Constraining cold accretion onto supermassive black holes:molecular gas in the cores of eight brightest cluster galaxies revealed by joint CO and CN absorption

To advance our understanding of the fuelling and feedback processes which power the Universe's most massive black holes, we require a significant increase in our knowledge of the molecular gas which exists in their immediate surroundings. However, the behaviour of this gas is poorly understood due to the difficulties associated with observing it directly. We report on a survey of 18 brightest cluster galaxies lying in cool cores, from which we detect molecular gas in the core regions of eight via carbon monoxide (CO), cyanide (CN) and silicon monoxide (SiO) absorption lines. These absorption lines are produced by cold molecular gas clouds which lie along the line of sight to the bright continuum sources at the galaxy centres. As such, they can be used to determine many properties of the molecular gas which may go on to fuel supermassive black hole accretion and AGN feedback mechanisms. The absorption regions detected have velocities ranging from -45 to 283 km s$^{-1}$ relative to the systemic velocity of the galaxy, and have a bias for motion towards the host supermassive black hole. We find that the CN N = 0 - 1 absorption lines are typically 10 times stronger than those of CO J = 0 - 1. This is due to the higher electric dipole moment of the CN molecule, which enhances its absorption strength. In terms of molecular number density CO remains the more prevalent molecule with a ratio of CO/CN $\sim 10$, similar to that of nearby galaxies. Comparison of CO, CN and HI observations for these systems shows many different combinations of these absorption lines being detected

A Ten Billion Solar Mass Outflow of Molecular Gas Launched by Radio Bubbles in the Abell 1835 Brightest Cluster Galaxy

We report ALMA Early Science observations of the Abell 1835 brightest cluster galaxy (BCG) in the CO (3-2) and CO (1-0) emission lines. We detect 5E10 solar masses of molecular gas within 10 kpc of the BCG. Its velocity width of ~130 km/s FWHM is too narrow to be supported by dynamical pressure. The gas may instead be supported in a rotating, turbulent disk oriented nearly face-on. The disk is forming stars at a rate of 100-180 solar masses per year. Roughly 1E10 solar masses of molecular gas is projected 3-10 kpc to the north-west and to the east of the nucleus with line of sight velocities lying between -250 km/s to +480 km/s with respect to the systemic velocity. Although inflow cannot be ruled out, the rising velocity gradient with radius is consistent with a broad, bipolar outflow driven by radio jets or buoyantly rising X-ray cavities. The molecular outflow may be associated with an outflow of hot gas in Abell 1835 seen on larger scales. Molecular gas is flowing out of the BCG at a rate of approximately 200 solar masses per year, which is comparable to its star formation rate. How radio bubbles lift dense molecular gas in their updrafts, how much gas will be lost to the BCG, and how much will return to fuel future star formation and AGN activity are poorly understood. Our results imply that radio-mechanical (radio mode) feedback not only heats hot atmospheres surrounding elliptical galaxies and BCGs, it is able to sweep higher density molecular gas away from their centers

European lipodystrophy registry: Background and structure

Background: Lipodystrophy syndromes comprise a group of extremely rare and heterogeneous diseases characterized by a selective loss of adipose tissue in the absence of nutritional deprivation or catabolic state. Because of the rarity of each lipodystrophy subform, research in this area is difficult and international co-operation mandatory. Therefore, in 2016, the European Consortium of Lipodystrophies (ECLip) decided to create a registry for patients with lipodystrophy. Results: The registry was build using the information technology Open Source Registry System for Rare Diseases in the EU (OSSE), an open-source software and toolbox. Lipodystrophy specific data forms were developed based on current knowledge of typical signs and symptoms of lipodystrophy. The platform complies with the new General Data Protection Regulation (EU) 2016/679 by ensuring patient pseudonymization, informational separation of powers, secure data storage and security of communication, user authentication, person specific access to data, and recording of access granted to any data. Inclusion criteria are all patients with any form of lipodystrophy (with the exception of HIV-associated lipodystrophy). So far 246 patients from nine centres (Amsterdam, Bologna, Izmir, Leipzig, M\ufcnster, Moscow, Pisa, Santiago de Compostela, Ulm) have been recruited. With the help from the six centres on the brink of recruitment (Cambridge, Lille, Nicosia, Paris, Porto, Rome) this number is expected to double within the next one or 2 years. Conclusions: A European registry for all patients with lipodystrophy will provide a platform for improved research in the area of lipodystrophy. All physicians from Europe and neighbouring countries caring for patients with lipodystrophy are invited to participate in the ECLip Registry. Study registration: ClinicalTrials.gov (NCT03553420). Registered 14 March 2018, retrospectively registered

Lipodystrophy-Linked LMNA p.R482W Mutation Induces Clinical Early Atherosclerosis and In Vitro Endothelial Dysfunction

