COMMUNITY CO-DESIGNED SCHISTOSOMIASIS CONTROL INTERVENTIONS FOR SCHOOL-AGED CHILDREN IN ZANZIBAR.

Top-down biomedical interventions to control schistosomiasis in sub-Saharan Africa have had limited success, primarily because they fail to engage with the social, political, economic and ecological contexts in which they are delivered. Despite the call to foster community engagement and to adapt interventions to local circumstances, programmes have rarely embraced such an approach. This article outlines a community co-designed process, based upon Human-Centered Design, to demonstrate how this approach works in practice. It is based on initial work undertaken by social science researchers, public health practitioners and community members from the Zanzibar Islands, Tanzania, between November 2011 and December 2013. During the process, 32 community members participated in a qualitative and quantitative data-driven workshop where they interpreted data on local infections from S. haematobium and co-designed interventions with the assistance of a facilitator trained in the social sciences. These interventions included the implementation of novel school-based education and training, the identification of relevant safe play activities and events at local schools, the installation of community-designed urinals for boys and girls and the installation of community-designed laundry-washing platforms to reduce exposure to cercariae-contaminated fresh water. It is suggested that the a community co-designed process, drawing from Human-Centered Design principles and techniques, enables the development of more sustainable and effective interventions for the control of schistosomiasis.

Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas (Observatoire dédié au Cancer Bretagne / Pays de la Loire).

BACKGROUND: In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer. METHODS/RESULTS: A study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks. CONCLUSION: Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.

En 2006, bevacizumab-FOLFIRI représente la thérapie ciblée administrable dès la première ligne chez les patients porteurs d'un cancer colorectal métastatique non opérable. Une série homogène de 111 patients colligés en région Bretagne et Pays de la Loire ayant reçu du bevacizumab- FOLFIRI en première ligne en 2006 révèle les résultats suivants: 51 réponses, 29 stabilités, 21 progressions et 10 toxicités avant évaluation. La médiane de survie globale (OS) est de 25,1 mois et la médiane de survie sans progression (PFS) de 10,2 mois. Dans le cas d'une chirurgie secondaire, l'OS médian triple de 18,8 mois chez les patients non réséqués versus 59,2 mois ceux réséqués. En comparant les sujets âgés de plus et de moins de 70 ans, aucune différence n'a été mise en évidence en termes de bénéfice ou de risque. Bevacizumab-FOLFIRI pourrait être administré en pratique courante chez les personnes âgées sous couvert d'une évaluation gériatrique et d'une approche multidisciplinaire.

An encyclopedia of mouse genes.

The laboratory mouse is the premier model system for studies of mammalian development due to the powerful classical genetic analysis possible (see also the Jackson Laboratory web site, http://www.jax.org/) and the ever-expanding collection of molecular tools. To enhance the utility of the mouse system, we initiated a program to generate a large database of expressed sequence tags (ESTs) that can provide rapid access to genes. Of particular significance was the possibility that cDNA libraries could be prepared from very early stages of development, a situation unrealized in human EST projects. We report here the development of a comprehensive database of ESTs for the mouse. The project, initiated in March 1996, has focused on 5' end sequences from directionally cloned, oligo-dT primed cDNA libraries. As of 23 October 1998, 352,040 sequences had been generated, annotated and deposited in dbEST, where they comprised 93% of the total ESTs available for mouse. EST data are versatile and have been applied to gene identification, comparative sequence analysis, comparative gene mapping and candidate disease gene identification, genome sequence annotation, microarray development and the development of gene-based map resources.

Rectal duplication cyst in adults treated with transanal endoscopic microsurgery.

Rectal duplication cyst is a rare entity that accounts for approximately 4% of all alimentary tract duplications. To the best of our knowledge, the presented cases are the first reports in the English literature of rectal duplication cyst resection by transanal endoscopic microsurgery. We present two patients; both are 41-year-old women with a palpable rectal mass. Workup revealed a submucosal posterior mass that was then resected by transanal endoscopic microsurgery. The pathology report described cystic lesions with squamous and columnar epithelium and segments of smooth muscle. These findings were compatible with rectal duplication cyst. Our limited experience showed good results with minimal morbidity and mortality for resection of rectal duplication cysts of limited size with no evidence of malignancy.

