in the detection of neoplastic lesions of the lung and associated hilar / mediastinal adenopathy than chest roentgenography. CT has a high efficacy in detecting neoplastic lesions of lung, delineating its lobar and segmental anatomy, thereby helping surgical resection of lung. In this study, CT guided FNAC and cytological findings correlated well with CT diagnosis of primary neoplastic lesions of lung. KEYWORDS Primary Lung Tumour, Contrast Enhanced Computed Tomography (CECT), Fine Needle Aspiration and Cytology (FNAC)

Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus

Introduction:We aimed to present our experience in managing renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus.Methods:Records of all patients aged 18 years and older, with a diagnosis of primary renal masses with IVC thrombus, presenting to our institute from January 2012 to August 2020 were retrospectively reviewed. Patients with tumor thrombus limited only to renal vein were excluded from the analysis. Their hospital course and outcomes were recorded and evaluated for predictors of survival.Results:During the study period, we treated 61 patients with a renal mass and concurrent IVC thrombus and 56 of these underwent surgery. 7 of them had level III and 6 had level IV thrombus. A total of six patients received neoadjuvant tyrosine kinase inhibitor (TKI) therapy and all of them showed a decrease in size and level of tumor thrombus and cardiopulmonary bypass was safely avoided. Fourteen patients had distant metastasis and underwent cytoreductive surgery and of these 12 patients received TKI therapy after surgery with a mean survival of 26.8 months. The overall survival at 2 and 5 years of nonmetastatic group was 81.1% and 47.5% respectively and in metastatic group was 35.1% and 0%, respectively. Poor performance status, distant metastasis, higher T stage, higher thrombus levels, and positive surgical margins were all predictors of decreased survival.Conclusions:Complete surgical resection in both nonmetastatic and metastatic RCC with IVC thrombus has long-term survival benefits. Neoadjuvant TKI therapy, with adequate preoperative planning, helps in decreasing the size of the thrombus and in safely avoiding bypass in level III and IV IVC thrombi.

Abstract 2926: CT26.WT-luc orthotopic syngeneic tumor model of colon cancer: development and immunotherapy response

Abstract Colorectal cancer (CRC) is a major contributor to the whole of cancer as a disease, representing 10% of all cases of cancer. Recent clinical studies and FDA approvals demonstrate strong possibilities for the future of immunotherapy in the treatment of CRC. Highly translational preclinical models of the disease are required to assess the effectiveness of novel immuno-oncology agents. The CT26.WT murine colon carcinoma model is a widely used syngeneic tumor model to evaluate the preclinical efficacy of immuno-oncology agents. Subcutaneous tumor models are limited in translatability compared to the orthotopic implant site including differential stromal interactions, immune cell infiltrate, and response to immunotherapy. We present the development of a robust murine orthotopic colon tumor model (CT26.WT-luc) assessed by bioluminescence imaging (BLI) and assessed for response to common checkpoint targets. All animal work was performed in an AAALAC accredited facility, in alignment with applicable animal welfare regulations and with predetermined humane euthanasia criteria on all studies. Subcutaneous CT26.WT-luc tumors were dissected into fragments and grafted onto the cecum of naïve Balb/c mice. Mice were subjected to BLI twice weekly for four weeks for longitudinal monitoring of tumor growth. The tumor engraftment rate was 95% based on BLI and necropsy, no spontaneous regressions were observed. The BLI derived tumor volume doubling time was 1.5 days and the median time on study was 21 days. Common clinical observations associated with disease progression were abdominal distension due to tumor growth and bodyweight gain. Necropsy revealed large primary masses attached to the cecum with large vascular involvement, and small nodules on the liver and abdominal wall. To assess the model response to immunotherapy, Balb/c mice bearing orthotopic CT26.WT-luc tumors were treated by intraperitoneal administration of 10mg/kg isotype control, anti-PD-L1, anti-CTLA-4 or anti-PD-1 twice weekly for two weeks (Bio X Cell). Administration of anti-PD-L1 resulted in one complete regression. Anti-CTLA-4 treatment resulted in a day 23 ΔT/ΔC of 0.1% and five partial regressions with no visibly detectable disease at necropsy. Administration of anti-PD-1 did not result in regressions or tumor free survivors. Administration of either anti-PD-L1 or anti-CTLA-4 provided an increase of life span over isotype control of 13 and 24 days, respectively. Terminal necropsy revealed no evidence of tumors or other lesions in 1 out of 8 animals administered anti-PD-L1, and 5 out of 8 animals administered anti-CTLA-4. This model represents a powerful tool with translational potential for assessing the efficacy of novel immune modulating agents with the possibility of combination therapy. Assessment of tumor response, cell and molecular differences between subcutaneous and orthotopic CT26.WT-luc tumors is ongoing. Citation Format: Patrick Allison, Derrik Germain, Meredith Baugher, Maryland Franklin. CT26.WT-luc orthotopic syngeneic tumor model of colon cancer: development and immunotherapy response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2926.

