Leaf-wise intersections and Rabinowitz Floer homology

In this article we explain how critical points of a particular perturbation of the Rabinowitz action functional give rise to leaf-wise intersection points in hypersurfaces of restricted contact type. This is used to derive existence and multiplicity results for leaf-wise intersection points in hypersurfaces of restricted contact type in general exact symplectic manifolds. The notion of leaf-wise intersection points was introduced by Moser.Comment: 18 pages, 1 figure; v3: completely rewritten, improved result

Transfluthrin eave-positioned targeted insecticide (EPTI) reduces human landing rate (HLR) of pyrethroid resistant and susceptible malaria vectors in a semi-field simulated peridomestic space

BACKGROUND: Volatile pyrethroids (VPs) are proven to reduce human-vector contact for mosquito vectors. With increasing resistance to pyrethroids in mosquitoes, the efficacy of VPs, such as transfluthrin, may be compromised. Therefore, experiments were conducted to determine if the efficacy of transfluthrin eave-positioned targeted insecticide (EPTI) depends on the resistance status of malaria vectors. METHODS: Ribbons treated with 5.25 g transfluthrin or untreated controls were used around the eaves of an experimental hut as EPTI inside a semi-field system. Mosquito strains with different levels of pyrethroid resistance were released simultaneously, recaptured by means of human landing catches (HLCs) and monitored for 24-h mortality. Technical-grade (TG) transfluthrin was used, followed by emulsifiable concentrate (EC) transfluthrin and additional mosquito strains. Generalized linear mixed models with binomial distribution were used to determine the impact of transfluthrin and mosquito strain on mosquito landing rates and 24-h mortality. RESULTS: EPTI treated with 5.25 g of either TG or EC transfluthrin significantly reduced HLR of all susceptible and resistant Anopheles mosquitoes (Odds Ratio (OR) ranging from 0.14 (95% Confidence Interval (CI) [0.11-0.17], P < 0.001) to 0.57, (CI [0.42-0.78] P < 0.001). Both TG and EC EPTI had less impact on landing for the resistant Anopheles arabiensis (Mbita strain) compared to the susceptible Anopheles gambiae (Ifakara strain) (OR 1.50 [95% CI 1.18-1.91] P < 0.001) and (OR 1.67 [95% CI 1.29-2.17] P < 0.001), respectively. The EC EPTI also had less impact on the resistant An. arabiensis (Kingani strain) (OR 2.29 [95% CI 1.78-2.94] P < 0.001) compared to the control however the TG EPTI was equally effective against the resistant Kingani strain and susceptible Ifakara strain (OR 1.03 [95% CI 0.82-1.32] P = 0.75). Finally the EC EPTI was equally effective against the susceptible An. gambiae (Kisumu strain) and the resistant An. gambiae (Kisumu-kdr strain) (OR 0.98 [95% CI 0.74-1.30] P = 0.90). CONCLUSIONS: Transfluthrin-treated EPTI could be useful in areas with pyrethroid-resistant mosquitoes, but it remains unclear whether stronger resistance to pyrethroids will undermine the efficacy of transfluthrin. At this dosage, transfluthrin EPTI cannot be used to kill exposed mosquitoes

Psychopathologie des Ganser-Syndroms: Literaturübersicht und Falldiskussion

Zusammenfassung: Das Kernsymptom des Ganser-Syndroms besteht im "Vorbeiantworten" auf einfache Fragen. Die Ursache dieses seltenen Syndroms ist unklar. Aktuelle Klassifikationssysteme zählen es zu den dissoziativen Störungen, wobei eine psychogene Ursache der Symptome angenommen wird. Anhand einer Literaturrecherche (n=151) wird jedoch gezeigt, dass das Ganser-Syndrom sehr häufig mit Hirnverletzungen assoziiert ist, wobei detaillierte bildgebende, neuropsychologische und neurologische Untersuchungen weitgehend fehlen. Wir stellen eine rechtshändige Patientin mit einem Ganser-Syndrom nach einem großen linkshemisphärischen Mediainfarkt vor. Die detaillierte neuropsychologische Untersuchung zeigte eine untypische Lateralisierung kognitiver Funktionen mit einer sog. gekreuzten Nichtaphasie und ausgeprägten frontal-exekutiven Funktionsstörungen. Unter Berücksichtigung sowohl der psychiatrischen als auch der neuropsychologischen Aspekte wird diskutiert, in welchem Zusammenhang das psychopathologische Symptom des "Vorbeiantwortens" mit spezifischen frontal-exekutiven Hirnfunktionsstörungen stehen könnt