Mitochondrial DNA A3243G mutation involved in familial diabetes, chronic intestinal pseudo-obstruction and recurrent pancreatitis.

AIMS: To report on a family with five members who carry the A3243G mutation in mitochondrial tRNA for leucine 1 (MTTL1) and present with diabetes, chronic intestinal pseudo-obstruction (CIPO) and recurrent pancreatitis, and to screen for this mutation in a cohort of 36 unrelated patients with recurrent pancreatitis. METHODS: The mutation was quantified in several tissue samples from patients. Respiratory chain activity was studied in muscle biopsies and fibroblast cultures. In addition, the thymidine phosphorylase gene (TP) involved in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) and three genes involved in chronic pancreatitis - PRSS1, SPINK1 and CFTR - were sequenced in affected patients. Finally, the MTTL1 gene was examined in 36 unrelated patients who had recurrent pancreatitis, but no mutations in the PRSS1 and SPINK1 genes. RESULTS: Heteroplasmy for the mtDNA A3243G mutation was found in all tissue samples from these patients, but no mutations were found in the genes coding for thymidine phosphorylase, PRSS1, SPINK1 and CFTR. Also, none of the 36 unrelated patients with recurrent pancreatitis were carrying any MTTL1 mutations. CONCLUSION: The mtDNA A3243G mutation associated with the gastrointestinal manifestations observed in the affected family should be regarded as a possible cause of CIPO and unexplained recurrent pancreatitis. However, the mutation is probably only weakly involved in cases of isolated recurrent pancreatitis.

Do elderly patients benefit from laparoscopic colorectal surgery?

BACKGROUND: The steadily increasing age of the population mandates that potential benefits of new techniques and technologies be considered for older patients. AIM: To analyze the short-term outcomes of laparoscopic (LAP) colorectal surgery in elderly compared to younger patients, and to patients who underwent laparotomy (OP). METHODS: A retrospective analysis of patients who underwent elective sigmoid colectomies for diverticular disease or ileo-colic resections for benign disorders; patients with stomas were excluded. There were two groups: age < 65 years (A) and age >or= 65 years (B). Parameters included demographics, body mass index (BMI), length of operation (LO), incision length (LI), length of hospitalization (LOS), morbidity and mortality. RESULTS: 641 patients (M/F - 292/349) were included between July 1991 and June 2006; 407 in group A and 234 in group B. There were significantly more LAP procedures in group A (244/407 - 60%) than in group B (106/234 - 45%) - p = 0.0003. Conversion rates were similar: 61/244 (25%) in group A, and 25/106 (24%) in group B (p = 0.78). There was no difference in LO between the groups in any type of operation. LOS was shorter in patients in group A who underwent OP: 7.1 (3-17) days versus 8.7 (4-22) days in group B (p <0.0001), and LAP: 5.3 (2-19) days versus 6.4 (2-34) days in group B (p = 0.01). In both groups LOS in the LAP group was significantly shorter than in OP group. There were no significant differences in major complications or mortality between the two groups; however, the complication rates in the OP groups were significantly higher than in LAP and CON combined (p = 0.003). CONCLUSIONS: Elderly patients who undergo LAP have a significantly shorter LOS and fewer complications compared to elderly patients who undergo OP. Laparoscopy should be considered in all patients in whom ileo-colic or sigmoid resection is planned regardless of age.

Endoscopic treatment of painful chronic pancreatitis: evaluation of a new flexible multiperforated plastic stent.