Primary hepatic neuroendocrine tumor.

SummaryPrimary hepatic neuroendocrine tumor (PHNET) is a rare type of neuroendocrine tumor (NET) that is also a primary hepatic tumor. Patients are present with almost no specific clinical symptoms and typically present with negative test results and atypical imaging characteristics; therefore, the differentiation of PHNET from other types of primary hepatic masses can be very difficult. In this article, we describe a case of PHNET that mimicked a liver helminth infection in a 57-year-old man. The diagnosis of PHNET in this patient was challenging, and the final diagnosis was based on imaging, histopathology features, and long-term follow-up.Learning pointsAn uncommon type of neuroendocrine tumor (NET) is a primary hepatic neuroendocrine tumor (PHNET).Primary hepatic neuroendocrine tumors are rare NET lesions found in the liver, characterized by non-specific clinical and imaging results, which can be easily confused with other liver lesions, including HCC and parasitic lesions.To have a conclusive diagnosis and classification, a mixture of many medical assessment techniques, such as imaging, gastrointestinal endoscopy, nuclear medicine, anatomy, including histopathology, and immunohistochemistry, is essential.

Tidal Circularization of Binaries by Resonance Locking. I. The Importance of the Pre-main Sequence

Abstract Although tidal dissipation in binary stars has been studied for over a century, theoretical predictions have yet to match the observed properties of binary populations. This work quantitatively examines the recent proposal of tidal circularization by resonance locking, where tidal dissipation arises from resonances between the star’s natural oscillation frequencies and harmonics of the orbital frequency, and where resonances are “locked” for an extended period of time due to concurrent stellar evolution. We focus on tidal resonances with axi-symmetric gravity modes, and examine binaries with primary masses from one to two solar masses. We find that orbital evolution via resonance locking occurs primarily during the star’s pre-main-sequence phase, with the main-sequence phase contributing negligibly. Resonance locking, ignoring nonlinearity, can circularize binaries with peri-center distances out to ∼10 stellar radii, corresponding to circular periods of ∼4–6 days. However, we find resonantly excited gravity modes will become nonlinear in stellar cores, which prevents them from reaching their full, linear amplitudes. We estimate that such a “saturated resonance lock” reduces the circularization period by about a third, but resonance locking remains much more effective than the cumulative actions of equilibrium tides. In a companion paper, we examine recent binary data to compare against theory.

Cerebrospinal Fluid Drop Metastases of Canine Glioma: Magnetic Resonance Imaging Classification.

Dissemination of glioma in humans can occur as leptomeningeal nodules, diffuse leptomeningeal lesions, or ependymal lesions. Cerebrospinal fluid (CSF) drop metastasis of glioma is not well-recognized in dogs. Ten dogs with at least two anatomically distinct and histologically confirmed foci of glioma were included in this study. The 10 dogs underwent 28 magnetic resonance imaging (MRI) examinations, with distant CSF drop metastasis revealed in 13 MRIs. The CSF drop metastases appeared as leptomeningeal nodules in four dogs, diffuse leptomeningeal lesions in six dogs, and ependymal lesions in seven dogs; six dogs had a combination of lesion types. Primary tumors were generally T2-heterogeneous and contrast-enhancing. Many metastases were T2-homogeneous and non-enhancing. Diffuse leptomeningeal lesions were seen as widespread extra-axial contrast-enhancement, again very dissimilar to the intra-axial primary mass. Primary masses were rostrotentorial, whereas metastases generally occurred in the direction of CSF flow, in ventricles, CSF cisterns, and the central canal or leptomeninges of the cervical or thoracolumbar spinal cord. Seven of the dogs had received therapy limited to the primary mass, such as surgery or stereotactic radiation, then developed metastasis in the following months. CSF drop metastasis of glioma may take a very different appearance on MRI to the primary mass, including periventricular lesions that are more homogeneous and less contrast-enhancing, rostral horn signal changes, or leptomeningeal enhancement ventral to the brainstem or encircling the spinal cord.

