Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer

There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients with advanced cancer. The aim of the present study was to examine whether an inflammation-based prognostic score (Glasgow Prognostic score, GPS) was associated with survival, in patients with inoperable gastro-oesophageal cancer. Patients diagnosed with inoperable gastro-oesophageal carcinoma and who had measurement of albumin and C-reactive protein concentrations, at the time of diagnosis, were studied (n=258). Clinical information was obtained from a gastro-oesophageal cancer database and analysis of the case notes. Patients with both an elevated C-reactive protein (>10 mg l−1) and hypoalbuminaemia (<35 g l−1) were allocated a GPS score of 2. Patients in whom only one of these biochemical abnormalities was present were allocated a GPS score of 1, and patients with a normal C-reactive protein and albumin were allocated a score of 0. On multivariate survival analysis, age (hazard ratio (HR) 1.22, 95% CI 1.02–1.46, P<0.05), stage (HR 1.55, 95% CI 1.30–1.83, P<0.001), the GPS (HR 1.51, 95% CI 1.22–1.86, P<0.001) and treatment (HR 2.53, 95% CI 1.80–3.56, P<0.001) were significant independent predictors of cancer survival. A 12-month cancer-specific survival in patients with stage I/II disease receiving active treatment was 67 and 60% for a GPS of 0 and 1, respectively. For stage III/IV disease, 12 months cancer-specific survival was 57, 25 and 12% for a GPS of 0, 1 and 2, respectively. In the present study, the GPS predicted cancer-specific survival, independent of stage and treatment received, in patients with inoperable gastro-oesophageal cancer. Moreover, the GPS may be used in combination with conventional staging techniques to improve the prediction of survival in patients with inoperable gastro-oesophageal cancer

The relationship between quality of life (EORTC QLQ-C30) and survival in patients with gastro-oesopohageal cancer

It remains unclear whether any aspect of quality of life has a role in predicting survival in an unselected cohort of patients with gastro-oesophageal cancer. Therefore the aim of the present study was to examine the relationship between quality of life (EORTC QLQ-C30), clinico-pathological characteristics and survival in patients with gastro-oesophageal cancer. Patients presenting with gastric or oesophageal cancer, staged using the UICC tumour node metastasis (TNM) classification and who received either potentially curative surgery or palliative treatment between November 1997 and December 2002 (n=152) participated in a quality of life study, using the EORTC QLQ-C30 core questionnaire. On univariate analysis, age (P &#60; 0.01), tumour length (P &#60; 0.0001), TNM stage (P&#60;0.0001), weight loss (P&#60;0.0001), dysphagia score (P&#60;0.001), performance status (P&#60;0.1) and treatment (P&#60;0.0001) were significantly associated with cancer-specific survival. EORTC QLQ-C30, physical functioning (P&#60;0.0001), role functioning (P&#60;0.001), cognitive functioning (P&#60;0.01), social functioning (P&#60;0.0001), global quality of life (P&#60;0.0001), fatigue (P&#60;0.0001), nausea/vomiting (P&#60;0.01), pain (P&#60;0.001), dyspnoea (P&#60;0.0001), appetite loss (P&#60;0.0001) and constipation (P&#60;0.05) were also significantly associated with cancer-specific survival. On multivariate survival analysis, tumour stage (P&#60;0.0001), treatment (P&#60;0.001) and appetite loss (P&#60;0.0001) were significant independent predictors of cancer-specific survival. The present study highlights the importance of quality of life (EORTC QLQ-C30) measures, in particular appetite loss, as a prognostic factor in these patients

Large amplitude solitary waves in and near the Earth's magnetosphere, magnetopause and bow shock: Polar and Cluster observations

International audienceSolitary waves with large electric fields (up to 100's of mV/m) have been observed throughout the magnetosphere and in the bow shock. We discuss observations by Polar at high altitudes ( ~ 4-8 RE ), during crossings of the plasma sheet boundary and cusp, and new measurements by Polar at the equatorial magnetopause and by Cluster near the bow shock, in the cusp and at the plasma sheet boundary. We describe the results of a statistical study of electron solitary waves observed by Polar at high altitudes. The mean solitary wave duration was ~ 2 ms. The waves have velocities from ~ 1000 km/s to > 2500 km/s. Observed scale sizes (parallel to the magnetic field) are on the order of 1-10lD, with eF/kTe from ~ 0.01 to O(1). The average speed of solitary waves at the plasma sheet boundary is faster than the average speed observed in the cusp and at cusp injections. The amplitude increases with both velocity and scale size. These observations are all consistent with the identification of the solitary waves as electron hole modes. We also report the discovery of solitary waves at the magnetopause, observed in Polar data obtained at the subsolar equatorial magnetopause. Both positive and negative potential structures have been observed with amplitudes up to ~ 25 mV/m. The velocities range from 150 km/s to >2500 km/s, with scale sizes the order of a kilometer (comparable to the Debye length). Initial observations of solitary waves by the four Cluster satellites are utilized to discuss the scale sizes and time variability of the regions where the solitary waves occur. Preliminary results from the four Cluster satellites have given a glimpse of the spatial and temporal variability of the occurrence of solitary waves and their association with other wave modes. In all the events studied, significant differences were observed in the waveforms observed simultaneously at the four locations separated by ~ 1000 km. When solitary waves were seen at one satellite, they were usually also seen at the other satellites within an interval of a few seconds. In association with an energetic electron injection and a highly compressed magnetosphere, Cluster has observed the largest amplitude solitary waves (>750 mV/m) ever reported in the outer magnetosphere

Combining timing characteristics with physical broad-band spectral modelling of black hole X-ray binary GX 339–4

