Median Nerve Compression by Gouty Tophi: A Case Report

We describe a case of median nerve compression by gouty tophi. This is a rare condition and presented with loss of function with paraesthesia of both hands in addition to multiple tophis. Surgery was chosen for immediate relief, where a debulking of left flexor digitorum superficialis with decompression of carpal tunnel was done and resulted in improvement of symptoms but became complicated due to inadequate physiotherapy

Fredholmness of Toeplitz operators on the Fock space

The Fredholm property of Toeplitz operators on the $p$-Fock spaces $F_\alpha^p$ on $\mathbb{C}^n$ is studied. A general Fredholm criterion for arbitrary operators from the Toeplitz algebra $\mathcal{T}_{p,\alpha}$ on $F_\alpha^p$ in terms of the invertibility of limit operators is derived. This paper is based on previous work, which establishes corresponding results on the unit balls $\mathbb{B}^n$

Algebras of Toeplitz operators on the n-dimensional unit ball

We study $C^*$-algebras generated by Toeplitz operators acting on the standard weighted Bergman space $\mathcal{A}_{\lambda}^2(\mathbb{B}^n)$ over the unit ball $\mathbb{B}^n$ in $\mathbb{C}^n$. The symbols $f_{ac}$ of generating operators are assumed to be of a certain product type, see (\ref{Introduction_form_of_the_symbol}). By choosing $a$ and $c$ in different function algebras $\mathcal{S}_a$ and $\mathcal{S}_c$ over lower dimensional unit balls $\mathbb{B}^{\ell}$ and $\mathbb{B}^{n-\ell}$, respectively, and by assuming the invariance of $a\in \mathcal{S}_a$ under some torus action we obtain $C^*$-algebras $\boldsymbol{\mathcal{T}}_{\lambda}(\mathcal{S}_a, \mathcal{S}_c)$ whose structural properties can be described. In the case of $k$-quasi-radial functions $\mathcal{S}_a$ and bounded uniformly continuous or vanishing oscillation symbols $\mathcal{S}_c$ we describe the structure of elements from the algebra $\boldsymbol{\mathcal{T}}_{\lambda}(\mathcal{S}_a, \mathcal{S}_c)$, derive a list of irreducible representations of $\boldsymbol{\mathcal{T}}_{\lambda}(\mathcal{S}_a, \mathcal{S}_c)$, and prove completeness of this list in some cases. Some of these representations originate from a ``quantization effect'', induced by the representation of $\mathcal{A}_{\lambda}^2(\mathbb{B}^n)$ as the direct sum of Bergman spaces over a lower dimensional unit ball with growing weight parameter. As an application we derive the essential spectrum and index formulas for matrix-valued operators

High Levels of Diversity Uncovered in a Widespread Nominal Taxon: Continental Phylogeography of the Neotropical Tree Frog

Species distributed across vast continental areas and across major biomes provide unique model systems for studies of biotic diversification, yet also constitute daunting financial, logistic and political challenges for data collection across such regions. The tree frog Dendropsophus minutus (Anura: Hylidae) is a nominal species, continentally distributed in South America, that may represent a complex of multiple species, each with a more limited distribution. To understand the spatial pattern of molecular diversity throughout the range of this species complex, we obtained DNA sequence data from two mitochondrial genes, cytochrome oxidase I (COI) and the 16S rhibosomal gene (16S) for 407 samples of D. minutus and closely related species distributed across eleven countries, effectively comprising the entire range of the group. We performed phylogenetic and spatially explicit phylogeographic analyses to assess the genetic structure of lineages and infer ancestral areas. We found 43 statistically supported, deep mitochondrial lineages, several of which may represent currently unrecognized distinct species. One major clade, containing 25 divergent lineages, includes samples from the type locality of D. minutus. We defined that clade as the D. minutus complex. The remaining lineages together with the D. minutus complex constitute the D. minutus species group. Historical analyses support an Amazonian origin for the D. minutus species group with a subsequent dispersal to eastern Brazil where the D. minutus complex originated. According to our dataset, a total of eight mtDNA lineages have ranges >100,000 km2. One of them occupies an area of almost one million km2 encompassing multiple biomes. Our results, at a spatial scale and resolution unprecedented for a Neotropical vertebrate, confirm that widespread amphibian species occur in lowland South America, yet at the same time a large proportion of cryptic diversity still remains to be discovered

Observation of the Low-Frequency Spectrum of the Water Trimer as a Sensitive Test of the Water-Trimer Potential and the Dipole-Moment Surface

© 2020 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA. Intermolecular interactions in bulk water are dominated by pairwise and non-pairwise cooperative interactions. While accurate descriptions of the pairwise interactions are available and can be tested by precise low-frequency spectra of the water dimer up to 550 cm−1, the same does not hold for the three-body interactions. Here, we report the first comprehensive spectrum of the water trimer in the frequency region from 70 to 620 cm−1 using helium-nanodroplet isolation and free-electron lasers. By comparison to accompanying high-level quantum calculations, the experimentally observed intermolecular bands can be assigned. The transition frequencies of the degenerate translation, the degenerate in-plane and the non-degenerate out-of-plane libration, as well as additional bands of the out-of-plane librational mode are reported for the first time. These provide a benchmark for state-of-the-art water potentials and dipole-moment surfaces, especially with respect to three-body interactions

Vaccination with recombinant neuraminidase protects against influenza virus infection in mice