Carney Complex With Endocrine Involvement Isolated to the Thyroid Gland

Abstract Introduction: Carney complex is a rare autosomal dominant disorder characterized by pigmented lesions of skin and mucosae, endocrine neoplasms or overactivity, and myxomas of the heart, skin, and other organs. Most patients have at least two affected endocrine organs at time of diagnosis. We present a case of Carney complex with endocrine involvement limited to the thyroid gland. Case: A 48-year-old female was referred for evaluation of thyroid nodules incidentally discovered on imaging for submandibular salivary gland swelling. Ultrasound evaluation of the thyroid revealed numerous, bilateral nodules that were mostly cystic or spongiform, though some had irregular borders and microcalcifications. A brother with Carney complex had been diagnosed with papillary carcinoma, and the patient decided to undergo thyroidectomy. Fortunately, no thyroid carcinoma was found on postsurgical histopathology. Initial biochemical evaluation showed no evidence of hypercortisolemia (8 AM cortisol 1.7 mcg/dL on 1 mg dexamethasone suppression test; 24-h urine cortisol 26.1 mcg [reference: 4-50]), growth hormone excess (IGF-1 190 ng/mL [reference: 52-328]), or hyperprolactinemia (prolactin 10 ng/mL [reference: 2.74-26.72]). Imaging showed no pituitary or adrenal masses. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer prior to referral. She was diagnosed with Carney complex at age 19 years, and her manifestations included atrial and ventricular myxomas, intraductal adenoma of the breast, multiple skin lesions (lentigines, blue nevi, and cutaneous myxomas), and myxomas of the external auditory canals. She is in a Carney complex kindred that includes her mother, two brothers, and a niece. Discussion: Carney complex is usually caused by inactivating mutations or large deletions in the protein kinase A type I alpha regulatory subunit (PRKAR1A) gene located on chromosome 17q22-24. Most mutations are inherited in an autosomal dominant manner, though approximately 30% of cases are due to de novo mutations. In a review of 365 cases, the median age at diagnosis was 20 years. Growth hormone adenomas or somatomammotroph hyperplasia occurs in approximately 75% of patients, and most have at least one additional endocrine abnormality including multinodular goiter, primary pigmented nodular adrenocortical hyperplasia, and testicular or ovarian masses. There is an approximately 10% chance of developing well differentiated thyroid carcinoma. Treatment for Carney complex is individualized depending on the patient’s presentation and includes excision or surgical removal of myxomas, neoplasms, and skin lesions, as well as regular evaluation for cardiac myxomas and endocrine overactivity. This case of Carney complex is unusual because the only endocrinopathy is multinodular goiter.

Population Properties of Compact Objects from the Second LIGO–Virgo Gravitational-Wave Transient Catalog

Abstract We report on the population of 47 compact binary mergers detected with a false-alarm rate of &lt; 1 yr − 1 in the second LIGO–Virgo Gravitational-Wave Transient Catalog. We observe several characteristics of the merging binary black hole (BBH) population not discernible until now. First, the primary mass spectrum contains structure beyond a power law with a sharp high-mass cutoff; it is more consistent with a broken power law with a break at 39.7 − 9.1 + 20.3 M ⊙ or a power law with a Gaussian feature peaking at 33.1 − 5.6 + 4.0 M ⊙ (90% credible interval). While the primary mass distribution must extend to ∼ 65 M ⊙ or beyond, only 2.9 − 1.7 + 3.5 % of systems have primary masses greater than 45 M ⊙ . Second, we find that a fraction of BBH systems have component spins misaligned with the orbital angular momentum, giving rise to precession of the orbital plane. Moreover, 12 %– 44 % of BBH systems have spins tilted by more than 90°, giving rise to a negative effective inspiral spin parameter, χ eff . Under the assumption that such systems can only be formed by dynamical interactions, we infer that between 25% and 93% of BBHs with nonvanishing ∣ χ eff ∣ &gt; 0.01 are dynamically assembled. Third, we estimate merger rates, finding R BBH = 23.9 − 8.6 + 14.3 Gpc − 3 yr − 1 for BBHs and R BNS = 320 − 240 + 490 Gpc − 3 yr − 1 for binary neutron stars. We find that the BBH rate likely increases with redshift ( 85 % credibility) but not faster than the star formation rate ( 86 % credibility). Additionally, we examine recent exceptional events in the context of our population models, finding that the asymmetric masses of GW190412 and the high component masses of GW190521 are consistent with our models, but the low secondary mass of GW190814 makes it an outlier.