GX 339–4 is a black hole X-ray binary that is a key focus of accretion studies, since it goes into outburst roughly every 2–3 yr. Tracking of its radio, infrared (IR), and X-ray flux during multiple outbursts reveals tight broad-band correlations. The radio emission originates in a compact, self-absorbed jet; however, the origin of the X-ray emission is still debated: jet base or corona? We fit 20 quasi-simultaneous radio, IR, optical, and X-ray observations of GX 339–4 covering three separate outbursts in 2005, 2007, 2010–2011, with a composite corona+jet model, where inverse Compton emission from both regions contributes to the X-ray emission. Using a recently proposed identifier of the X-ray variability properties known as power-spectral hue, we attempt to explain both the spectral and evolving timing characteristics, with the model. We find the X-ray spectra are best fit by inverse Compton scattering in a dominant hot corona (kT_e ∼ hundreds of keV). However, radio and IR-optical constraints imply a non-negligible contribution from inverse Compton scattering off hotter electrons (kT_e ≥ 511 keV) in the base of the jets, ranging from a few up to ∼50 per cent of the integrated 3–100 keV flux. We also find that the physical properties of the jet show interesting correlations with the shape of the broad-band X-ray variability of the source, posing intriguing suggestions for the connection between the jet and corona

Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer

Background Emergency presentation is recognized to be associated with poorer cancer-specific survival following curative resection for colorectal cancer. The present study examined the hypothesis that an enhanced systemic inflammatory response, prior to surgery, might explain the impact of emergency presentation on survival. Methods In all, 188 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 55 (29&#37;) presented as emergencies. The systemic inflammatory response was assessed using the Glasgow Prognostic Score (mGPS), which is the combination of an elevated C-reactive protein (&gt;10 mg/L) and hypoalbuminemia (&lt;35 g/L). Results In the emergency group, tumor stage was greater (P &lt; 0.01), more patients received adjuvant therapy (P &lt; 0.01) more patients had an elevated mGPS (P &lt; 0.01), and more patients died of their disease (P &lt; 0.05). The minimum follow-up was 12 months; the median follow-up of the survivors was 48 months. Emergency presentation was associated with poorer 3-year cancer-specific survival in those patients aged 65 to 74 years (P &lt; 0.01), in both males and females (P &lt; 0.05), in the deprived (P &lt; 0.01), in patients with tumor-node-metastasis (TNM) stage II disease (P &lt; 0.01), in those who received no adjuvant therapy (P &lt; 0.01), and in the mGPS 0 and 1 groups (P &lt; 0.05) groups. On multivariate survival analysis of patients undergoing potentially curative surgery for TNM stage II colon cancer, emergency presentation (P &lt; 0.05) and mGPS (P &lt; 0.05) were independently associated with cancer-specific survival. Conclusions These results suggest that emergency presentation and the presence of systemic inflammatory response prior to surgery are linked and account for poorer cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Both emergency presentation and an elevated mGPS should be taken into account when assessing the likely outcome of these patients

Bhjet: a public multi-zone, steady state jet + thermal corona spectral model

Accreting black holes are sources of major interest in astronomy, particular those launching jets because of their ability to accelerate particles, and dramatically affect their surrounding environment up to very large distances. The spatial, energy and time scales at which a central active black hole radiates and impacts its environment depend on its mass. The implied scale-invariance of accretion/ejection physics between black hole systems of different central masses has been confirmed by several studies. Therefore, designing a self-consistent theoretical model that can describe such systems, regardless of their mass, is of crucial importance to tackle a variety of astrophysical sources. We present here a new and significantly improved version of a scale invariant, steady-state, multi-zone jet model, which we rename bhjet, resulting from the efforts of our group to advance the modelling of black hole systems. We summarise the model assumptions and basic equations, how they have evolved over time, and the additional features that we have recently introduced. These include additional input electron populations, the extension to cyclotron emission in near-relativistic regime, an improved multiple inverse Compton scattering method, external photon seeds typical of AGN and a magnetically-dominated jet dynamical model as opposed to the pressure-driven jet configuration present in older versions. In this paper, we publicly release the code on Github and, in order to facilitate the user's approach to its many possibilities, showcase a few applications as a tutorial.Comment: 28 pages, 16 figures, accepted for publication on MNRAS, code available at https://github.com/matteolucchini1/BHJet/, updated to the latest version of the manuscrip

An elevated C-reactive protein concentration, prior to surgery, predicts poor cancer-specific survival in patients undergoing resection for gastro-oesophageal cancer

There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients undergoing resection for a variety of tumours. The aim of the present study was to examine the relationship between clinico-pathological status, preoperative C-reactive protein concentration and cancer-specific survival in patients undergoing resection for gastro-oesophageal cancer. One hundred and twenty patients attending the upper gastrointestinal surgical unit in the Royal Infirmary, Glasgow, who were selected for potentially curative surgery, were included in the study. Laboratory measurements of haemoglobin, white cell, lymphocyte and platelet counts, albumin and C-reactive protein were carried out at the time of diagnosis. All patients underwent en-bloc resection with lymphadenectomy and survived at least 30 days following surgery. On multivariate analysis, only the positive to total lymph node ratio (hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.44–2.84, P<0.001) and preoperative C-reactive protein concentration (HR 3.53, 95% CI 1.88–6.64, P<0.001) were independent predictors of cancer-specific survival. The patient group with no evidence of a preoperative systemic inflammatory response (C-reactive protein ⩽10 mg l−1) had a median survival of 79 months compared with 19 months in the elevated systemic inflammatory response group (P<0.001). The results of the present study indicate that in patients selected to undergo potentially curative resection for gastro-oesophageal cancer, the presence of an elevated preoperative C-reactive protein concentration is an independent predictor of poor cancer-specific survival