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Background Colonoscopy is a commonly utilized procedure in gastroenterology, but it carries risks of complications, with perforation being the most dreaded. The management of colonic perforation remains a topic of debate, as it can be effectively treated through surgical or non-surgical approaches. Our objective is to detail clinical presentations, diagnostic methods, and potential therapeutic options. Cases For this study, we gathered clinical and radiological data from two cases of colonic perforation following colonoscopy. We examined clinical presentations, diagnostic methods employed, and the different therapeutic approaches used for each case. In both cases, patients exhibited symptoms of colonic perforation following colonoscopy. The first case was managed conservatively, with progressive clinical improvement. The second case showed signs of pneumoperitoneum, but no perforation was found during laparoscopic intervention. Both patients recovered well and experienced no complications during follow-up. Conclusions Our study highlights the importance of understanding the risks associated with colonoscopy, particularly in patients with risk factors. It also underscores the diversity of available treatment approaches for iatrogenic colonic perforation, emphasizing the significance of a multidisciplinary approach in determining the optimal therapeutic strategy.

Drivers occupy a workstation that require safety measures. The objective of this paper was to assess the causes of occupational unfitness of professional drivers. This is a descriptive, retrospective study covering all cases of drivers sent for an evaluation of their fitness to work, carried out in the Department of occupational medicine at Farhat Hached teaching hospital in Sousse, from January 1st, 2008, until December 30th, 2020. 155 drivers were enrolled in this study. Most drivers drove buses (52.3%), 26.5% were diabetic, 29% had ophthalmological pathologies and 36.8% had chronic lower back pain. Seventy-four percent were defined unfit. Subjects over 50-years-old (p=0.034; OR = 2.45; 95% CI [1.05-5.71]), high job seniority (p=0.015; OR= 1.71; 95% CI [-7.60-0.81]), cardiac pathology (p=0.022; OR = 7.7; 95% CI [1.0-59.5]) and right and left single ocular visual acuity ≤ 5/10 (p=0.008; OR = 10.43; 95% CI [1.31-82.91] and p

Pancreatic cancer remains one of the greatest challenges in oncology for which therapeutic intervention is urgently needed. We previously demonstrated that the intra-tumoral gene transfer of somatostatin receptor 2, to combat tumor aggressiveness, or of deoxycytidine kinase and uridylate monophosphate kinase, to sensitize to gemcitabine chemotherapy, has anti-tumoral potential in experimental models of cancer. Here, we describe the development of the CYL-02 non-viral gene therapy product that comprises a DNA-plasmid encoding for the three aforementioned genes, which expression is targeted to tumor cells, and complexed with polyethyleneimine non-viral vector. We performed pre-clinical toxicology, bio-distribution, and therapeutic activity studies of CYL-02 in two rodent models of pancreatic cancer. We found that CYL-02 is safe, does not increase gemcitabine toxicity, is rapidly cleared from blood following intravenous administration, and sequestered in tumors following intra-tumoral injection. CYL-02 drives the expression of therapeutic genes in cancer cells and strongly sensitizes tumor cells to gemcitabine, both in vitro and in vivo, with significant inhibition of tumor cells dissemination. This study was instrumental for the later use of CYL-02 in patients with advanced pancreatic cancer, demonstrating that rigorous and thorough preclinical investigations are informative for the clinical transfer of gene therapies against this disease.

Soil health indicators are a set of measurable and interpretable chemical, physical and biological parameters related to soil functional processes that can be used to assess the state of soil health under different agroecosystems. Multiple indicators are examined in the case of soil health assessment after adoption no-till system such as, total carbon and its fractions, nitrogen, bulk density, aggregate stability and infiltration of water. In this chapter, we use organic carbon (particulate, associated and microbial) and visual structure indicators to assess soil health after a short and long duration of adoption no-till by depth under agro-pedo-climate context in Algeria. Three plots submitted in NT to different transition durations (3, 6 and 9 years) and a control plot submitted in CT were studied. Soil samples were taken at two depths (H1: 0-10 and H2: 10-20 cm). Analytical results showed that indicators in the surface horizon were significantly (p

The broad acceptance of sustainable and renewable energy sources as a means of integrating them into electrical power networks is essential to promote sustainable development. Microgrids using direct currents (DCs) are becoming more and more popular because of their great energy efficiency and straightforward design. In this work, we discuss the control of a PV-based renewable energy system and a battery- and supercapacitor-based energy storage system in a DC microgrid. We describe a hierarchical control approach based on sliding-mode controllers and the Lyapunov stability theory. To balance the load and generation, a fuzzy logic-based energy management system has been created. Using a neural network, maximum power defects for the PV system were determined. The global asymptotic stability of the framework has been verified using Lyapunov stability analysis. In order to simulate the proposed DC microgrid and controllers, MATLAB/SimulinkR (2019a) was utilized. The outcomes show that the system operates effectively with changing production and consumption.