Black Hole Mass Function of Coalescing Binary Black Hole Systems: Is there a Pulsational Pair-instability Mass Cutoff?

Abstract We analyze the LIGO/Virgo GWTC-2 catalog to study the primary mass distribution of the merging black holes. We perform hierarchical Bayesian analysis and examine whether the mass distribution has a sharp cutoff for primary black hole masses below 65 M ⊙, as predicted in the pulsational pair-instability supernova model. We construct two empirical mass functions. One is a piece-wise function with two power-law segments joined by a sudden drop. The other consists of a main-truncated power-law component, a Gaussian component, and a third very massive component. Both models can reasonably fit the data and a sharp drop of the mass distribution is found at ∼50M ⊙, suggesting that the majority of the observed black holes can be explained by the stellar evolution scenarios in which the pulsational pair-instability process takes place. On the other hand, the very massive subpopulation, which accounts for at most several percent of the total, may be formed through hierarchical mergers or other processes.

The Diagnostic and Prognostic Roles of Combined Expression of Novel Biomarkers in Lung Adenocarcinoma and Lung Squamous Cell Carcinoma: An Immunohistochemical Study.

Background & Objective:Diagnosis and discrimination of lung adenocarcinoma (LUAD) from lung squamous cell carcinoma (LUSC) is critical to select the appropriate treatment regimen as recently targeted therapies require accurate subtyping of nonsmall-cell lung carcinoma (NSCLCs). There are currently several biomarkers that could be used for differentiation between LUAD and LUSC, but they have less sensitivity, specificity, and clinical applicability. The aim of this study was to assess the diagnostic and prognostic values of CLCA2, SPATS2, ST6GALNAC1, and Adipophilin tissue expression in the tissues retrieved from LUAD and LUSC patients using immunohistochemistry.Methods:The current study was performed on the samples retrieved from sixty primary lung masses that were diagnosed as LUAD and LUSC. Immunohistochemistry was performed by using a panel of CLCA2, SPATS2, and ST6GALNAC1. We assessed the diagnostic roles of the studied markers in the discrimination between LUAD and LUSC and their prognostic values. Results:SPATS2 and CLCA2 were expressed higher in LUSC than LUAD. ST6GALNAC1 and Adipophilin showed higher expression in LUAD than LUSC (P<0.001). The sensitivity and specificity of CLCA2, SPATS2, ST6GALNAC1 and Adipophilin in adequate subtyping and reaching the accurate diagnosis was 100%. We found only significant difference in survival rate between the patients with negative and positive CLCA2 expression (P=0.038 and P=0.019, respectively). Conclusion:The combination of biomarkers of CLCA2, SPATS2, ST6GALNAC1, and Adipophilin may lead to an appropriate subtyping of lung cancer and reaching accurate diagnosis with the highest sensitivity and specificity.

Role of positron emission tomography/computed tomography in the evaluation of renal cell carcinoma.

Introduction:Positron emission tomography (PET) is not a standard recommendation in most of the major guidelines for the evaluation of renal cell carcinoma (RCC). Earlier studies evaluating PET scan in patients with RCC have provided discordant results. However, with the advent of newer hybrid PET/computed tomography (CT) scanning systems, this modality has shown increased efficacy in the evaluation of primary renal masses along with the detection of extrarenal metastases, restaging recurrent RCC, and also in monitoring response to targeted therapy. We performed a systematic review of the existing literature on the role of PET scan in the evaluation of RCC.Methodology:We systematically searched the databases of PubMed/Medline, Embase, and Google Scholar to identify studies on the use of PET scan in RCC. Using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 94 full-text articles were selected, of which 54 relevant articles were then reviewed, after a consensus by the authors.Results:Several studies have shown similar sensitivity and specificity of fluoro-2-deoxy-2-d-glucose-PET (FDG-PET) scan as compared to conventional CT scan for the initial diagnosis of RCC, and an improved sensitivity and specificity for the detection of metastases and recurrences following curative therapy. The PET scan may also play a role in predicting the initial tumor biology and pathology and predicting the prognosis as well as the response to therapy.Conclusion:The current guidelines do not recommend PET scan in the staging armamentarium of RCCs. However, FDG-PET scan is as efficacious, if not better than conventional imaging alone, in the evaluation of the primary and metastatic RCC, as well as in evaluating the response to therapy, due to its ability to pick up areas of increased metabolic activity early on. Newer tracers such as Ga68 prostate specific membrane antigen-labeled ligands may help in opening up newer avenues of theragnostics.