OBJECTIVES: Endoscopic stents are a validated treatment for painful chronic calcifying pancreatitis (CCP). Biliary-type stents are the most commonly used, but have certain drawbacks. The aim of this single-center retrospective study was to evaluate the feasibility, and the short- and medium-term efficacy of a new pancreatic stent (Johlin model, Cook) for pain relief. METHODS: Thirteen patients with painful CCP were treated with a Johlin stent. Stent specifications were studied as well as feasibility and efficacy. Success was defined as relief of pain. RESULTS: There was no placement failure with the initial stent, which was 13.4+/-2.1cm in length and 9.8+/-0.6 Fr in diameter. Immediate total pain relief following stenting occurred in 11 patients. The average follow-up time was 11+/-7 months (range 1.5-24 months). Stents were left in place for 4.5+/-3 months (range 0.5-13.5 months). At the end of follow-up, endoscopic treatment was considered effective in 12 patients. Endoscopic retrograde cholangiopancreatographic (ERCP) complications consisted of uncomplicated acute pancreatitis (10%). CONCLUSION: Pancreatic stenting using the Johlin stent (Cook) is feasible, has no particular adverse events and is effective for immediate as well as medium-term pain improvement.

Laparoscopic surgery for inflammatory bowel diseases.

Since the introduction of laparoscopy into colorectal surgery in the early 1990s, almost every procedure was attempted laparoscopically. Performing laparoscopic colectomies in patients with inflammatory bowel diseases (IBD) might prove to be extremely challenging due to the inflammatory features of the diseases and the potential complications they may pose; dealing with inflammatory masses, fistulas and abscesses, short and thick mesentery, friable bowel wall, and the need to operate in all the abdominal quadrants, mobilizing long segments of large and small bowel and controlling multiple large blood vessels is not an easy task. Consequently, many very experienced surgical groups conducted numerous trials in an attempt to determine whether laparoscopy in IBD is indeed beneficial or not. The focus of this review is minimally invasive procedures in patients with ulcerative colitis (UC) and Crohn's disease (CD).

[Image-guided percutaneous gastrostomy]. / Gastrostomie Percutanée Radiologique.

Gastrostomy is mainly used to provide longterm enteral nutrition. Percutaneous techniques are generally preferred to surgery except for specific cases. Image-guided percutaneous gastrostomy, currently used less than the gastroscopy-guided technique, is a simple, reliable and advantageous technique in managing these frequently debilitated patients. The different aspects of the procedure will be described: indications, contraindications, technique, follow-up, main complications and technical variations.

Functional characterization of sensory rhodopsin II from Halobacterium salinarum expressed in Escherichia coli.

Sensory rhodopsin II (SRII) from Halobacterium salinarum is heterologously expressed in Escherichia coli with a yield of 3-4 mg of purified SRII per liter cell culture. UV/Vis absorption spectroscopy display bands characteristic for native SRII. The resonance Raman spectrum provides evidence for a strongly hydrogen-bonded Schiff base like in mammalian rhodopsin but unlike to the homologous pSRII from Natronobacterium pharaonis. Laser flash spectroscopy indicates that SRII in detergent as well as after reconstitution into polar lipids shows its typical photochemical properties with prolonged photocycle kinetics. The first functional heterologous expression of SRII from H. salinarum provides the basis for studies with its cognate transducer HtrII to investigate the molecular processes involved in phototransduction as well as in chemotransduction.

Crystallographic investigation of the dependence of calcium and phosphate ions for notexin.

The crystal structure of the neurotoxic phospholipase A2, notexin, revealed three binding sites for sulphate ions which were suggested to be phosphate binding sites of importance for the activity of the toxin. The present investigation shows that the sulphate ion bound to the major binding site alters the structure of residues 60-75. In the absence of sulphate and phosphate, the structure of this loop has a conformation which partly resembles the non-neurotoxic PLA2s. The affinity of notexin for phosphate is 17 microM, as measured by the increase in fluorescence at 345 nm. Since the concentrations of phosphate and sulphate ions in blood plasma are 3 and 1 mM, respectively, the binding site must be occupied under physiological conditions. This major sulphate/phosphate binding site explains the specific affinity labelling by pyridoxal phosphate. Pyridoxal phosphate binds to this anion binding site which allows the reaction with Lys-88 or Lys-89. The structure of notexin in the presence and absence of Ca2+ shows only small local structural differences.