Drowsiness is a main factor for various costly defects, even fatal accidents in areas such as construction, transportation, industry and medicine, due to the lack of monitoring vigilance in the mentioned areas. The implementation of a drowsiness detection system can greatly help to reduce the defects and accident rates by alerting individuals when they enter a drowsy state. This research proposes an electroencephalography (EEG)-based approach for detecting drowsiness. EEG signals are passed through a preprocessing chain composed of artifact removal and segmentation to ensure accurate detection followed by different feature extraction methods to extract the different features related to drowsiness. This work explores the use of various machine learning algorithms such as Support Vector Machine (SVM), the K nearest neighbor (KNN), the Naive Bayes (NB), the Decision Tree (DT), and the Multilayer Perceptron (MLP) to analyze EEG signals sourced from the DROZY database, carefully labeled into two distinct states of alertness (awake and drowsy). Segmentation into 10 s intervals ensures precise detection, while a relevant feature selection layer enhances accuracy and generalizability. The proposed approach achieves high accuracy rates of 99.84% and 96.4% for intra (subject by subject) and inter (cross-subject) modes, respectively. SVM emerges as the most effective model for drowsiness detection in the intra mode, while MLP demonstrates superior accuracy in the inter mode. This research offers a promising avenue for implementing proactive drowsiness detection systems to enhance occupational safety across various industries.

In the dynamic realm of sustainable energy storage technologies, the global research landscape presents myriad scientific and economic challenges. The erratic growth of renewable energies alongside the phasing out of conventional power plants poses a significant hurdle in maintaining a stable balance between energy supply and demand. Consequently, energy storage solutions play a pivotal role in mitigating substantial fluctuations in demand. Metal–air batteries, distinguished by their superior energy density and enhanced safety profile compared to other storage devices, emerge as promising solutions. Leveraging the well-established lead–acid battery technology, this study introduces a novel approach utilising open-cell foam manufactured through the Excess Salt Replication process as an anode for lead–air battery cells. This innovation not only conserves lead but also reduces battery weight. By employing a 25% antimonial lead alloy, open-cell foams with diameters ranging from 2 mm to 5 mm were fabricated for the antimonial lead–air battery. Preliminary findings suggest that the effective electrical conductivity of primary battery cells, measured experimentally, surpasses that of cells composed of the same dense, non-porous antimonial lead alloy. This improvement is primarily attributed to their extensive specific surface area, facilitating oxidation–reduction reactions. A correlation between effective electrical conductivity and cell diameter is established, indicating optimal conductivity achieved with a 5 mm cell diameter. These results underscore the feasibility of implementing such an electrical system.

In this work, we introduce a diurnal rodent, the Mongolian gerbil (Meriones unguiculatus) (MG) as an alternative to study retinal cone system physiology and pathophysiology in mice. The cone system is of particular importance, as it provides high-acuity and color vision and its impairment in retinal disorders is thus especially disabling. Despite their nocturnal lifestyle, mice are currently the most popular animals to study cone-related diseases due to the high availability of genetically modified models. However, the potential for successful translation of any cone-related results is limited due to the substantial differences in retinal organization between mice and humans. Alternatively, there are diurnal rodents such as the MG with a higher retinal proportion of cones and a macula-like specialized region for improved visual resolution, the visual streak. The focus of this work was the evaluation of the MG’s cone system functionality using full-field electroretinography (ERG), together with a morphological assessment of its retinal/visual streak organization via angiography, optical coherence tomography (OCT), and photoreceptor immunohistochemistry. We found that rod system responses in MGs were comparable or slightly inferior to mice, while in contrast, cone system responses were much larger, more sensitive, and also faster than those in the murine counterparts, and in addition, it was possible to record sizeable ON and OFF ERG components. Morphologically, MG cone photoreceptor opsins were evenly distributed throughout the retina, while mice show a dorsoventral M- and S-opsin gradient. Additionally, each cone expressed a single opsin, in contrast to the typical co-expression of opsins in mice. Particular attention was given to the visual streak region, featuring a higher density of cones, elongated cone and rod outer segments (OSs), and an increased thickness of the inner and outer retinal layers in comparison to peripheral regions. In summary, our data render the MG a supreme model to investigate cone system physiology, pathophysiology, and to validate potential therapeutic strategies in that context.