Cardiac magnetic resonance imaging in differential diagnosis of cardiac masses

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): S. Orsola Hospital Background Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead an accurate diagnosis. Purpose To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods : Ninety-three patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours. Results The descriptive analysis of the morphologic features showed that diameter &amp;gt; 50mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p &amp;lt; 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p &amp;lt;0.001). When analysing the four subgroups, CMR features did not discriminate between primitive malignant masses and metastasis. Conversely, hyperintensity signal and EGE were able to distinguish benign primitive lesions from pseudotumors (p = 0.002). Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumors. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to exclude a pseudotumor diagnosis and reduced the probability of a primary benign tumor. Conclusions Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features, may discriminate primary benign masses and pseudotumours. Abstract Figure. Benign and malignant cardiac masses

Implementing primordial binaries in simulations of star cluster formation with a hybrid MHD and direct N-body method

ABSTRACT The fraction of stars in binary systems within star clusters is important for their evolution, but what proportion of binaries form by dynamical processes after initial stellar accretion remains unknown. In previous work, we showed that dynamical interactions alone produced too few low-mass binaries compared to observations. We therefore implement an initial population of binaries in the coupled magnetohydrodynamics and direct N-body star cluster formation code torch. We compare simulations with, and without, initial binary populations and follow the dynamical evolution of the binary population in both sets of simulations, finding that both dynamical formation and destruction of binaries take place. Even in the first few million years of star formation, we find that an initial population of binaries is needed at all masses to reproduce observed binary fractions for binaries with mass ratios above the q ≥ 0.1 detection limit. Our simulations also indicate that dynamical interactions in the presence of gas during cluster formation modify the initial distributions towards binaries with smaller primary masses, larger mass ratios, smaller semimajor axes and larger eccentricities. Systems formed dynamically do not have the same properties as the initial systems, and systems formed dynamically in the presence of an initial population of binaries differ from those formed in simulations with single stars only. Dynamical interactions during the earliest stages of star cluster formation are important for determining the properties of binary star systems.

Outcomes of gasless laparoendoscopic single-port partial nephrectomy in 356 consecutive patients: Feasibility of a clampless and sutureless technique.

To investigate the outcomes and feasibilities of gasless laparoendoscopic single-port clampless sutureless partial nephrectomy. We reviewed 356 consecutive patients with primary unilateral non-metastatic renal masses who underwent gasless laparoendoscopic single-port partial nephrectomy (2011-2018), which was performed retroperitoneally using a three-dimensional flexible endoscope, without vascular clamping or renorrhaphy in principle. The median tumor size was 2.5cm, and 213 (60%), 105 (29%), and 38 (11%) patients had peripheral, central, and hilar tumors, respectively. Clampless and sutureless partial nephrectomy was accomplished in 337 patients (95%), while eight (2%) and 16 (4%) patients required vascular clamping and renorrhaphy, respectively. The median operative time and blood loss were 220min and 266mL, respectively; eight patients (2%) received blood transfusion. Clavien-Dindo grade 3a complications occurred in 27 patients (8%); all these patients had urinary leakage treated with ureteral stent placement, one of whom also developed a postoperative pseudoaneurysm. Among 324 patients diagnosed with renal cell carcinoma, six (2%) had positive surgical margins, and one (0.3%) and seven (2%) developed metastatic and local recurrences, respectively. During a median follow-up of 54months, no patient died from kidney cancer. The median percent decrease in estimated glomerular filtration rate at 3months after surgery was 5.7%. No patient experienced postoperative acute renal failure, while one patient with preexisting renal impairment started dialysis at 70months after surgery. Clampless and sutureless partial nephrectomy can be safely accomplished in most patients undergoing gasless laparoendoscopic single-port surgery, yielding favorable oncological and functional outcomes.