Primary pulmonary hypertension. Responses to indomethacin, terbutaline, and isoproterenol.

Primary pulmonary hypertension remains a difficult therapeutic problem. Sublingual isoproterenol (Isuprel) has been effective in a few cases but the every-two-hour dosage schedule is inconvenient on a long-term basis. A case of primary pulmonary hypertension is described in which terbutaline sulfate and indomethacin were given a trial. There was no sustained response to terbutaline but there seemed to be a response to indomethacin and isoproterenol.

Sonography, CT, and MR imaging: a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage.

BACKGROUND AND PURPOSE: Sonography, CT, and MR imaging are commonly used to screen for neonatal intracranial ischemia and hemorrhage, yet few studies have attempted to determine which imaging technique is best suited for this purpose. The goals of this study were to compare sonography with CT and MR imaging prospectively for the detection of intracranial ischemia or hemorrhage and to determine the prognostic value(s) of neuroimaging in neonates suspected of having hypoxic-ischemic injury (HII). METHODS: Forty-seven neonates underwent CT (n = 26) or MR imaging (n = 24) or both (n = 3) within the first month of life for suspected HII. Sonography was performed according to research protocol within an average of 14.4 +/- 9.6 hours of CT or MR imaging. A kappa analysis of interobserver agreement was conducted using three independent observers. Infants underwent neurodevelopmental assessment at ages 2 months (n = 47) and 2 years (n = 26). RESULTS: CT and MR imaging had significantly higher interobserver agreement (P < .001) for cortical HII and germinal matrix hemorrhage (GMH) (Grades I and II) compared with sonography. MR imaging and CT revealed 25 instances of HII compared with 13 identified by sonography. MR imaging and CT also revealed 10 instances of intraparenchymal hemorrhage (>1 cm, including Grade IV GMH) compared with sonography, which depicted five. The negative predictive values of neuroimaging, irrespective of technique used, were 53.3% and 58.8% at the 2-month and 2-year follow-up examinations, respectively. CONCLUSION: CT and MR imaging have significantly better interobserver agreement for cortical HII and GMH/intraventricular hemorrhage and can reveal more instances of intraparenchymal hemorrhage compared with sonography. The absence of neuroimaging findings on sonograms, CT scans, or MR images does not rule out later neurologic dysfunction.

Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: implications for intervention development.

This study examined the prevalence of consistent condom use among inner-city women at risk for HIV, measured the distribution of these women across the stages of change for condom use, determined psychosocial factors associated with the stages, and suggested intervention strategies based on the results. The 5-city sample of women aged 15-34 years consisted predominantly of African Americans. Only 18% reported consistent condom use with main partners and 45% with other partners. Logistic regressions compared women in each stage of change with those in higher stages for each partner type. Results indicated that women who practice or intend to practice consistent condom use were more likely to talk with others about condoms, acknowledge the advantages of condoms, have higher self-efficacy for condom use, and indicate that people important to them favored condom use. Intervention approaches are suggested for women in different stages of change for condom use.

PIP: This cross-sectional study examines the prevalence of consistent condom use among inner-city women at risk for HIV and measured the distribution of these women across the stages of change for condom use. It further determined the psychosocial factors that could be used by program planners to design interventions for these women in different stages of change. The study sample was composed of women aged 15-34 years who were mostly African-Americans (79%). In the results, only 18% reported consistent condom use with main partners and 45% with other partners. The results further indicated that women who practice or intend to practice consistent condom use were more likely to talk with others about condoms, acknowledge the advantages of condoms, have higher self-efficacy for condom use, and state that people important to them favored condom use.