The objective of this study is to investigate, through numerical simulations, the flow and heat transfer characteristics of Al2O3, Cu, TiO2, and SiC water-based nanofluids flowing over micro-cylinder groups arranged in an inline configuration. The simulations were carried out under laminar flow conditions, and the analysis considered seven different low values of the Reynolds number, with a constant volume fraction of 2%. The aim of this investigation was to determine how nanofluids, i.e., suspensions of nanoparticles in water as the base fluid, can affect the pressure drop and heat transfer performance in micro-cylinder groups. To accomplish this, the finite volume method was employed to evaluate the impact of the nanofluids on pressure drop and heat transfer characteristics in the micro-cylinder groups. The study results demonstrate that, for all the nanofluids studied, the pressure drop and friction factor of the micro-cylinder groups increased with increasing Reynolds number. This behavior can be attributed to the interaction between the nanoparticles and the wall, which results in an increase in friction. Furthermore, the Nusselt number was found to increase with increasing Reynolds number. The SiC/Water nanofluid exhibited the highest Nusselt numbers among the four nanofluids tested, indicating that it provides better heat transfer performance than the other nanofluids. These results are consistent with experimental findings, indicating that the numerical simulations were accurate and reliable.

BackgroundThis study aimed to define immunological markers of exposure to L. major parasites and identify correlates of protection against infection.MethodsWe analyzed a cohort of 790 individuals at risk of developing ZCL living in endemic areas with varying L. major infection prevalence. One area had a high infection prevalence indicated by high proportions of leishmanin skin test (LST) positive subjects, while the other areas were recent foci with lower infection prevalence. Blood samples were collected before the transmission season to measure Interferon gamma (IFN-γ), Interleukin 10 (IL-10), and Granzyme B (GrB) levels in response to parasite stimulation in peripheral blood mononuclear cells. A one-year follow-up period involved active detection of new ZCL cases to estimate disease incidence after a transmission season and identify immune correlates of protection.ResultsThe study population showed heterogeneity in parasite contact, evident from specific scars and/or positive LST results, significantly higher in the old focus compared to recent foci. IFN-γ and GrB were markers of parasite exposure and reliable indicators of immunity to L. major. Positive correlations were observed between IFN-γ/IL-10 and GrB/IL-10 ratios and LST results. Unexpectedly, only 29 new ZCL cases (4%) appeared after a transmission season, with 27 cases reported in recent foci and 2 in the oldest focus. Our findings indicate that individuals in L. major endemic areas are likely to develop ZCL regardless of their LST status. We showed that high pre-transmission season levels of IFN-γ and GrB produced by PBMC, along with a high IFN-γ/IL-10 ratio, were associated with protection.ConclusionThis study on a large cohort at risk of ZCL confirmed IFN-γ and GrB as protective factors against the disease. A high IFN-γ/IL-10 ratio, but not GrB/IL-10 ratio was associated with resistance. These results are valuable for developing and evaluating of a vaccine against human leishmaniasis.

Plastic waste is a significant environmental and ecological problem that requires urgent action. Indeed, plastic waste pollutes our oceans, rivers, and lakes, harming aquatic life and marine ecosystems. Plastic debris also poses a threat to terrestrial wildlife, as animals can mistake plastic for food or become entangled in it, leading to injury or death. In addition, plastic production requires fossil fuels, leading to greenhouse gas emissions contributing to climate change. That is why recycling plastic waste is an important step towards reducing the environmental impact of plastic and creating a more sustainable future. The present work is part of this approach, and it aims to investigate the effects of the size of the plastic fibers and their percentages on the performances of Hot Mix Asphalt (HMA) in road pavement. Marshall Tests were carried out on the reference asphalt (without adding plastic) and the asphalt containing plastic waste in order to highlight the effect of these additives on the mechanical performance of asphalt mixtures. It has been found that the addition of PET plastic waste considerably improves the mechanical properties of the HMA. The findings revealed that additives composed of plastic fibres of size ranging between 0.125 and 1.25 mm give the best results in terms of Marshall’s Stability and Flow, by acting as reinforcement to the bitumen-aggregate mixtures. Furthermore, the optimum plastic content was found to be about 3.75% by weight of bitumen. It can be noted that the proposed solution fits very well with sustainable development.

