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Recent analysis of data sets from two extensive air shower cosmic-ray detectors shows tantalizing evidence of an anisotropic overabundance of cosmic rays toward the Galactic center region that "turns on" around 1018 eV. We demonstrate that the anisotropy could be due to neutrons created in the Galactic center region through charge exchange in proton-proton collisions, where the incident, high-energy protons obey a ~E-2 power law associated with acceleration at a strong shock. We show that the normalization supplied by the gamma-ray signal from EGRET GC source 3EG J1746-2851 (ascribed to p-p-induced neutral pion decay at GeV energies), together with a very reasonable spectral index of 2.2, predicts a neutron flux at ~1018 eV fully consistent with the extremely high energy cosmic-ray data. Likewise, the normalization supplied by the very recent GC data from the HESS air Cerenkov telescope at ~TeV energies is almost equally compatible with the ~1018 eV cosmic-ray data. Interestingly, however, the EGRET and HESS data appear to be themselves incompatible. We find a plausible resolution of this discrepancy in an effective two-source model. Finally, we argue that the shock acceleration is probably occurring in the shell of Sagittarius A East, an unusual supernova remnant located very close to the Galactic center. In support of this contention we note that (1) the extended shell of this object could provide both of the sources suggested by the gamma-ray data and (2) the unusually strong magnetic field at this remnant, together with a perpendicular shock geometry, allow for acceleration of protons up to the extreme energies required to explain the cosmic-ray anisotropy. If the connection between the anisotropy and Sagittarius A East could be firmly established, it would be the first direct evidence for a particular Galactic source of cosmic rays up to energies near 1019 eV.

Background:To date, the relationship between vascular access (VA) failure and plasma total homocysteine level has been investigated only in mixed dialysis populations (ie, patients with a native arteriovenous [AV] fistula or arterial graft), whereas almost no data exist for hemodialysis patients with a native AV fistula. Methods:In this prospective cohort study, we examined the relationship between plasma total homocysteine level and the methylenetetrahydrofolate reductase (MTHFR) gene and VA-related incident morbidity in a cohort of 205 hemodialysis patients, all with a native AV fistula. Results:During follow-up, 78 patients experienced 1 or more VA thrombotic episodes. Patients with incident VA thrombosis had a significantly greater plasma total homocysteine level compared with patients without this event (P= 0.046). In Kaplan-Meier survival analysis, the hazard ratio for VA thrombosis increased in parallel with homocysteine level, such that patients in the third homocysteine level tertile had a relative risk for this outcome 1.72 times (95% CI, 1.21 to 2.24) greater than in those in the first tertile (log-rank test, 6.81; P= 0.009). In a multiple Cox regression model, plasma total homocysteine level was confirmed to be an independent predictor of AV fistula outcome. Plasma total homocysteine level was significantly greater (P< 0.001) in patients with the TT genotype of the MTHFR gene than in those with the CT or CC genotype. Conclusion:VA thrombosis in dialysis patients is associated with hyperhomocysteinemia. Intervention studies are needed to clarify whether decreasing plasma homocysteine concentrations may prevent VA failure in hemodialysis patients.

Motivated by recent observations that show that starless molecular cloud cores exhibit subsonic inward velocities, we revisit the collapse problem for polytropic gaseous spheres. In particular, we provide a generalized treatment of protostellar collapse in the spherical limit and find semianalytic (self-similar) solutions, corresponding numerical solutions, and purely analytic calculations of the mass infall rates (the three approaches are in good agreement). This study focuses on collapse solutions that exhibit nonzero inward velocities at large radii, as observed in molecular cloud cores, and extends previous work in four ways: (1) the initial conditions allow nonzero initial inward velocity, (2) the starting states can exceed the density of hydrostatic equilibrium so that the collapse itself can provide the observed inward motions, (3) we consider different equations of state, especially those that are softer than isothermal, and (4) we consider dynamic equations of state that are different from the effective equation of state that produces the initial density distribution. This work determines the infall rates over a wide range of parameter space, as characterized by four variables: the initial inward velocity v[?], the overdensity L of the initial state, the index G of the static equation of state, and the index g of the dynamic equation of state. For the range of parameter space applicable to observed cores, the resulting infall rate is about a factor of 2 larger than that found in previous theoretical studies (those with hydrostatic initial conditions and v[?] = 0).

