Neurological manifestaions among Sudanese patients with multiple myeloma

Background: Multiple myeloma may involve the nervous system at every level, including the neuromuscular junction, peripheral nerve, plexus, spinal nerve root, spinal cord, meninges, and brain. Such involvement may be primary or secondary, as well as non-invasive paraneoplastic effects.Objective: To find out the perevalence and pattern of CNS manifestations in Sudanese patients with multiple myeloma seen in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital.Methodology: This is a prospective descriptive cross sectional, hospital based study. It was conducted in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital in the period from June2009 to June 2010. 50 patients with multiple myeloma were included in the study.Results: Males were more than females with ratio of 2.8:1. The common (36%) age of presentation was between 55-64 years. There was increased incidence of multiple myeloma in patients from the west of Sudan. Farmers and free workers had high incidence of multiple myeloma (34% and 27%respectively). The study demonstrated that the most common non-  neurological symptoms was locomotor symptoms (24%) ,while the most common neurological symptoms were backache and neck pain .The most common neurological findings were cord compression (8%) followed by peripheral neuropathy (2%) and CVA (2%). 22% of patients completed treatment with good response, 12% with partial response, 18% with no response and 48% are still on treatment.Conclusion: CNS involvement among our studied group was not  uncommon.Keywords: neuromuscular, paraneoplastic, monoclonal immunoglobulin

Dynamical mechanism of atrial fibrillation: a topological approach

While spiral wave breakup has been implicated in the emergence of atrial fibrillation, its role in maintaining this complex type of cardiac arrhythmia is less clear. We used the Karma model of cardiac excitation to investigate the dynamical mechanisms that sustain atrial fibrillation once it has been established. The results of our numerical study show that spatiotemporally chaotic dynamics in this regime can be described as a dynamical equilibrium between topologically distinct types of transitions that increase or decrease the number of wavelets, in general agreement with the multiple wavelets hypothesis. Surprisingly, we found that the process of continuous excitation waves breaking up into discontinuous pieces plays no role whatsoever in maintaining spatiotemporal complexity. Instead this complexity is maintained as a dynamical balance between wave coalescence -- a unique, previously unidentified, topological process that increases the number of wavelets -- and wave collapse -- a different topological process that decreases their number.Comment: 15 pages, 14 figure

Double beta decay of 100Mo^{100}Mo: the deformed limit

The double beta decay of $^{100}Mo$ to the ground state and excited states of $^{100}Ru$ is analysed in the context of the pseudo SU(3) scheme. The results of this deformed limit are compared with the vibrational one based on the QRPA formalism. Consistency between the deformed limit and the experimental information is found for various $\beta\beta$ transitions, although, in this approximation some energies and B(E2) intensities cannot reproduced.Comment: 16 pages, revtex, no figures. Submmitted to Phys. Rev.

Renal ammonium excretion after an acute acid load: Blunted response in uric acid stone formers but not in patients with type 2 diabetes

Idiopathic uric acid nephrolithiasis is characterized by elevated urinary net acid excretion and insufficient buffering by ammonium, resulting in excessively acidic urine and titration of the relatively soluble urate anion to insoluble uric acid. Patients with type 2 diabetes have similar changes in urinary pH, net acid excretion, and ammonium in 24-h urine collections at baseline, even after controlling for dietary factors, and are at increased risk for uric acid nephrolithiasis. However, not all patients with type 2 diabetes develop kidney stones, suggesting that uric acid stone formers may have additional urinary defects, perhaps not apparent at baseline. We performed a metabolic study of 14 patients with idiopathic uric acid nephrolithiasis, 13 patients with type 2 diabetes, and 8 healthy control subjects of similar body mass index. After equilibration on a fixed diet for 5 days, subjects were given a single oral acid load (50 meq ammonium chloride), and urine was collected hourly for 4 h. Uric acid stone formers had a lower ammonium excretory response to acute acid loading compared with diabetic and nondiabetic nonstone formers, suggesting that an ammonium excretory defect unique to uric acid stone formers was unmasked by the acid challenge. The Zucker diabetic fatty rat also did not show impaired urinary ammonium excretion in response to acute acid challenge. A blunted renal ammonium excretory response to dietary acid loads may contribute to the pathogenesis of idiopathic uric acid nephrolithiasis. © 2013 the American Physiological Society

A New Class of Majoron-Emitting Double-Beta Decays

Motivated by the excess events that have recently been found near the endpoints of the double beta decay spectra of several elements, we re-examine models in which double beta decay can proceed through the neutrinoless emission of massless Nambu-Goldstone bosons (majorons). Noting that models proposed to date for this process must fine-tune either a scalar mass or a VEV to be less than 10 keV, we introduce a new kind of majoron which avoids this difficulty by carrying lepton number $L=-2$. We analyze in detail the requirements that models of both the conventional and our new type must satisfy if they are to account for the observed excess events. We find: (1) the electron sum-energy spectrum can be used to distinguish the two classes of models from one another; (2) the decay rate for the new models depends on different nuclear matrix elements than for ordinary majorons; and (3) all models require a (pseudo) Dirac neutrino, having a mass of a several hundred MeV, which mixes with $\nu_e$.Comment: 43 pages, 10 figures (included), [figure captions are now included