While the efficacy of most influenza virus vaccines is measured by the ability to induce antibodies against the hemagglutinin (HA), antibodies against the viral neuraminidase (NA) are also correlated with less severe disease in humans and animal models. Yet, neither the amount nor the enzymatic activity of NA is standardized in current seasonal vaccines, and the breadth of NA-based protection is unknown. In the present study, different subtypes of recombinant NA were expressed in a baculovirus system and used to vaccinate mice prior to homologous, heterologous, or heterosubtypic virus challenge. Additionally, pre- and post-vaccination human serum samples from vaccinees that received TIV were studied to compare induction of antibodies against the HA and NA. Finally, the amounts of NA in 4 different vaccine formulations from 2013-2014 were quantified using ELISA. Mice immunized with N2 were 100% protected from morbidity and mortality in a homologous challenge and displayed significantly reduced viral lung titers. Heterologous challenge with a drifted strain resulted in morbidity but no mortality. Mice immunized with B/Yamagata/16/88 NA were 100% protected from morbidity and mortality when lethally challenged with a recent Victoria lineage strain. In our human cohorts, the increase in endpoint titers against N1 NA post-vaccination was less robust than that against HA and, as our quantification data suggests, the N1 NA amounts in seasonal vaccine formulations is quite variable. To confirm the broad protective effects of anti-influenza B NA antibodies on a monoclonal level, a panel of mouse monoclonal antibodies was generated against influenza B virus NA; several of these displayed broad reactivity in ELISA to whole virus and recombinant NA and protected against lethal influenza B virus challenge in mice when delivered at a dose of 5 mg/kg prophylactically, or therapeutically, 48 hours post-infection. Analysis of the protective epitopes is currently in progress. The demonstrated protective capacity of anti-NA antibodies suggests that targeting the NA through vaccination may offer increased protection against influenza virus infection

Comparative Evaluation of Combined Navigated Laser Photocoagulation and Intravitreal Ranibizumab in the Treatment of Diabetic Macular Edema

Objective: To evaluate if a standardized combination therapy regimen, utilizing 3 monthly ranibizumab injections followed by navigated laser photocoagulation, reduces the number of total ranibizumab injections required for treatment of diabetic macular edema (DME). Research Design and Methods: A 12-month, prospective comparison of 66 patients with center-involving DME: 34 patients with combination therapy were compared to 32 patients treated with ranibizumab monotherapy. All patients initially received 3 monthly ranibizumab injections (loading phase) and additional injections pro re nata (PRN). Combination therapy patients additionally received navigated laser photocoagulation after the loading phase. Main outcome measures were mean number of injections after the loading phase and change in BCVA from baseline to month 12. Results: Navigated laser combination therapy and ranibizumab monotherapy similarly improved mean BCVA letter score (+8.41 vs. +6.31 letters, p=0.258). In the combination group significantly less injections were required after the 3 injection loading phase (0.88 +/- 1.23 vs. 3.88 +/- 2.32, p<=0.001). By month 12, 84% of patients in the monotherapy group had required additional ranibizumab injections as compared to 35% in the combination group (p<=0.001). Conclusions: Navigated laser combination therapy demonstrated significant visual gains in most patients. Retreatment rate and number of injections were significantly lower compared to ranibizumab monotherapy and compared to the results of conventional laser combination therapy previously reported in pivotal anti-VEGF studies

Burst versus continuous delivery design in digital mental health interventions: Evidence from a randomized clinical trial

Objective Digital mental health interventions delivered via smartphone-based apps effectively treat various conditions; however, optimizing their efficacy while minimizing participant burden remains a key challenge. In this study, we investigated the potential benefits of a burst delivery design (i.e. interventions delivered only in pre-defined time intervals) in comparison to the continuous delivery of interventions. Methods We randomly assigned 93 participants to the continuous delivery (CD) or burst delivery (BD) group. The CD group engaged in ReApp, a mobile app that increases positive cognitive reappraisal with a consistent delivery schedule that provides five prompts per day throughout the 3-week-long study, while the BD group received five daily prompts only in the first and third weeks of the study. Results No significant differences were found between the groups in terms of adherence, mental health outcomes (specifically depressive and anxiety symptoms), level of perceived stress, and perceived helpfulness of intervention. The BD group showed a significantly decreased perceived difficulty of intervention over time. Conclusions The results suggest that the burst delivery may be as suitable for digital mental health interventions as the continuous delivery. The perceived difficulty of the intervention declined more steeply for the BD group, indicating that it improved the feasibility of the positive cognitive reappraisal intervention without hurting its efficacy. This outcome may inform the design of less burdensome interventions with improved outcomes in future research

Positive cognitive reappraisal flexibility is associated with lower levels of perceived stress

This study investigates the role of positive cognitive reappraisal (PCR) flexibility and variability in mental health in response to real-life stressors among college students. We employed ecological momentary assessment and intervention through ReApp, a mobile app designed to train and promote PCR. We analyzed data from the intervention group of a randomized controlled trial with a total of 100 participants who used ReApp for three weeks. Stressors due to health problems, uncomfortable environment (e.g., rainy weather, crowded buses, etc.), and lack of time were reported most frequently. Stressors related to the war in Ukraine, fear of the future, exams, and COVID-19 were reported as the most severe. To reappraise these stressors, the participants used mostly acceptance and problem-solving tactics. A key finding is the role of emotional demand–dependent PCR flexibility in mental health. Specifically, the flexible adaptation of PCR tactics in response to stressor severity was associated with a more substantial decline in perceived stress over the study period among participants reporting low tendency to use PCR at the study's baseline (β = 0.963, p = .016, Cohen's f = 0.26). In contrast, stressor domain–dependent flexibility and contextually independent between-tactic variability had no moderating effect on stress, depression, and anxiety symptoms. This study contributes to the field of emotion regulation flexibility by highlighting the adaptive role of emotional demand–dependent PCR flexibility in mental well-being among young adults navigating real-life stressors and underscores the importance of tailoring interventions based on the emotional demands of stressors