Role of PET/CT in Differentiating Synchronous Second Primary Lung Masses from Lung Metastases

Abstract Background: In case of multiple pulmonary and extrapul-monary lesions, it is difficult to determine if the lung mass was primary lesion or metastasis from a distant organ, even in multiple pulmonary lesions. it is difficult to determine sit of primary one. Aim of Study: We retrospectively measure the SUVmax and D SUVmax in pulmonary and extrapulmonary lesions and identify if there is a cutoff value of SUVmax between patho-logically proved synchronous second primary and metastatic lesions. Patients and Methods: 65 patients (50 male and 15 female with age ranged from 35 to 70 years) who had multiple pulmonary and extrapulmonary lesions were evaluated by PET/CT, all patients were evaluated by oncology physicians, patients were selected after histopathological evaluation, patients with lung metastasis taken as a control group. SUVmax and D SUVmax were measured in both groups. Results: A significant (DSUV) max difference between both included groups: Metastatic lung cancers and second primary lung tumours with a cutoff value of 35% while no significant DSUVmax between the studied cases in the same groups, as below this level approved for metastatic lesion and above this cutoff values consistent with the synchronous second primary tumour, this help in better staging and man-agement of lung cancer. Conclusion: PET CT is considered as a functional non-invasive technique, we recommended that all patients with multiple pulmonary and extrapulmonary lesions to add this investigation, before taking the decision of management, it can differentiate between multiple primaries and metastatic lesion depending upon the FDG activity.

On the Origin of GW190521-like Events from Repeated Black Hole Mergers in Star Clusters

Abstract LIGO and Virgo have reported the detection of GW190521, from the merger of a binary black hole (BBH) with a total mass around 150 M ⊙. While current stellar models limit the mass of any black hole (BH) remnant to about 40–50 M ⊙, more massive BHs can be produced dynamically through repeated mergers in the core of a dense star cluster. The process is limited by the recoil kick (due to anisotropic emission of gravitational radiation) imparted to merger remnants, which can escape the parent cluster, thereby terminating growth. We study the role of the host cluster metallicity and escape speed in the buildup of massive BHs through repeated mergers. Almost independent of host metallicity, we find that a BBH of about 150 M ⊙ could be formed dynamically in any star cluster with escape speed ≳200 km s−1, as found in galactic nuclear star clusters as well as the most massive globular clusters and super star clusters. Using an inspiral-only waveform, we compute the detection probability for different primary masses (≥60 M ⊙) as a function of secondary mass and find that the detection probability increases with secondary mass and decreases for larger primary mass and redshift. Future additional detections of massive BBH mergers will be of fundamental importance for understanding the growth of massive BHs through dynamics and the formation of intermediate-mass BHs.

Evaluation of primary lateral neck mass in adults: Cross sectional study

Aim: Primary Lateral neck mass (PLNM) is a disease that expresses a pathology in neck, excluding thyroid and skin tumors. The spectrum ranges from “lumps, mass or tumors,” congenital tumors, inflammatory diseases, and benign neoplasm to malignant neoplasm. The current Skandalakis algorithm excludes thyroid pathology. Correct anamnesis and physical examination are especially important for data collection. We herein analyzed the methods of study in PLNM. Methods: This cross-sectional study was performed with review of medical records from January 2010 to July 2019. All patients with diagnoses of PLMN and older than 15 years of age were analyzed. We excluded patients with “classic” and unknown lateral neck masses. Standardized protocols for data collection were implemented to minimize or avoid bias. The statistical analysis was carried out with STATA v 14.0. Results: A total of 78 patients were studied. Age and time of evolution were the most crucial factors in presumptive diagnoses. The most frequent location was the anterior triangle in the neck (77%). Murmurs and thrills were clinically defined as vascular pathologies. Mobility on all axes without fixation to deep planes were clinically defined as Lipoma. The pathological examinations were more frequently reported as lymphomas (32), which were followed by Branchial Cleft Cysts. Ultrasound was a complementary study useful in congenital malformations to determine cystic characteristics. The presence of “B symptoms” and FNA (fine needle aspiration) are useful in primary Lymphoproliferative adenopathy. MRI (Magnetic resonance image) and Angio-MRI are useful in tumors of nervous origin (schwannomas, neurofibromas, and paragangliomas tumors). Malignant soft tissue tumors (sarcomas) need complementary studies and imaging for surgical planning. Conclusion: Differential diagnoses of the primary lateral neck masses challenge surgeons. Anamnesis and physical examination are the most crucial factors for the presumptive diagnoses. Complementary studies and imaging should be requested with selective criteria.