Role of systemic inflammation scores in pulmonary metastasectomy for colorectal cancer

Background: Patients with pulmonary metastases from colorectal cancer can benefit from surgical removal.However, the biological determinants of postsurgical outcome are not completely elucidated. We evaluated the role of host systemic inflammation status in this setting. Methods: The modified Glasgow prognostic score (based on serum C-reactive protein and albumin levels) and the neutrophil-to-lymphocyte (NTL) ratio were obtained from 44 patients who received curative-intent metastasectomy, and were used as indicators of systemic inflammation status.We tested the impact of both of these parameters on overall survival (OS) and progression-free survival (PFS), as well as their correlation with other well-known prognosticators. Results: Five-year PFS and OS rates were 18% and 49%, respectively. At univariate analysis,multiple metastases, disease-free interval <36 months, and a Glasgow score of 2 (P = 0.031)were significantly associated to aworse PFS rate.A NTL ratio >3 predicted disease progression in the short-term(P = 0.036), but the effect on late events was weaker (P = 0.079). Factors associated with worse OS were multiple metastasis (P = 0.002), elevated carcinoembryonic antigen (P = 0.009), a Glasgowscore of 2 (P = 0.029), and a faster metastasis growth (P = 0.008).At Cox regression analysis, neither a Glasgow score of 2, nor elevated NTL ratio showed an independent effect on survival rates. Conclusions: Systemic inflammation scores did not perform well as independent survival prognosticators in patients undergoing curative-intent pulmonary metastasectomy. Further investigation is warranted to evaluate whether these measurements could still be useful when restricting the analysis to specific patient subcategories or to diverse postoperative phases

Eddington limited starbursts in the central 10pc of AGN, and the Torus in NGC1068

We present results from a survey of nearby AGN using the near infrared adaptive optics integral field spectrograph SINFONI. These data enable us to probe the distribution and kinematics of the gas and stars at spatial resolutions as small as 0.085arcsec. We find strong evidence for recent but short lived starbursts residing in very dense nuclear disks. On scales of less than 10pc these would have reached Eddington-limited luminosities when active, perhaps accounting for their short duration. In addition, for NGC1068 at a resolution of 6pc, we present direct observations of molecular gas close around the AGN which we identify with the obscuring torus.Comment: Conference proceedings to appear in "The Central Engine of Active Galactic Nuclei", ed. L. C. Ho and J.-M. Wang (San Francisco: ASP

Duration of air leak is reduced after awake nonresectional lung volume reduction surgery

OBJECTIVE: Prolonged air leak occurs frequently after lung volume reduction surgery (LVRS) and can negatively affect both morbidity and hospital stay. We hypothesised that awake nonresectional LVRS could reduce the duration of air leak in emphysema patients. METHODS: This analysis included 66 patients undergoing awake, unilateral plication of the most emphysematous lung regions under sole epidural anaesthesia. Primary outcome measure was the rate of prolonged (>7 days) air leak; secondary outcome measures included the mean duration of air leak, hospital stay and early discharges (<or=4 days). All results were retrospectively compared with those of a similar control group undergoing resectional LVRS under general anaesthesia. RESULTS: Intergroup comparisons showed that demographics and baseline data were well matched. Prolonged air leak occurred in 12 patients (18%) in the awake group versus 27 patients (40%) in the control group (p=0.007) with a mean duration of 5.2+/-6.5 days versus 7.9+/-7.6 days (p<0.0002). Mean hospital stay was significantly shorter in the awake group (6.3+/-2.8 days vs 9.2+/-5.6 days, p<0.0001). At univariate analysis, resectional LVRS (p=0.007), higher severity of emphysema (p<0.0001) and lower diffusion capacity for carbon monoxide (p=0.0001) correlated with occurrence of prolonged air leak; however, logistic regression indicated high severity of emphysema as the most important factor predicting prolonged air leak (odds ratio=4.85, p<0.0001). At 6 months, dyspnoea index, FEV1 and 6 min walking test improved significantly in both study groups. CONCLUSIONS: In this study, awake nonresectional LVRS was associated with a lower rate of prolonged air leak and a shorter hospital stay than the standard resectional technique

Talc pleurodesis for malignant pleural effusion: efficacy and factors predicting recurrence

