A Highly Sensitive and Selective Optical Sensor for the On-Line Detection of Cesium in Water.

In this study, we have undertaken the development of two fluorescent sensors based on calixarene compounds for the purpose of detecting cesium in water. By introducing the sulfonate functional groups, we have considerably improved the water solubility of sensors, enabling complete dissolution of products in aqueous media and direct analysis of polluted water samples. Through rigorous experiments, we have demonstrated that the complexation of Cs+ ions with sensors 1 and 2 in water leads to a remarkable enhancement of fluorescence. This fluorescence enhancement serves as a reliable indication of cesium presence and allows for sensitive detection. To further advance the practical application of our sensors, we have successfully integrated calixarene sensors 1 and 2 into a microfluidic sensor chip. This integration has enabled real-time, on-line measurements and has resulted in the development of a portable detection device capable of detecting cesium ions in water samples at parts per billion (ppb) levels. This device holds great promise for environmental monitoring and assessment, providing a convenient and efficient solution for cesium detection. Our work represents a significant advancement in the field of cesium detection, displaying the efficacy of calixarene-based fluorescent sensors and their integration into microfluidic systems. The enhanced water solubility, fluorescence response, and portability of our detection device offers tremendous potential for applications in environmental monitoring, water quality assessment, and emergency response scenarios where rapid and accurate cesium detection is crucial.

Volvulus of the appendix secondary to appendicular mucocele.

A 44-year-old woman presented with appendicular volvulus secondary to an appendicular mucocele. Appendicular volvulus symptomatology is similar to that of acute appendicitis. Diagnosis is often interoperative. In the event of secondary volvulus, surgical procedure addresses the underlying pathology; in our case, it consisted in appendicectomy and mesoappendix resection.

Oncological impact of anastomotic leakage after laparoscopic mesorectal excision.

BACKGROUND: The effect of anastomotic leakage on oncological outcomes after total mesorectal excision (TME) is controversial. This study aimed to assess the influence of symptomatic and asymptomatic anastomotic leakage on oncological outcomes after laparoscopic TME. METHODS: All patients who underwent restorative laparoscopic TME for rectal adenocarcinoma with curative intent from 2005 to 2014 were identified from an institutional database. Asymptomatic anastomotic leakage was defined by CT performed systematically 4-8 weeks after rectal surgery, with no relevant clinical symptoms or laboratory examination findings during the postoperative course. RESULTS: Of a total of 428 patients, anastomotic leakage was observed in 120 (28·0 per cent) (50 asymptomatic, 70 symptomatic). After a mean follow-up of 40 months, local recurrence was observed in 36 patients (8·4 per cent). Multivariable Cox regression identified three independent risk factors for reduced local recurrence-free survival (LRFS): symptomatic anastomotic leakage (odds ratio (OR) 2·13, 95 per cent c.i. 1·29 to 3·50; P = 0·003), positive resection margin (R1) (OR 2·41, 1·40 to 4·16; P = 0·001) and pT3-4 category (OR 1·77, 1·08 to 2·90; P = 0·022). Patients with no risk factor for reduced LRFS had an estimated 5-year LRFS rate of 87·7(s.d. 3·2) per cent, whereas the rate dropped to 75·3(4·3) per cent with one risk factor, 67(7) per cent with two risk factors, and 14(13) per cent with three risk factors (P < 0·001). Asymptomatic anastomotic leakage was not significantly associated with LRFS in multivariable analysis. CONCLUSION: Symptomatic anastomotic leakage is a risk factor for disease recurrence in patients with rectal adenocarcinoma.

Unexplained polyposis: a challenge for geneticists, pathologists and gastroenterologists.

Two main colorectal polyposis syndromes have been described, familial adenomatous polyposis and MUTYH-associated polyposis syndromes. Some polyposis remains unexplained: 20% of adenomatous polyposis and serrated polyposis. The aim of this study was to evaluate in a cohort of patients with unexplained polyposis whether a genetic defect could be detected. Individuals presenting polyposis with more than 40 adenomas or more than 20 serrated polyps (hyperplastic, sessile serrated and mixed), without causative mutation identified, were included. Complementary explorations on APC or MUTYH were performed: search for APC mosaicism, splicing-affecting mutations, large genomic rearrangement of MUTYH. Four genes of Wnt pathway (AXIN2, PPP2R1B, WIF1, SFRP1) and two genes of transforming growth factor-ß (TGF-ß) pathway (SMAD4, BMPR1A) were screened for germline mutation. Twenty-five patients had an unexplained adenomatous polyposis (familial or sporadic). Five pathogenic mutations were found: four in APC gene (with one case of mosaicism) and one in BMPR1A gene. The exploration of APC mosaicism was better performed from adenoma DNA with high-resolution melting. The screening of the candidate genes did not find any causative mutation. Thirteen individuals had an unexplained serrated polyposis and a frameshift on SMAD4 gene was identified. All mutations were identified in familial cases of polyposis. After new pathological examination, both BMPR1A and SMAD4 cases were found to be associated with a juvenile polyposis while the polyposis was initially described as adenomatous or undetermined. In 17% (6/38) of the patients the causative mutation of the polyposis was identified. Genetic causes were heterogeneous. Sporadic polyposis patients must be considered as potential APC mosaicism. The histological classification of polyposis is strongly important in direct genetic exploration.

