The dense molecular gas in the z∼6\rm z\sim6 QSO SDSS J231038.88+185519.7 resolved by ALMA

We present ALMA observations of the CO(6-5) and [CII] emission lines and the sub-millimeter continuum of the $z\sim6$ quasi-stellar object (QSO) SDSS J231038.88+185519.7. Compared to previous studies, we have analyzed a synthetic beam that is ten times smaller in angular size, we have achieved ten times better sensitivity in the CO(6-5) line, and two and half times better sensitivity in the [CII] line, enabling us to resolve the molecular gas emission. We obtain a size of the dense molecular gas of $2.9\pm0.5$ kpc, and of $1.4\pm0.2$ kpc for the 91.5 GHz dust continuum. By assuming that CO(6-5) is thermalized, and by adopting a CO--to--$H_2$ conversion factor $\rm \alpha_{CO} = 0.8~ M_{\odot}~K^{-1}~ (km/s)^{-1} ~pc^{2}$, we infer a molecular gas mass of $\rm M(H_2)=(3.2 \pm0.2) \times 10^{10}\rm M_{\odot}$. Assuming that the observed CO velocity gradient is due to an inclined rotating disk, we derive a dynamical mass of $\rm M_{dyn}~sin^2(i) = (2.4\pm0.5) \times 10^{10}~ M_{\odot}$, which is a factor of approximately two smaller than the previously reported estimate based on [CII]. Regarding the central black hole, we provide a new estimate of the black hole mass based on the C~IV emission line detected in the X-SHOOTER/VLT spectrum: $\rm M_{BH}=(1.8\pm 0.5) \times 10^{9}~ M_{\odot}$. We find a molecular gas fraction of $\rm \mu=M(H_2)/M^*\sim4.4$, where $\rm M^*\approx M_{dyn} - M(H_2)-M(BH)$. We derive a ratio $v_{rot}/\sigma \approx 1-2$ suggesting high gas turbulence, outflows/inflows and/or complex kinematics due to a merger event. We estimate a global Toomre parameter $Q\sim 0.2-0.5$, indicating likely cloud fragmentation. We compare, at the same angular resolution, the CO(6-5) and [CII] distributions, finding that dense molecular gas is more centrally concentrated with respect to [CII]. We find that the current BH growth rate is similar to that of its host galaxy.Comment: A&A in pres

Speed limits for radiation-driven SMBH winds

Context. Ultra-fast outflows (UFOs) have become an established feature in analyses of the X-ray spectra of active galactic nuclei (AGN). According to the standard picture, they are launched at accretion disc scales with relativistic velocities, up to 0.3-0.4 times the speed of light. Their high kinetic power is enough to induce an efficient feedback on a galactic scale, possibly contributing to the co-evolution between the central supermassive black hole (SMBH) and the host galaxy. It is, therefore, of paramount importance to gain a full understanding of UFO physics and, in particular, of the forces driving their acceleration and the relation to the accretion flow from which they originate.Aims. In this paper, we investigate the impact of special relativity effects on the radiative pressure exerted onto the outflow. The radiation received by the wind decreases for increasing outflow velocity, v, implying that the standard Eddington limit argument has to be corrected according to v. Due to the limited ability of the radiation to counteract the black hole gravitational attraction, we expect to find lower typical velocities with respect to the non-relativistic scenario.Methods. We integrated the relativistic-corrected outflow equation of motion for a realistic set of starting conditions. We concentrated on a range of ionisations, column densities, and launching radii consistent with those typically estimated for UFOs. We explore a one-dimensional, spherical geometry and a three-dimensional setting with a rotating, thin accretion disc.Results. We find that the inclusion of special relativity effects leads to sizeable differences in the wind dynamics and that v is reduced up to 50% with respect to the non-relativistic treatment. We compare our results with a sample of UFOs from the literature and we find that the relativistic-corrected velocities are systematically lower than the reported ones, indicating the need for an additional mechanism, such as magnetic driving, to explain the highest velocity components. Finally, we note that these conclusions, derived for AGN winds, are generally applicable

On the importance of special relativistic effects in modelling ultra-fast outflows

