XMM-Newton and NuSTAR joint observations of Mrk 915: a deep look into the X-ray properties

We report on the X-ray monitoring programme (covering slightly more than 11 days) carried out jointly by XMM-Newton and NuSTAR on the intermediate Seyfert galaxy Mrk 915. The light curves extracted in different energy ranges show a variation in intensity but not a significant change in spectral shape. The X-ray spectra reveal the presence of a two-phase warm absorber: a fully covering mildly ionized structure [log xi/(erg cm/s)~2.3, NH~1.3x10^21 cm-2] and a partial covering (~90 per cent) lower ionized one [log xi/(erg cm/s)~0.6, NH~2x10^22 cm-2]. A reflection component from distant matter is also present. Finally, a high-column density (NH~1.5x10^23 cm-2) distribution of neutral matter covering a small fraction of the central region is observed, almost constant, in all observations. Main driver of the variations observed between the datasets is a decrease in the intrinsic emission by a factor of ~1.5. Slight variations in the partial covering ionized absorber are detected, while the data are consistent with no variation of the total covering absorber. The most likely interpretation of the present data locates this complex absorber closer to the central source than the narrow line region, possibly in the broad line region, in the innermost part of the torus, or in between. The neutral obscurer may either be part of this same stratified structure or associated with the walls of the torus, grazed by (and partially intercepting) the line of sight.Comment: 14 pages, 10 figures, 4 tables. Accepted for publication in MNRA

Barriers to Dermatological Care in Patients who Received Extensive Mohs Surgery - An In-Depth Qualitative Analysis

Background: Dermatological care needs to be accessible for the elderly, but they face prominent challenges contributing to delays in diagnosis and treatment. Prolonged management of may lead to widespread cutaneous malignancies, necessitating extensive Mohs surgery. Objective: To identify areas for early intervention in the geriatric population who have undergone extensive Mohs surgery. Methods: We performed a qualitative study on 10 patients 65 years and older (68-91) from Atrium Health Wake Forest Baptist dermatology clinics between December 2022 and February 2023, who had extensive Mohs surgery (3 or more layers removed). Results: Three major areas for potential intervention for cutaneous carcinoma identified in our study were lack of knowledge, delayed care, and relationships. Discussion: Early cutaneous carcinoma intervention is essential to avoid extensive Mohs micrographic surgery and the associated risks, and to optimize patient health outcomes

A possible sub-kiloparsec dual AGN buried behind the galaxy curtain

Although thousands of galaxy mergers are known, only a handful of sub-kiloparsec-scale supermassive black hole (SMBH) pairs have been confirmed so far, leaving a huge gap between the observed and predicted numbers of such objects. In this work, we present a detailed analysis of the Sloan Digital Sky Survey optical spectrum and of near-infrared (NIR) diffraction limited imaging of SDSS J1431+4358. This object is a local radio-quiet type 2 active galactic nucleus (AGN) previously selected as a double AGN candidate on the basis of the double-peaked [OIII] emission line. The NIR adaptive optics-assisted observations were obtained at the Large Binocular Telescope with the LUCI+FLAO camera. We found that most of the prominent optical emission lines are characterized by a double-peaked profile, mainly produced by AGN photoionization. Our spectroscopical analysis disfavors the hypothesis that the double-peaked emission lines in the source are the signatures of outflow kinematics, leaving open the possibility that we are detecting either the rotation of a single narrow-line region or the presence of two SMBHs orbiting around a common central potential. The latter scenario is further supported by the high-spatial resolution NIR imaging: After subtracting the dominant contribution of the stellar bulge component in the host galaxy, we detect two faint nuclear sources at r < 0.5 kpc projected separation. Interestingly, the two sources have a position angle consistent with that defined by the two regions where the [OIII] double peaks most likely originate. Aside from the discovery of a promising sub-kiloparsec scale dual AGN, our analysis shows the importance of an appropriate host galaxy subtraction in order to achieve a reliable estimate of the incidence of dual AGNs at small projected separations

Unveiling Sub-Pc supermassive black hole binary candidates in active galactic nuclei

The elusive supermassive black hole binaries (SMBHBs) are thought to be the penultimate stage of galaxy mergers, preceding a final coalescence phase. SMBHBs are sources of continuous gravitational waves, possibly detectable by pulsar timing arrays; the identification of candidates could help in performing targeted gravitational wave searches. Due to SMBHBs\u2019 origin in the innermost parts of active galactic nuclei (AGN), X-rays are a promising tool for unveiling their presence, by means of either double Fe K\u3b1 emission lines or periodicity in their light curve. Here we report on a new method for selecting SMBHBs by means of the presence of a periodic signal in their Swift Burst Alert Telescope (BAT) 105 month light curves. Our technique is based on Fisher\u2019s exact g-test and takes into account the possible presence of colored noise. Among the 553 AGN selected for our investigation, only the Seyfert 1.5 galaxy Mrk 915 emerges as a candidate SMBHB; from subsequent analysis of its light curve we find a period P0 = 35 \ub1 2 months, and the null hypothesis is rejected at the 3.7\u3c3 confidence level. We also present a detailed analysis of the BAT light curve of the only previously X-ray-selected binary candidate source in the literature, the Seyfert 2 galaxy MCG+11-11-032. We find P0 = 26.3 \ub1 0.6 months, consistent with the one inferred from previously reported double Fe K\u3b1 emission lines

Swift data hint at a binary Super Massive Black Hole candidate at sub-parsec separation