[A detailed lipidograph: enzymatic determination of cholesterol, phospholipids and glycerides in plasma lipoprotein after a cellulose acetate electrophoretic procedure (author's transl)]. / Lipidogramme détaillé: évaluation enzymatique du cholestèrol, des phospholipides et des glycerides après électrophorèse du plasma sur acétate de cellulose.

The specific determination of cholesterol and its evaluation in lipoproteins separated by cellulose acetate electrophoresis is described. Using this technique, the authors extended the specific lipid determinations to phospholipids and glycerides. The precision, linearity, accuracy of the methods are satisfactory for fractions greater than 10%. Phospholipids and cholesterol values in alpha lipoproteins are compared with those obtained in the supernatant by concanavalin A precipitation; the differences between the two methods are not significant. We suggest using these three enzymatic determinations to produce a detailed lipidograph. For a selected population, the lipid values in each fraction (expressed in g/l and in mmol/l) were close to those given in the literature. We compared our lipidograph, expressed in SI units, with the Oil Red O stained lipidograph; the difference was not significant.

The Women and Infants Demonstration Project: an integrated approach to AIDS prevention and research.

The Women and Infants Demonstration Project is a multisite, behavioral intervention research effort funded by the Centers for Disease Control. The project is evaluating a theory-based, integrated intervention model to increase the use of condoms for prevention of both sexually transmitted diseases (STDs) and unintended pregnancy among women and their partners at risk of infection with HIV. The importance of utilizing carefully targeted, credible and persistent risk reduction interventions to effect lasting behavior change has become evident over the last ten years of the AIDS epidemic. The theory-based intervention components being evaluated in this intervention study involve one-on-one stage-tailored outreach; the development and distribution of community-tailored HIV prevention materials, called role-model stories; and the development of organizational and peer networking, all within a community mobilization framework. This article describes each of the intervention components being evaluated during this 5-year study. Such an intervention effort represents an important contribution in the design of community-level AIDS prevention intervention efforts which support individual-level behavioral changes by women at risk for HIV and other sexually transmitted infections.

PIP: The Women and Infants Demonstration Project is a multi-site, behavioral intervention research effort currently being funded by the US Centers for Disease Control. The project is evaluating a theory-based, integrated intervention model to increase condom use for the prevention of sexually transmitted diseases (STD) and unintended pregnancy among women and their partners at risk of infection with HIV. The theory-based intervention components being evaluated in the study involve one-on-one stage-tailored outreach; the development and distribution of community-tailored HIV prevention materials, known as role model stories; and the development of organizational and peer networking, all within a community mobilization framework. Each of the intervention components being evaluated is described.

A model of community mobilization for the prevention of HIV in women and infants. Prevention of HIV in Women and Infants Demonstration Projects.

The prevention of HIV in Women and Infants Demonstration Projects use a conceptual model for maximizing broad community participation for HIV prevention called the Community Mobilization Framework. The projects' comprehensive approach attempts to bring about changes on a community level using a model which encourages community-wide participation of persons with various roles and relationships in the community. The Community Mobilization Framework is one way to systematically conceptualize the organization of the community for the purpose of mobilizing the maximum number of community members around a common health initiative. A community becomes mobilized around an issue by endorsing health-enhancing attitudes, behaviors, and projects supporting positive health outcomes. This mobilization is expressed through the promotion, support, and delivery of motivational and informational health messages which convey consistent ideas, themes, and images. There are two fundamental bases of the Community Mobilization Framework. The first is its characterization of the variety of individual, social, and organizational roles and relationships in the community that might be used in a concerted campaign for HIV prevention for women. The second basis of the model is the description of the nature and extent of the involvement, which includes a continuum of involvement, ranging from simple endorsement to building active coalitions around a health initiative. The paper discusses practical methods of applying these principles, with the Women and Infants Demonstration Projects providing concrete examples.

[Rectal micropolyps after total colectomy in familial polyposis. Efficacy of sulindac]. / Micropolypes rectaux après colectomie totale pour polypose familiale. Efficacité du sulindac.