Impact of Acute Kidney Injury and CKD on Adverse Outcomes in Critically Ill Septic Patients

Introduction: Chronic kidney disease (CKD) and acute kidney injury (AKI) are strongly associated with excess morbidity and mortality and frequently co-occur in critically ill septic patients, but how their interplay affects clinical outcomes is not well elucidated. Methods: We conducted a single-center, retrospective cohort study of 2632 adult patients admitted to the intensive care unit (ICU) with severe sepsis or septic shock. Subjects were classified into 6 groups according to baseline CKD (no-CKD: estimated glomerular filtration rate [eGFR] ≥60; CKD: eGFR 15−59 ml/min per 1.73 m2) and incident AKI by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria (no-AKI, AKI stage 1, AKI stages ≥2) during ICU stay. Study outcomes were 90-day mortality (in hospital or within 90 days of discharge) and incident/progressive CKD. Results: Prevalent CKD was 46% and incident AKI was 57%. Adjusted hazard ratios (95% confidence intervals) for 90-day mortality relative to the reference group of no-CKD/no-AKI were 1.5 (1.1−2.0) in no-CKD/AKI stage 1, 2.4 (1.9−3.1) in no-CKD/AKI stages≥2, 1.1 (0.8−1.4) in CKD/no-AKI, 1.2 (0.9−1.6) in CKD/AKI stage 1, and 2.2 (1.7−2.9) in CKD/AKI stages ≥2. A similar trend was observed for incident/progressive CKD during a median follow-up of 15.3 months. Conclusion: Stage 1 AKI on CKD was not associated with an independent increased risk of adverse outcomes in critically ill septic patients. AKI stages ≥2 on CKD and any level of AKI in no-CKD patients were strongly and independently associated with adverse outcomes. Sepsis-associated stage 1 AKI on CKD may represent distinct underlying pathophysiology, with more prerenal cases and less severe de novo intrinsic damage, which needs further investigation

Blood and feather concentrations of toxic elements in a Baltic and an Arctic seabird population

We report blood and feather concentrations of elements in the Baltic Sea and Arctic population of common eiders (Somateria mollissima). The endangered Baltic Sea population of eiders was demonstrably affected by element pollution in the 1990s. While blood concentrations of Hg were higher in Baltic breeding eiders, blood Se, As and Cd concentrations were higher in Arctic eiders. Blood concentrations of Pb, Cr, Zn and Cu did not differ between the two populations. While blood Pb concentrations had declined in Baltic eiders since the 1990s, Hg concentrations had not declined, and were above concentrations associated with adverse oxidative effects in other bird species. Inconsistent with blood concentrations, feather concentrations suggested that Pb, Zn, and Cd exposure was higher in Baltic eiders, and that Hg exposure was higher in Arctic eiders. Our study thus emphasizes the need for comprehensive evaluation of toxic element status, covering the annual cycle of a species. (C) 2016 Elsevier Ltd. All rights reserved.Peer reviewe

Fully-Renormalized QRPA fulfills Ikeda sum rule exactly

The renormalized quasiparticle-RPA is reformulated for even-even nuclei using restrictions imposed by the commutativity of the phonon creation operator with the total particle number operator. This new version, Fully-Renormalized QRPA (FR-QRPA), is free from the spurious low-energy solutions. Analytical proof is given that the Ikeda sum rule is fullfiled within the FR-QRPA.Comment: 9 page

Shell Model Study of the Double Beta Decays of 76^{76}Ge, 82^{82}Se and 136^{136}Xe

The lifetimes for the double beta decays of $^{76}$Ge, $^{82}$Se and $^{136}$Xe are calculated using very large shell model spaces. The two neutrino matrix elements obtained are in good agreement with the present experimental data. For $<1$ eV we predict the following upper bounds to the half-lives for the neutrinoless mode: $T^{(0\nu)}_{1/2}(Ge) > 1.85\,10^{25} yr.$, $T^{(0\nu)}_{1/2}(Se) > 2.36\,10^{24} yr.$ and $T^{(0\nu)}_{1/2}(Xe) > 1.21\,10^{25} yr$. These results are the first from a new generation of Shell Model calculations reaching O(10$^{8}$) dimensions

Marginalization of end-use technologies in energy innovation for climate protection

Mitigating climate change requires directed innovation efforts to develop and deploy energy technologies. Innovation activities are directed towards the outcome of climate protection by public institutions, policies and resources that in turn shape market behaviour. We analyse diverse indicators of activity throughout the innovation system to assess these efforts. We find efficient end-use technologies contribute large potential emission reductions and provide higher social returns on investment than energy-supply technologies. Yet public institutions, policies and financial resources pervasively privilege energy-supply technologies. Directed innovation efforts are strikingly misaligned with the needs of an emissions-constrained world. Significantly greater effort is needed to develop the full potential of efficient end-use technologies