The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

Background Lumbar spinal stenosis (LSS) affects mainly elderly patients. To this day, it is unclear whether comorbidities influence treatment success. The aim of this systematic review and meta-analysis was to assess the impact of comorbidities on the treatment effectiveness in symptomatic LSS. Methods We conducted a systematic review and meta-analysis and reviewed prospective or retrospective studies from Medline, Embase, Cochrane Library and CINAHL from inception to May 2020, including adult patients with LSS undergoing surgical or conservative treatment. Main outcomes were satisfaction, functional and symptoms improvement, and adverse events (AE). Proportions of outcomes within two subgroups of a comorbidity were compared with risk ratio (RR) as summary measure. Availability of ≥3 studies for the same subgroup and outcome was required for meta-analysis. Results Of 72 publications, 51 studies, mostly assessing surgery, there was no evidence reported that patients with comorbidities were less satisfied compared to patients without comorbidities (RR 1.06, 95% confidence interval (CI) 0.77 to 1.45, 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, 72%). A limited number of studies found no influence of comorbidities on functional and symptoms improvement. Older age did not affect satisfaction, symptoms and functional improvement, and AE (age >80 years RR 1.22, 95% CI 0.98 to 1.52, 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, 58%). Conclusion In patients with LSS and comorbidities (in particular diabetes), a higher risk for AE should be considered in the treatment decision. Older age alone was not associated with an increased risk for AE, less functional and symptoms improvement, and less treatment satisfaction

Quelques plats pour la m\'etrique de Hofer

We show, by an elementary and explicit construction, that the group of Hamiltonian diffeomorphisms of certain symplectic manifolds, endowed with Hofer's metric, contains subgroups quasi-isometric to Euclidean spaces of arbitrary dimension.Comment: 9 pages, minor change

A Poincar\'e-Birkhoff theorem for tight Reeb flows on S3S^3

We consider Reeb flows on the tight $3$-sphere admitting a pair of closed orbits forming a Hopf link. If the rotation numbers associated to the transverse linearized dynamics at these orbits fail to satisfy a certain resonance condition then there exist infinitely many periodic trajectories distinguished by their linking numbers with the components of the link. This result admits a natural comparison to the Poincar\'e-Birkhoff theorem on area-preserving annulus homeomorphisms. An analogous theorem holds on $SO(3)$ and applies to geodesic flows of Finsler metrics on $S^2$.Comment: 67 pages. To appear in Inventiones Mathematica

A VEGF-A splice variant defective for heparan sulfate and neuropilin-1 binding shows attenuated signaling through VEGFR-2

Abstract.: The development of functional blood and lymphatic vessels requires spatio-temporal coordination of the production and release of growth factors such as vascular endothelial growth factors (VEGFs). VEGF family proteins are produced in multiple isoforms with distinct biological properties and bind to three types of VEGF receptors. A VEGF-A splice variant, VEGF-A165b, has recently been isolated from kidney epithelial cells. This variant is identical to VEGF-A165 except for the last six amino acids encoded by an alternative exon. VEGF-A165b and VEGF-A165 bind VEGF receptors 1 and 2 with similar affinity. VEGF-A165b elicits drastically reduced activity in angiogenesis assays and even counteracts signaling by VEGF-A165. VEGF-A165b weakly binds to heparan sulfate and does not interact with neuropilin-1, a coreceptor for VEGF receptor 2. To determine the molecular basis for altered signaling by VEGF-A165b we measured VEGF receptor 2 and ERK kinase activity in endothelial cells in culture. VEGF-A165 induced strong and sustained activation of VEGF receptor 2 and ERK-1 and −2, while activation by VEGF-A165b was only weak and transient. Taken together these data show that VEGF-A165b has attenuated signaling potential through VEGF receptor 2 defining this new member of the VEGF family as a partial receptor agonis

Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression.

To analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment. Retrospective multicenter study using the Swiss Pediatric Rheumatology registry. Children with rheumatic diseases followed in a Swiss center for pediatric rheumatology and treated with cDMARD and/or bDMARD with a clinical diagnosis of varicella or herpes zoster between January 2004 and December 2013 were included. Twenty-two patients were identified, of whom 20 were treated for juvenile idiopathic arthritis, 1 for a polyglandular autoimmune syndrome type III, and 1 for uveitis. Of these 22 patients, 16 had varicella and 6 had herpes zoster. Median age at VZV disease was 7.6 years (range 2 to 17 years), with 6.3 years (range 2 to 17 years) for those with varicella and 11.6 years (range 5 to 16 years) for those with herpes zoster. The median interval between start of immunosuppression and VZV disease was 14.1 months (range 1 to 63 months). Two patients had received varicella vaccine (1 dose each) prior to start of immunosuppression. Concomitant immunosuppressive therapy was methotrexate (MTX) monotherapy (n = 9) or bDMARD monotherapy (n = 2), or a combination of bDMARD with prednisone, MTX or Leflunomide (n = 11). Four patients experienced VZV related complications: cellulitis in 1 patient treated with MTX, and cellulitis, sepsis and cerebellitis in 3 patients treated with biological agents and MTX combination therapy. Six children were admitted to hospital (range of duration: 4 to 9 days) and 12 were treated with valaciclovir or aciclovir. The clinical course of varicella and herpes zoster in children under immunosuppression is variable, with 4 (18 %) of 22 children showing a complicated course. Thorough assessment of VZV disease and vaccination history and correct VZV vaccination according to national guidelines at diagnosis of a rheumatic autoimmune disease is essential to minimize VZV complications during a later immunosuppressive treatment