The aim of this study was to assess the effectiveness of sulindac therapy for eradication of micropolyps in 8 patients with familial polyposis coli. All patients had undergone colectomy and ileoproctostomy 4.5 years (range 3 months-20 years) before and had tubulous adenomas micropolyps in the rectum. Initial sulindac therapy 200 mg or 300 mg daily was started in all patients and was continued in 7 patients. In these 7 patients macroscopic and microscopic eradication of micropolyps was obtained within 3.4 months (1-8). After discontinuation of sulindac therapy, recurrence of micropolyps occurred in 4 patients within 3 to 4 months. Three patients had no recurrence with a follow-up of 1 to 19 months. A new eradication of micropolyps was obtained in these 4 patients with a second sulindac cure within 3 to 6 months. These observations confirm the effectiveness of sulindac therapy for eradication of tubulous adenomas micropolyps in familial polyposis, but after discontinuation of therapy, recurrence is frequent. Continuous or intermittent therapy might reduce recurrence.

[Predictive factors of response to chemotherapy in epidermoid cancer of the esophagus. Study apropos of 60 patients and evaluation of a response score]. / Facteurs prédictifs de réponse à la chimiothérapie du cancer épidermoïde de l'oesophage. Etude à propos de 60 patients et élaboration d'un score de réponse.

The aim of this study was to select predictive factors for response to chemotherapy in esophageal squamous cell carcinoma. Sixty patients, aged between 39 and 77 years (mean 61.5) received two initial chemotherapy sessions of 5 FU (1 mg/m2/24 h) and cisplatinum (20 mg/m2/24 h) during four days. Sixteen clinical, endoscopic, biological, and histological factors were collected. The response to chemotherapy was evaluated one month after completion of the second session by means of endoscopic and computed tomographic data. Thirty-two percent (CI: 20-44 percent) of patients had an objective response to chemotherapy (according to WHO criteria). Univariate analysis showed two predictive factors: obstructing pattern of tumor (P less than 0.01) and albuminemia less than 35 g/l (P less than 0.01). A response score was calculated with a stepwise regression model. The score correctly predicted a satisfactory response to chemotherapy with a sensitivity and specificity of 84.2 and 73 percent, respectively. Overall survival of these patients was statistically higher (P less than 0.001) compared with patients without any response. A satisfactory response to chemotherapy in patients with esophageal squamous cell carcinoma can be expected according to certain pretreatment factors.

[Lansoprazole versus ranitidine in the prevention of early recurrences of digestive hemorrhages from gastroduodenal ulcers. Randomized double-blind multicenter study]. / Lansoprazole versus ranitidine dans la prévention des récidives précoces des hémorragies digestives ulcéreuses gastro-duodénales. Etude multicentrique randomisée en double aveugle.

Strong inhibition of acid secretion could be able to decrease gastric and duodenal ulcer early rebleeding. OBJECTIVE--The aim of this double blind randomized trial was to compare early rebleeding rates of 2 groups of patients treated with ranitidine (600 mg/day) or lansoprazole (60 mg/day) per os for 6 consecutive days. METHODS--Seventy five patients with a high risk of rebleeding (clinical and endoscopical criteria) were included in this trial. These ulcers were Ia (n = 10), Ib (n = 20), IIa (n = 13), IIb (n = 32) in Forrest classification. RESULTS--Nineteen out of 75 patients rebled (25.3%): 11 out of 37 (30%) and 8 out of 38 (21%) in the ranitidine and lansoprazole groups respectively. Rates of rebleeding were 10%, 12.5%, 36% and 29% respectively in the ulcers grade Ia (previously treated with endoscopic sclerosis), Ib, IIa and IIb in the Forest classification. CONCLUSION--The rates of rebleeding were not statistically different in the 2 groups of treatment. The high rebleeding rates observed with Forrest IIa and IIb and duodenal ulcers support the need of haemostatic endoscopic therapy associated to antisecretory treatment in such patients.