Outflows are observed in a variety of astrophysical sources. Remarkably, ultra-fast ($v\geq 0.1c$), outflows in the UV and X-ray bands are often seen in AGNs. Depending on their energy and mass outflow rate, respectively $\dot{E}_{out}, \dot{M}_{out}$, such outflows may play a key role in regulating the AGN-host galaxy co-evolution process through cosmic time. It is therefore crucial to provide accurate estimates of the wind properties. Here, we concentrate on special relativistic effects concerning the interaction of light with matter moving at relativistic speed relatively to the source of radiation. Our aim is to assess the impact of these effects on the observed properties of the outflows and implement a relativistic correction in the existing spectral modelling routines. We define a simple procedure to incorporate relativistic effects in radiative transfer codes. Following this procedure, we run a series of simulations to explore the impact of these effects on the simulated spectra, for different $v$ and column densities of the outflow. The observed optical depth is usually considered a proxy for the wind $N_H$, independently on its velocity. However, our simulations show that the observed optical depth of an outflow with a given column density $N_H$ decreases rapidly as the velocity of the wind approaches relativistic values. This, in turn, implies that when estimating $N_H$ from the optical depth, it is necessary to include a velocity-dependent correction, already for moderate velocities (e.g. $v \geq 0.05c$). This correction linearly propagates to the derived $\dot{M}_{out}, \dot{E}_{out}$. As an example of these effects, we calculate the relativistically corrected values of $\dot{M}_{out}$ and $\dot{E}_{out}$ for a sample of $\sim 30$ Ultra-Fast Outflows taken from the literature, and find correction factors of $20-120 \%$ within the observed range of outflowing velocities.Comment: 6 pages, 5 figures. Accepted for publication in A&

A multicenter retrospective clinical study of CD5/CD10-negative chronic B cell leukemias.

CD5-negative chronic B cell lymphoproliferative disorders in leukemic phase (B-CLPD) are heterogeneous and relatively uncommon pathologies that often lack a histopathological definition because of the absence of accessible pathological tissue. We describe the clinical features and evolution-related variables of 156 patients with CD5/CD10-negative B-CLPD (median age 66 years, range 25-86). The median follow-up was 51 months (range 6-216), and overall 3- and 5-year survival was respectively 87 and 76%; 50 patients needed therapy at diagnosis, 56 during follow-up, and 50 remained untreated until the last control. A combined clinical, histological, cytomorphological, immunophenotypical, and cytogenetic diagnostic approach allowed the complete classification of only a minority of patients as being affected by splenic marginal zone or lymphoplasmacytic lymphoma; the majority of cases remained unclassifiable. Multivariate analysis showed that the clinicohematological variables adversely related to overall survival were serum LDH levels and age, whereas high serum LDH levels, hemoglobin levels of <11 g/dl, and splenomegaly related to treatment-free time (in "wait and see" cases); only splenomegaly related to time to progression (in treated patients). In conclusion, our retrospective study describes the clinical features and variables related to evolution in a large group of patients with CD5/CD10-negative chronic B-cell lymphoid leukemias and underlines the fact that a probable lymphoplasmacytic or marginal zone normal cell origin can be supposed in such leukemic forms, but never surely demonstrated

Long-Term Follow-Up of the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma Trial

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We analyzed long-term results of the response-adapted trial for adult patients with advanced-stage Hodgkin lymphoma. The aim was to confirm noninferiority of treatment de-escalation by omission of bleomycin from doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for interim fluorodeoxyglucose positron emission tomography (iPET)-negative patients and assess efficacy and long-term safety for iPET-positive patients who underwent treatment intensification with escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone (BEACOPP/BEACOPP14). The median follow-up is 7.3 years. For all patients, the 7-year progression-free survival (PFS) and overall survival (OS) are 78.2% (95% CI, 75.6 to 80.5) and 91.6% (95% CI, 89.7 to 93.2), respectively. The 1.3% difference in 3-year PFS (95% CI, -3.0 to 4.7) between ABVD and doxorubicin, vinblastine, and dacarbazine (AVD) now falls within the predefined noninferiority margin. Among 172 patients with positive iPET, the 7-year PFS was 65.9% (95% CI, 58.1 to 72.6) and the 7-year OS was 83.2% (95% CI, 76.2 to 88.3). The cumulative incidence of second malignancies at 7 years was 5.5% (95% CI, 4.0 to 7.5) for those receiving ABVD/AVD and 2.5% (95% CI, 0.8 to 7.7) for those escalated to BEACOPP. With extended follow-up, these results confirm noninferiority of treatment de-escalation after a negative iPET. Escalation with BEACOPP for iPET-positive patients is effective and safe, with no increase in second malignancies

ABVD plus radiotherapy versus EVE plus radiotherapy in unfavorable stage IA and IIA Hodgkin's lymphoma: results from an Intergruppo Italiano Linfomi randomized study.