Objective—Some mutations in LMNA, encoding A-type lamins, are responsible for Dunnigan-type-familial partial lipodystrophy (FPLD2), with altered fat distribution and metabolism. The high prevalence of early and severe cardiovascular outcomes in these patients suggests that, in addition to metabolic risk factors, FPLD2-associated LMNA mutations could have a direct role on the vascular wall cells. Approach and Results—We analyzed the cardiovascular phenotype of 19 FPLD2 patients aged >30 years with LMNA p.R482 heterozygous substitutions, and the effects of p.R482W-prelamin-A overexpression in human coronary artery endothelial cells. In 68% of FPLD2 patients, early atherosclerosis was attested by clinical cardiovascular events, occurring before the age of 45 in most cases. In transduced endothelial cells, exogenous wild-type-prelamin-A was correctly processed and localized, whereas p.R482W-prelamin-A accumulated abnormally at the nuclear envelope. Patients’ fibroblasts also showed a predominant nuclear envelope distribution with a decreased rate of prelamin-A maturation. Only p.R482W-prelamin-A induced endothelial dysfunction, with decreased production of NO, increased endothelial adhesion of peripheral blood mononuclear cells, and cellular senescence. p.R482W-prelamin-A also induced oxidative stress, DNA damages, and inflammation. These alterations were prevented by treatment of endothelial cells with pravastatin, which inhibits prelamin-A farnesylation, or with antioxidants. In addition, pravastatin allowed the correct relocalization of p.R482W-prelamin-A within the endothelial cell nucleus. These data suggest that farnesylated p.R482W-prelamin-A accumulation at the nuclear envelope is a toxic event, leading to cellular oxidative stress and endothelial dysfunction. Conclusions—LMNA p.R482 mutations, responsible for FPLD2, exert a direct proatherogenic effect in endothelial cells, which could contribute to patients’ early atherosclerosis

Long‐term efficacy and safety of once‐monthly pasireotide in Cushing's disease: A Phase III extension study

Objectives Many patients with Cushing's disease (CD) require chronic pharmacotherapy to control their hypercortisolism. We evaluated the efficacy and safety of long‐acting pasireotide during a long‐term extension study in patients with CD. Design Open‐label extension to a 12‐month Phase III study of long‐acting pasireotide in CD (N = 150; NCT01374906). Patients Patients with mean urinary free cortisol (mUFC) ≤ upper limit of normal (ULN) or receiving clinical benefit at core study end could continue long‐acting pasireotide during the extension. Results Eighty‐one of 150 (54.0%) enrolled patients entered the extension. Median overall exposure to pasireotide at study end was 23.9 months; 39/81 (48.1%) patients completed the extension (received ≥ 12 months’ treatment during the extension and could transit to a separate pasireotide safety study). mUFC was ≤ULN in 42/81 (51.9%), 13/81 (16.0%) and 43/81 (53.1%) patients at extension baseline, month (M) 36 and last assessment. Median mUFC remained within normal limits. Median late‐night salivary cortisol was 2.6 × ULN at core baseline and 1.3 × ULN at M36. Clinical improvements were sustained over time. Forty‐two (51.9%) patients discontinued during the extension: 25 (30.9%) before M24 and 17 (21.0%) after M24. Hyperglycaemia‐related AEs occurred in 39.5% of patients. Mean fasting glucose (FPG) and glycated haemoglobin (HbA1c) were stable during the extension, with antidiabetic medication initiated/escalated in some patients. Sixty‐six (81.5%) and 71 (88.9%) patients were classified as having diabetes (HbA1c ≥ 6.5%, FPG ≥ 7.0 mmol/L, antidiabetic medication use, or history of diabetes) at extension baseline and last assessment. Conclusions Long‐acting pasireotide provided sustained biochemical and clinical improvements, with no new safety signals emerging, supporting its use as an effective long‐term therapy for CD

Medullary and papillary carcinoma of the thyroid gland occurring as a collision tumor with lymph node metastasis: A case report

<p>Abstract</p> <p>Introduction</p> <p>Papillary thyroid carcinoma and medullary thyroid carcinoma are two different thyroid neoplasia. The simultaneous occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma as a collison tumor with metastases from both lesions in the regional lymph nodes is a rare phenomenon.</p> <p>Case presentation</p> <p>A 32-year-old Iranian man presented with a fixed anterior neck mass. Ultrasonography revealed two separate thyroid nodules as well as a suspicious neck mass that appeared to be a metastatic lesion. The results of thyroid function tests were normal, but the preoperative calcitonin serum value was elevated. Our patient underwent a total thyroidectomy with neck exploration. Two separate and ill-defined solid lesions grossly in the right lobe were noticed. Histological and immunohistochemical studies of these lesions suggested the presence of medullary thyroid carcinoma and papillary thyroid carcinoma. The lymph nodes isolated from a neck dissection specimen showed metastases from both lesions.</p> <p>Conclusions</p> <p>The concomitant occurrence of papillary thyroid carcinoma and medullary thyroid carcinoma and the exact diagnosis of this uncommon event are important. The treatment strategy should be reconsidered in such cases, and genetic screening to exclude multiple endocrine neoplasia 2 syndromes should be performed. For papillary thyroid carcinoma, radioiodine therapy and thyroid-stimulating hormone suppressive therapy are performed. However, the treatment of medullary thyroid carcinoma is mostly radical surgery with no effective adjuvant therapy.</p