Dual/binary Supermassive Black Hole (SMBH) systems are the inevitable consequence of the current Lambda Cold Dark Matter cosmological paradigm. In this context, we discuss here the properties of MCG+11-11-032, a local (z=0.0362) Seyfert 2 galaxy. This source was proposed as a dual AGN candidate on the basis of the presence of double-peaked [OIII] emission lines in its optical spectrum. MCG+11-11-032 is also an X-ray variable source and was observed several times by the Swift X-ray Telescope (XRT) on time scales from days to years. In this work, we analyze the SDSS-DR13 spectrum and find evidence for double-peaked profiles in all the strongest narrow emission lines. We also study the XRT light curve and unveil the presence of an alternating behavior of the intrinsic 0.3-10 keV flux, while the 123-month Swift BAT light curve supports the presence of almost regular peaks and dips almost every 25 months. In addition, the XRT spectrum suggests for the presence of two narrow emission lines with rest-frame energies of E~6.16 keV and E~6.56 keV. Although by considering only the optical emission lines, different physical mechanisms may be invoked to explain the kinematical properties, the X-ray results are most naturally explained by the presence of a binary SMBH in the center of this source. In particular, we evidence a remarkable agreement between the putative SMBH pair orbital velocity derived from the BAT light curve and the velocity offset derived by the rest-frame Delta_E between the two X-ray line peaks in the XRT spectrum (i.e. Delta_v~0.06c).Comment: 11 pages, 9 figures, 3 tables. Accepted for publication in MNRA

An international, phase III randomized trial in patients with mucinous epithelial ovarian cancer (mEOC/GOG 0241) with long-term follow-up: and experience of conducting a clinical trial in a rare gynecological tumor

Objectives We evaluated four different treatment regimens for advanced-stage mucinous epithelial ovarian cancer. Methods We conducted a multicenter randomized factorial trial (UK and US). Patients were diagnosed with primary mEOC: FIGO stage II–IV or recurrence after stage I disease. Treatment arms were paclitaxel-carboplatin, oxaliplatin-capecitabine, paclitaxel-carboplatin-bevacizumab, or oxaliplatin-capecitabine-bevacizumab. Chemotherapy was given 3-weekly for 6 cycles, and bevacizumab (3-weekly) was continued as maintenance (for 12 cycles). Endpoints included overall-survival (OS), progression-free survival (PFS), toxicity and quality of life (QoL). Results The trial stopped after 50 patients were recruited due to slow accrual. Median follow-up was 59 months. OS hazard ratios (HR) for the two main comparisons were: 0.78 (p = 0.48) for Oxal-Cape vs. Pac-Carbo (each with/without bevacizumab), and 1.04 (p = 0.92) for bevacizumab vs. no bevacizumab. Corresponding PFS HRs were: 0.84 and 0.80. Retrospective central pathology review revealed only 45% (18/40) cases with available material had confirmed primary mEOC. Among these, OS HR for Oxal-Cape vs. Pac-Carbo was 0.36 (p = 0.14); PFS HR = 0.62 (p = 0.40). Grade 3–4 toxicity was seen in 61% Pac-Carbo, 61% Oxal-Cape, 54% Pac-Carbo-Bev, and 85% Oxal-Cape-Bev. QoL was similar between the four arms. Conclusion mEOC/GOG0241 represents an example of a randomized rare tumor trial. Logistical challenges led to early termination, including difficulties in local histopathological diagnosis and accessing drugs outside their labelled indication. There was misalignment between central funders who support clinical trials in rare cancers and the deprioritisation of such work by those managing and funding research at a local level. Rare cancer trials should include centralised pathology review before treatment. Clinical trial registry number: ISRCTN83438782

Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive

Surgical-pathological findings in type 1 and 2 endometrial cancer: An NRG Oncology/Gynecologic Oncology Group study on GOG-210 protocol

To report clinical and pathologic relationships with disease spread in endometrial cancer patients

Inclusion of MUC1 (Ma695) in a panel of immunohistochemical markers is useful for distinguishing between endocervical and endometrial mucinous adenocarcinoma*

BACKGROUND: Distinguishing endocervical adenocarcinoma (ECA) from endometrial mucinous adenocarcinoma (EMMA) is clinically significant in view of the differences in their management and prognosis. In this study, we used a panel of tumor markers to determine their ability to distinguish between primary endocervical adenocarcinoma and primary endometrial mucinous adenocarcinoma. METHODS: Immunohistochemistry using monoclonal antibodies to MUC1 (Ma695), p16, estrogen receptor (ER), progesterone receptor (PR), and vimentin, was performed to examine 32 cases, including 18 EMMAs and 14 ECAs. For MUC1, cases were scored based on the percentage of staining pattern, apical, apical and cytoplasmic (A/C), or negative. For p16, cases were scored based on the percentage of cells stained. For the rest of the antibodies, semiquantitative scoring system was carried out. RESULTS: For MUC1, majority of EMMA (14 of 18 cases, 78%) showed A/C staining, whereas only few ECA (2 of 14, 14%) were positive. The difference of MUC1 expression in the two groups of malignancy was statistically significant (p < 0.001). Staining for p16 was positive in 10 of 14 (71%) ECA and 4 of 18 (22%) EMMA. Estrogen receptor was positive in 3 of 14 (21%) ECA and 17 of 18 (94%) EMMA. Progesterone receptor was positive in 3 of 14 (21%) ECA and 16 of 18 (89%) EMMA. Vimentin was positive in 1 of 14 (7%) ECA, and 9 of 18 (50%) EMA, with median and range of 0 (0–6), and 1.5 (0–9) respectively. CONCLUSION: A panel of immunohistochemical markers including MUC1, p16, ER, PR, and vimentin is recommended, when there is morphological and clinical doubt as to the primary site of endocervical or endometrial origin