BACKGROUND: In 1997, the Intergruppo Italiano Linfomi started a randomized trial to evaluate, in unfavorable stage IA and IIA Hodgkin's lymphoma (HL) patients, the efficacy and toxicity of the low toxic epirubicin, vinblastine and etoposide (EVE) regimen followed by involved field radiotherapy in comparison to the gold standard doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) regimen followed by the same radiotherapy program. PATIENTS AND METHODS: Patients should be younger than 65 years with unfavorable stage IA and IIA HL (i.e. stage IA or IIA with bulky disease and/or subdiaphragmatic disease, erythrocyte sedimentation rate higher than 40, extranodal (E) involvement, hilar involvement and more than three involved lymph node areas). RESULTS: Ninety-two patients were allocated to the ABVD arm and 89 to the EVE arm. Complete remission (CR) rates at the end of treatment program [chemotherapy (CT) + RT] were 93% and 92% for ABVD and EVE arms, respectively (P = NS). The 5-year relapse-free survival (RFS) rate was 95% for ABVD and 78% for EVE (P < 0.05). As a consequence of the different relapse rate, the 5-year failure-free survival (FFS) rate was significantly better for ABVD (90%) than for EVE (73%) arm (P < 0.05). No differences in terms of overall survival (OS) were observed for the two study arms. CONCLUSIONS: In unfavorable stage IA and IIA HL patients, no differences were observed between ABVD and EVE arms in terms of CR rate and OS. EVE CT, however, was significantly worse than ABVD in terms of RFS and FFS and cannot be recommended as initial treatment for HL

The role of high-dose therapy and autologous stem cell transplantation in patients with primary refractory Hodgkin's lymphoma: a report from the Gruppo Italiano per lo Studio dei Linfomi (GISL)

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Incidence, mortality, and survival of hematological malignancies in Northern Italian patients: an update to 2020

BackgroundHematological malignancies (HMs) represent a heterogeneous group of diseases with diverse etiology, pathogenesis, and prognosis. HMs' accurate registration by Cancer Registries (CRs) is hampered by the progressive de-hospitalization of patients and the transition to molecular rather than microscopic diagnosis. Material and methodsA dedicated software capable of automatically identifying suspected HMs cases by combining several databases was adopted by Reggio Emilia Province CR (RE-CR). Besides pathological reports, hospital discharge archives, and mortality records, RE-CR retrieved information from general and biomolecular laboratories. Incidence, mortality, and 5-year relative survival (RS) reported according to age, sex, and 4 HMs' main categories, were noted. ResultsOverall, 7,578 HM cases were diagnosed from 1996 to 2020 by RE-CR. HMs were more common in males and older patients, except for Hodgkin Lymphoma and Follicular Lymphoma (FL). Incidence showed a significant increase for FL (annual percent change (APC)=3.0), Myeloproliferative Neoplasms (MPN) in the first period (APC=6.0) followed by a significant decrease (APC=-7.4), and Myelodysplastic Syndromes (APC=16.4) only in the first period. Over the years, a significant increase was observed in 5-year RS for Hodgkin -, Marginal Zone -, Follicular - and Diffuse Large B-cell-Lymphomas, MPN, and Acute Myeloid Leukemia. The availability of dedicated software made it possible to recover 80% of cases automatically: the remaining 20% required direct consultation of medical records. ConclusionsThe study emphasizes that HM registration needs to collect information from multiple sources. The digitalization of CRs is necessary to increase their efficiency

Prevalence and distribution of vascular calcifications at CT scan in patients with and without large vessel vasculitis: A matched cross-sectional study

Objectives The aim of this study was to compare the prevalence, entity and local distribution of arterial wall calcifications evaluated on CT scans in patients with large vessel vasculitis (LVV) and patients with lymphoma as reference for the population without LVV. Methods All consecutive patients diagnosed with LVVs with available baseline positron emission tomography-CT (PET-CT) scan performed between 2007 and 2019 were included; non-LVV patients were lymphoma patients matched by age (±5 years), sex and year of baseline PET-CT (≤2013; &gt;2013). CT images derived from baseline PET-CT scans of both patient groups were retrospectively reviewed by a single radiologist who, after setting a threshold of minimum 130 Hounsfield units, semiautomatically computed vascular calcifications in three separate locations (coronaries, thoracic and abdominal arteries), quantified as Agatston and volume scores. Results A total of 266 patients were included. Abdominal artery calcifications were equally distributed (mean volume 3220 in LVVs and 2712 in lymphomas). Being in the LVVs group was associated with the presence of thoracic calcifications after adjusting by age and year of diagnosis (OR 4.13, 95% CI 1.35 to 12.66; p=0.013). Similarly, LVVs group was significantly associated with the volume score in the thoracic arteries (p=0.048). In patients &gt;50 years old, calcifications in the coronaries were more extended in non-LVV patients (p=0.027 for volume). Conclusion When compared with patients without LVVs, LVVs patients have higher calcifications in the thoracic arteries, but not in coronary and abdominal arteries