Background The self-locating catheter invented by Nicola Di Paolo has been used increasingly in Italy and elsewhere since 1994, with about a thousand patients currently implanted every year. Twelve grams of tungsten inserted into the tip of the conventional Tenckhoff catheter during extrusion does not significantly change its form, but suffices to keep the tip firmly in the Douglas cavity.Objective The aim of the present study was to confirm our preliminary results in a large population of peritoneal dialysis patients.Setting 16 Italian nephrology departments.Results In addition to confirming the validity of the new catheter, the present results show that patients with the new catheter have fewer episodes of peritonitis, tunnel infection, cuff extrusion, catheter malfunction, obstruction, and leakage.Conclusion The present multicenter control study confirms preliminary results and demonstrates that complications of peritoneal dialysis, such as cuff extrusion, infection, peritonitis, early leakage, and obstruction, are statistically less frequent in patients with self-locating catheters than in patients with classic Tenckhoff catheters.

Sgr A East appears to be a single, mixed-morphology 10,000 yr old supernova remnant (SNR) at the Galactic center. It also appears to belong to a class of remnants that have been observed and detected at 1720 MHz, the transition frequency of OH maser emission. However, if the EGRET source 3EG J1746-2852, coincident with the Galactic center, is itself associated with this object, it would endow it with a g-ray luminosity almost 2 orders of magnitude greater than that of the other EGRET-detected SNRs. We here reconsider the viability of a pion-production mechanism as the source of the broadband emission observed from Sgr A East, and show that what connects these objects--and ultimately also accounts for their different g-ray emissivity--is the very important interaction between the expanding SNR shell and the surrounding molecular cloud environment. The singularly high g-ray luminosity of Sgr A East, as well as its unusually steep radio spectral index, can thereby be attributed to the high-density (nH = 103 cm-3), strongly magnetized (B ~ 0.18 mG) environment in which it is located.

Background. It has been suggested that changes in immune response to infectious agents in patients on haemodialysis might be due to impaired monocyte function; uraemic and haemodialysed patients overproduce proinflammatory cytokines, such as interleukin‐1 beta (IL‐1β), tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6).Methods. We quantitated the cytokines released into the plasma and into the supernatants of 24‐h cultured purified monocytes, under basal conditions and after stimulation by lipopolysaccharide from Escherichia coli, in 15 healthy subjects (CON), 20 uraemic patients who had not yet started dialysis (CRF) and 60 haemodialysed patients (HD), who were divided into three groups of 20 patients corresponding to short‐, medium‐ and long‐term dialysis.Results. Monocytes from HD patients spontaneously secreted significantly higher levels of cytokines than those from controls and uraemic patients who had not yet started dialysis. After stimulation with lipopolysaccharide (LPS), cytokine levels in culture supernatants of cells from HD patients were significantly lower than those from controls and uraemic patients. Moreover, levels of cytokines in monocyte supernatants and plasma from short‐, medium‐ and long‐term haemodialysed patients decreased progressively with dialytic age. Monocytes from haemodialysed patients tended to be constitutively active, but their ability to secrete proinflammatory cytokines was inversely correlated with dialytic age.Conclusions. These results indicate that prolonged treatment with dialysis can be considered a form of chronic stress that causes the progressive activation of monocytes, which ultimately leads to monocyte exhaustion and dysfunction.

It has been suggested that changes in immune response to infectious agents in patients on haemodialysis might be due to impaired monocyte function; uraemic and haemodialysed patients overproduce proinflammatory cytokines, such as interleukin-1 beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6).

Cardiac troponin T (cTnT) predicts death and cardiovascular outcomes in clinically stable patients with end-stage renal disease. Because this protein is synthesized exclusively in myocardial cells, its predictive power for these outcomes may be because it reflects, besides cardiac ischemia, left ventricular (LV) mass, which is a strong predictor of cardiovascular death in this population per se. We tested the relationship between cTnT level and LV mass and the predictive power of this cardiac protein for all-cause and cardiovascular mortality in a cohort of hemodialysis patients (n = 199) without acute coronary syndrome and heart failure followed up for an average of 35 months (range, 0.8 to 52 months). cTnT was measured by means of a third-generation electrochemiluminescence immunoassay. cTnT level was related directly to interventricular septum (r= 0.36; P< 0.001) and posterior wall thickness (r= 0.40; P< 0.001), as well as LV mass (r= 0.45; P< 0.001). On multivariate analysis, after age, LV mass was the strongest independent predictor of cTnT level (β = 0.28; P< 0.001). Serum cTnT level was significantly related to all-cause and cardiovascular mortality on univariate analysis (P< 0.001). On multivariate Cox regression analysis, the adjusted risk for all-cause death was 2.39 times (95% confidence interval [CI], 1.13 to 5.06; P= 0.02) greater in patients in the third cTnT tertile than the first tertile, and a similar pattern emerged for cardiovascular mortality (hazard ratio, 2.35; 95% CI, 1.01 to 5.49; P= 0.048). In hemodialysis patients, plasma cTnT level is independently related to LV mass and predicts all-cause and cardiovascular mortality. These data support the hypothesis that this marker can be usefully applied for risk stratification in clinically stable dialysis patients. © 2002 by the National Kidney Foundation, Inc.