The oxidation of monoterpenes under atmospheric conditions has been the subject of numerous studies. They were motivated by the formation of oxidized organic molecules (OOMs), which, due to their low vapor pressure, contribute to the formation of secondary organic aerosols (SOA). Among the different reaction mechanisms proposed for the formation of these oxidized chemical compounds, it appears that the autoxidation mechanism, involving successive events of O2 addition and H migration, common to both low-temperature-combustion and atmospheric conditions, leads to the formation of highly oxidized products (HOPs). However, cool-flame oxidation (∼500–800 K) of terpenes has not received much attention even if it can contribute to atmospheric pollution through biomass burning and wildfires. Under such conditions, terpenes can be oxidized via autoxidation. In the present work, we performed oxidation experiments with limonene–oxygen–nitrogen and α-pinene–oxygen–nitrogen mixtures in a jet-stirred reactor (JSR) at 590 K, a residence time of 2 s, and atmospheric pressure. Oxidation products were analyzed by liquid chromatography, flow injection, and soft-ionization–high resolution mass spectrometry. H–D exchange and 2,4-dinitrophenyl hydrazine derivatization were used to assess the presence of OOH and C=O groups in oxidation products, respectively. We probed the effects of the type of ionization used in mass spectrometry analyses on the detection of oxidation products. Heated electrospray ionization (HESI) and atmospheric-pressure chemical ionization (APCI) in positive and negative modes were used. We built an experimental database consisting of literature data for atmospheric oxidation and presently obtained combustion data for the oxidation of the two selected terpenes. This work showed a surprisingly similar set of oxidation products' chemical formulas, including oligomers, formed under the two rather different conditions, i.e., cool-flame and simulated atmospheric oxidation. Data analysis (in HESI mode) indicated that a subset of chemical formulas is common to all experiments, independently of experimental conditions. Finally, this study indicates that more than 45 % of the detected chemical formulas in this full dataset can be ascribed to an autoxidation reaction.

Objectives Shared decision-making between rheumatologists and patients has become an overarching principle in current treatment recommendations in rheumatoid arthritis (RA). Therefore, in the present study, we aimed to assess the satisfaction of patients with RA with their treatment and to investigate the associated factors. Material and methods A cross-sectional study was carried out in the Rheumatology Department of Mongi Slim Hospital. We included adults with RA receiving their current disease-modifying anti- rheumatic drugs for at least 12 months. Satisfaction among patients was assessed by the Treatment Satisfaction Questionnaire for Medica-tion (TSQM) and it was defined by a score ≥ 80%. The factors indirectly influencing patient satisfac-tion that were assessed were: satisfaction with medical care management, disease activity, function-al impact, professional impact, and the impact of RA. Multivariable regression analysis was applied to determine the predictors of satisfaction. Results We included 70 patients (63 female/7 male) with a mean age of 57.8 ±10.6 years. The mean disease duration was 13.71 ±7.2 years. Mean TSQM scores were 65.42 ±14.77 for convenience, 68.71 ±18 for effectiveness, 70.60 ±24.5 for side effects, and 67.95 ±17.10 for global satisfaction. Satisfaction rates were: 20% for convenience, 39% for effectiveness, 46% for side effects and 30% for global satisfaction. In multivariable analysis, the predictors of global dissatisfaction were Rheumatoid Arthritis Impact of Disease (RAID) overall score (p = 0.003) and the degree of physical difficulties (p = 0.001). Satisfac-tion with the physician was correlated with better global satisfaction (p = 0.029). Difficulties in adapt-ing to RA (p = 0.043) and current treatment with biologics (p = 0.027) were predictors of dissatisfaction with convenience. Predictors of dissatisfaction with efficiency were the RAID over-all score (p = 0.032) and the difficulties of adapting to RA (p = 0.013). The predictors of satisfaction with side effects were a lower degree of interference with domestic work (p = 0.02) and better in-volvement of the patient in the treatment decision (p = 0.014). Conclusions The satisfaction with the attending physician, the participation in the treatment decision, and the impact of RA seem to influence treatment satisfaction the most. These data suggest that a better understanding of patients’ medical needs and preferences would improve satisfaction outcomes.