Frequent mutation in North African patients with MUTYH-associated polyposis.

MUTYH-associated polyposis (MAP) has been characterized as an autosomal recessive disease predisposing to a variable number of colorectal adenomas with a high risk of cancer. Numerous studies have indicated that two missense mutations (Y179C and G396D) account for about 80% of MUTYH allelic variants in Europeans. Ethnic and geographic differences in the mutation spectrum have been observed. The aim of this study was to report mutations in patients from North Africa, determine the incidence of the c.1227_1228dup mutation in our cohort of MUTYH patients and to evaluate the existence of a founder effect. Within a group of 36 families with MAP, 11 were shown to have a homozygous c.1227_1228dup mutation. These families came from Algeria (n = 5), Tunisia (n = 4), Morocco (n = 1) and Portugal (n = 1). Probands belonging to families of North African origin showed a significantly higher frequency of c.1227_1228dup (78.6% vs 4.5%, p < 0.0001). Haplotype analyses were performed using 10 microsatellite markers surrounding the MUTYH gene spanning a region of 4.4 cM. We identified a common haplotype of at least 1.3 cM in all families suggesting a founder effect for this mutation.

[Evaluation of stress in surgical trainees: prospective study of heart rate during laparoscopic cholecystectomy]. / Stress des chirurgiens en formation: Etude prospective de la cardio-fréquence lors de cholécystectomies laparoscopiques.

INTRODUCTION: Surgical training is stressful, particularly in the operating room setting. The purpose of the study is to evaluate and quantitate intra-operative stress in surgical trainees. MATERIAL: and methods: Cardiac rate was used as a measure of stress during surgical cases; surgical residents serving as the primary surgeon and assistant during 21 laparoscopic cholecystectomies underwent telemetry monitoring. RESULTS: Intra-operative cardiac rate increased by 4-10%, particularly in the resident serving as primary surgeon. The most stressful moments of the procedure were the draping of the surgical field, trocar placement, clip application, and extraction of the gallbladder. CONCLUSION: This study offers a measure of the stress of surgical residents in the operating room. Heart rate is not the ideal parameter of stress, yet it gives a good idea of the level of stress. The identification of stress-inducing factors may help residents to deal with difficult situations.

[How to advise an infertile couple]. / Que faire devant un couple sterile?

PIP: Infertility is a serious problem in many regions of Africa. In parts of Gabon for example sterility rates of 25% are not unknown. In the absence of contraception, 80% of couples will conceive within 1 year and 10% will do so at a later time without treatment. In 40% of cases, infertility is attributable to the male and in 20% both spouses play a role. The most important phase of an initial infertility consultation is getting a complete medical history, including age, duration of infertility, contraceptive usage, history of gynecological infections or pelvic surgery, and menstrual pattern. Whether the sterility is primary or secondary and the circumstances of any previous pregnancies should be determined. Other conditions such as bilharziasis should be ruled out. The husband should be asked about his urologic and general health. The clinical examination of the women should consider her weight in relation to height and any signs of infection or other anomaly that could explain infertility. Conditions possibly responsible for infertility should be treated if possible. If the results are normal, the woman should be instructed to record her basal body temperature. Hormonal treatment can be provided if the temperature curve is abnormal. 2 other common tests, sperm analysis and the postcoital test, require specialized laboratories and are not possible everywhere. If all the tests are normal, the couple should be reassured and instructed to return in several months if pregnancy has not ensued. Among other possible procedures are hysterography in case of a history of abortion or curettage and laparoscopy is there is there is suspicion of hydrosalpinx on hysterography, tubal patency is not confirmed by hysterography, or no cause of sterility is found after 2 years. Analysis of the levels of estradiol, progesterone, and prolactin can be used to assess the functioning of the corpus luteum. Infections cause a large proportion of cases of infertility; the struggle against infertility should thus begin with prevention of sexually transmitted diseases and tuberculosis.^ieng

[Frères des Hommes--actions with grass roots participation aimed at satisfying priority needs: from theory to practice]. / Frères des Hommes - des actions participatives à la base visent à satisfaire les besoins prioritaires: de la théorie à la pratique.

Brothers of All Men (Frères des Hommes) is a group of the two objectives of which are concrete direct action in the Third World, where the underdevelopment situation is most crucial, and an information and sensitization action in Europe. The primary health-care concept is fashionable presently, and this is all well. In the light of Brothers of All Men's practical experience in the field, at the grass roots, and on several continents, the author, however, wants to call attention, among the current enthusiasm, to serious difficulties, and certain failures, encountered in primary health-care projects undertaken with the participation of the concerned communities. He does it in particular on the basis of efforts in Sahelian Africa and Bangladesh. He also recalls that it is not the Third World partner who is supposed to assist in pursuing the goals of a foreign cooperation agency, but the latter which proposes its collaboration to the former. Consquently, projects must be formulated by the local communities and controlled by them. The implementation of primary health-care programmes requires the conjunction of two flux, a real popular dynamics locally, at the periphery, and a clearly defined national political will. It appears that, for the time being, those conditions are more easily found in congress halls than in the field.