The relativistic jets in active galactic nuclei (AGNs) are probably driven by the action of supermassive, spinning black holes. There is very little direct evidence for this, however, since the nuclei of active galaxies are difficult to study. This is now changing with new, high-resolution multiwavelength observations of nearby sources such as Sgr A* at the Galactic center and the nucleus of NGC 6251 (hereafter called NGC 6251*). In this paper, we explore the possibility that the radiative properties of the most compact region in NGC 6251* may be understood in the same sense as Sgr A*, though with some telling differences that may hint at the nature of jet formation. We show that observations of this object with ASCA, ROSAT, HST, and VLBI together may be suggesting a picture in which Bondi-Hoyle accretion from an ambient ionized medium feeds a standard disk accreting at ~ 4.0 x 1022 g s-1. Somewhere near the event horizon, this plasma is heated to more than 1011 K, where it radiates via thermal synchrotron (producing a radio component) and self-Comptonization (accounting for a nonthermal X-ray flux). This temperature is much greater than its virial value and the hot cloud expands at roughly the sound speed (~0.1c), after which it begins to accelerate on a parsec scale to relativistic velocities. In earlier work, the emission from the extended jet has been modeled successfully using nonthermal synchrotron self-Compton processes, with a self-absorbed inner core. In the picture we are developing here, the initial ejection of matter is associated with a self-absorbed thermal radio component that dominates the core emission on the smallest scales. The nonthermal particle distributions responsible for the emission in the extended jet are then presumably energized, e.g., via shock acceleration, within the expanding, hot gas. The power associated with this plasma represents an accretion efficiency of about 0.54, requiring dissipation in a prograde disk around a rapidly spinning black hole (with spin parameter a ~ 1).

To determine levels of natriuretic peptides (NPs) in patients with end-stage renal disease (ESRD) and to examine the relationship of these cardiovascular pep-tides to left ventricular hypertrophy (LVH) and to cardiac mortality.

Maps of the Galactic electron-positron annihilation radiation show evidence for three distinct and significant features: (1) a central bulge source, (2) emission in the Galactic plane, and (3) an enhancement of emission at positive latitudes above the Galactic center. In this paper, we explore the possibility that Sgr A East, a very prominent radio structure surrounding the Galactic nucleus, may be a significant contributor to the central bulge feature. The motivation for doing so stems from a recently proposed link between this radio object and the EGRET ?-ray source 2EG J1746-2852. If this association is correct, then Sgr A East is also expected to be a source of copious positron production. The results presented here show that indeed Sgr A East must have produced a numerically significant population of positrons, but also that most of them have not yet had sufficient time to thermalize and annihilate. As such, Sgr A East by itself does not appear to be the dominant currentsource of annihilation radiation, but it will be when the positrons have cooled sufficiently and they have become thermalized. This raises the interesting possibility that the bulge component may be a result of the relics of earlier explosive events like the one that produced Sgr A East.

EGRET (20 MeV-30 GeV), on board the Compton Gamma Ray Observatory, has observed high-energy emission from about ~40-50 active galactic nuclei. Theoretical models of this emission based on the upscattering of thermal disk photons by cooling, relativistic electrons can successfully account for the EGRET observations, but they predict a considerably greater X-ray flux than that actually observed in a majority of these sources. This inconsistency may be an indication that the particles are energized during the Compton scattering process, since the X-ray emission is produced by the lowest energy electrons, whose density may be relatively small because of the acceleration. Such a situation may arise as a result of resistive field generation in electromagnetic acceleration schemes, which we here explore. A key feature of this model is the assumed existence of a current associated with the azimuthal component Bph of the underlying magnetic field by a slight imbalance in the energy distributions of outwardly moving, relativistic electrons and protons produced at the disk surface via shock acceleration. The generation of an electric field (via magnetic field line reconnection) is thus required to maintain the current in the presence of a resistivity induced by the radiative drag on the relativistic electrons. We show that the resulting spectrum can exhibit a significant deficit of X-rays compared with gamma rays. In addition, because of the unidirectional flow of the current associated with Bph, this model would predict that the electrons are energized relative to the protons in the outflow only on one side of the disk. They should be decelerated on the reverse side. As such, we would anticipate that any given blazar should have a ~50% probability of being gamma-ray-bright, which appears to be consistent with the observed ratio.

In Western countries the phenomenon of “tattooing” is expanding and tattoos are considered a new fashion among young people. In this paper we briefly trace the history of tattooing, the techniques used, the analysis of pigments used, and their possible adverse reactions. We also carried out a review of the international literature on the use of Q-switched laser in tattoo removal and its complications, and we describe our experience in the use of this technique.