Background: Patients with borderline pancreatic cancer have a poor prognosis despite the recent development of multidisciplinary treatments that include chemotherapy. Nowadays induction chemotherapy is developing into a powerful cure to convert borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancers (LAPC) into a resectable cancer. This report supplements published data on the management border line pancreatic cancer and emphasizes the possibility of complete pathological response after chemotherapy in such cases. Case presentation: A 60-year-old man, with a type 2 Diabetes Mellitus, was diagnosed with a 3-centimeter T2N1M0 borderline pancreatic head tumor. Ultrasound endoscopy found a close contact with the superior mesenteric vein (< 180°) and an endoscopically guided biopsy confirmed the diagnosis of ductal adenocarcinoma. The patient underwent systemic chemotherapy with six injections of FOLFIRINOX without radiotherapy. The radiological re-staging revealed a cancer down-sizing of 2cm and tumor became resectable. The patient underwent a Whipple procedure with uneventful follow-up. The pathological examination of the specimen concluded to pathological complete response. The twelve lymph nodes evaluated were negative. Following surgery, adjuvant chemotherapy FOLFIRINOX was given. After three years of follow-up, there is no evidence of recurrence.

Perforation of the intestine caused by an ingested foreign object remains a complex challenge in terms of clinical presentation, diagnosis, and treatment. A 55-year-old man presented with complaints of right-sided abdominal pain and functional impairment of the lower limbs. Physical examination revealed an afebrile status and tenderness in the right upper quadrant of the abdomen. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a duodenal perforation caused by a densely linear foreign body. Additionally, a collection in the psoas muscle and contiguous spondylodiscitis were identified. To address this condition, an endoscopic procedure was performed to extract the toothpick successfully, and a CT-guided fine-needle aspiration was conducted to collect the fluid. Spondylodiscitis was managed with antibiotic therapy and immobilization. Remarkably, significant clinical and radiological improvement was observed within a span of three weeks. This case emphasizes the importance of multidisciplinary care involving interventional treatments as a viable and safe alternative to surgical intervention.

Background: Crohn's Disease is a chronic, idiopathic, and transmural inflammatory condition that mainly affects the distal ileum. It is characterized by intricate pathophysiology and numerous complications, some of which can be fatal. In this report, we present a case study of acute generalized peritonitis resulting from the perforation of a distal ileal loop, inaugurating the diagnosis of Crohn's disease. Case presentation: A 43-year-old patient presented with a clinical presentation of acute peritonitis. He had a one-year history of intermittent abdominal pain and diarrhea. As the maximum pain was in the right iliac fossa, an acute appendicitis complicated with peritonitis was considered and the patient underwent laparoscopic exploration, without morphologic exploration. Peroperative observation found an inflamed conglomerate of small bowel loops associated with sclerolipomatosis, and purulent peritonitis by perforation of a distal ileal loop, 40 cm from the ileocaecal valve. A peritoneal toilet, ileocaecal resection, and ileo-colostomy were performed. The postoperative course was uneventful. Discussion: Various complications may arise during the evolution of Crohn’s disease. However, fatal complication such as generalized peritonitis leading to the diagnosis is rare. The underlying pathophysiology of free perforation remains unknown. The most common site affected is the terminal ileum. The surgical treatment is based on a limited resection of the affected bowel segment, followed by a temporary stoma. A primary anastomosis can be performed in selected patients. Conclusion: Perforative peritonitis as an initial presentation of Crohn's disease is challenging. Surgery is obviously required for acute peritonitis, with limited resection with or without anastomosis.

Over the past decade, effect-based monitoring (EBM) has been increasingly applied for water quality monitoring. Despite being recommended as a monitoring tool in several guideline documents, the use of EBM remains limited to research projects. This study aimed to review the bioanalytical data published from studies conducted on wastewater, drinking water or reuse and to identify knowledge gaps and priorities for action. The results provide an overview of the biological effects associated with raw and treated waters, the reduction of these effects by treatment and a comparison of the detected response with effect-based trigger values. This review highlights a lack of data for many biological effects and the need to more thoroughly investigate effects such as aryl hydrocarbon receptor agonism, genotoxicity and oxidative stress. The results show that most drinking water schemes effectively eliminate the biological effects associated with environmental micropollutants. However, the oxidative stress response and genotoxicity, likely related to formed disinfection by-products, deserve closer attention since they seem to represent a higher concern in drinking water than any other effect. Overall, existing wastewater treatment schemes are less effective in removing biological effects, and consequently, priority should be given to the improvement of wastewater treatment for the better protection of the environment. HIGHLIGHTS This study performs a wide review of effect-based monitoring in water contexts.; It includes the latest limits (trigger values) for health and environmental risk assessments using effect-based monitoring.; Results are put into context of water treatment performance for both drinking water and wastewater.;