Objectives: To identify potential factors predicting recurrence after talc pleurodesis for malignant pleural effusion. Methods: Retrospective study of two cohorts of consecutive patients undergoing surgery for malignant pleural effusion (T VATS/talc pleurodesis number of procedures n = 41, IPC VATS/indwelling pleural catheter n = 41). Data analysed: ASA, performance status, underlying histology, amount of effusion drained at initial procedure, morbidity, recurrence of effusion (RecEff), redo surgery due to recurrence. The definition of RecEff was based on imaging (at least CxR) and related report issued by a senior radiologist. Median radiological follow-up of both groups was identical (8 months). Statistical analysis was done through SPSS ver 21. Results: The RecEff rate was 20% in the IPC group and 32% in the T group. Fifty percent (4/8) of patients with failed pleurodesis in the IPC group required redo surgery compared to 92% (12/13) in the T group, which was significant. Median time to recurrence in the IPC group was 9 months, in the T group 4 months. In the T group the only relevant factor associated with recurrence was lung cancer histology (P = 0.055). The statistical significance of ASA score >2 (P = 0.042) and performance status 2 (P = 0.019) in this context is difficult to interpret. There were no significant differences between cohorts in age (69.5 years [60-78.2]), gender (41 males and 41 females), ASA (3 [2-3]), performance status (1 [1-2]), millilitres of effusion drained (1600 [1000-2550]), site of primary (mesothelioma 32% of patients, lung Ca 21%) and morbidity (7%). Conclusions: The recurrence rate after talc pleurodesis was notably higher compared to the IPC group in our study and a significant number of patients affected required redo surgery. Lung cancer histology was the only clinically relevant predictor of recurrence in the talc group, potentially favouring the choice of a primary IPC insertion for these patients rather than chemical pleurodesis

Low, Milky-Way like, Molecular Gas Excitation of Massive Disk Galaxies at z~1.5

We present evidence for Milky-Way-like, low-excitation molecular gas reservoirs in near-IR selected massive galaxies at z~1.5, based on IRAM Plateau de Bure Interferometer CO[3-2] and NRAO Very Large Array CO[1-0] line observations for two galaxies that had been previously detected in CO[2-1] emission. The CO[3-2] flux of BzK-21000 at z=1.522 is comparable within the errors to its CO[2-1] flux, implying that the CO[3-2] transition is significantly sub-thermally excited. The combined CO[1-0] observations of the two sources result in a detection at the 3 sigma level that is consistent with a higher CO[1-0] luminosity than that of CO[2-1]. Contrary to what is observed in submillimeter galaxies and QSOs, in which the CO transitions are thermally excited up to J>=3, these galaxies have low-excitation molecular gas, similar to that in the Milky Way and local spirals. This is the first time that such conditions have been observed at high redshift. A Large Velocity Gradient analysis suggests that molecular clouds with density and kinetic temperature comparable to local spirals can reproduce our observations. The similarity in the CO excitation properties suggests that a high, Milky-Way-like, CO to H_2 conversion factor could be appropriate for these systems. If such low-excitation properties are representative of ordinary galaxies at high redshift, centimeter telescopes such as the Expanded Very Large Array and the longest wavelength Atacama Large Millimeter Array bands will be the best tools for studying the molecular gas content in these systems through the observations of CO emission lines.Comment: 5 pages, 4 figures. ApJ Letters in pres

Feeding AGN: new results from the NUGA survey

The NUGA project is a high-resolution (0.5''-1'') CO survey of low luminosity AGN including the full sequence of activity types (Seyferts, LINERs and transition objects). NUGA aims to systematically study the different mechanisms for gas fueling of AGNs in the Local Universe. In this paper we discuss the latest results of this recently completed survey, which now includes newly acquired subarcsec resolution observations for all targets of the sample. The large variety of circumnuclear disk morphologies found in NUGA galaxies (m=1, m=2 and stochastic instabilities) is a challenging result that urges the refinement of current dynamical models. In this paper we report on new results obtained in 4 study cases for NUGA: NGC4826, NGC7217, NGC4579 and NGC6951Comment: 4 pages, 2 figures. Contributed talk to appear in "The Interplay among Black Holes, Stars and ISM in Galactic Nuclei," Proc. IAU 222 (Gramado, Brazil), eds. Th. Storchi Bergmann, L.C. Ho, H.R. Schmit

NUGA: the IRAM survey of AGN spiral hosts

The NUclei of GAlaxies (NUGA) project is a combined effort to carry out a high-resolution (<1'') interferometer CO survey of a sample of 12 nearby AGN spiral hosts, using the IRAM array. We map the distribution and dynamics of molecular gas in the inner 1 kpc of the nuclei with resolutions of 10-50 pc, and study the mechanisms for gas fueling of the different low-luminosity AGN. First results show evidence for the occurrence of strong m=1 gas instabilities in Seyferts. NUGA maps allow us to address the origin/nature of m=1 modes and their link with m=2 modes and acoustic instabilities, present in other targets.Comment: 1 gzipped tar file containing 1 Latex file + 3 eps figures. Proceedings of ''Active Galactic Nuclei: from Central Engine to Host Galaxy'', meeting held in Meudon, France, July 23-27, 2002, Eds.: S. Collin, F. Combes and I. Shlosman. To be published in ASP Conference Serie