Viscosimetric squeeze flow of suspensions

The rheology of particle suspensions has been extensively explored in the case of a simple shear flow, but less in other flow configurations which are also important in practice. Here we investigate the behavior of a suspension in a squeeze flow, which we revisit using local pressure measurements to deduce the effective viscosity. The flow is generated by approaching a moving disk to a fixed wall at constant velocity in the low Reynolds number limit. We measure the evolution of the pressure field at the wall and deduce the effective viscosity from the radial pressure drop. After validation of our device using a Newtonian fluid, we measure the effective viscosity of a suspension for different squeezing speeds and volume fractions of particles. We find results in agreement with the Maron-Pierce law, an empirical expression for the viscosity of suspensions that was established for simple shear flows. We prove that this method to determine viscosity remains valid in the limit of large gap width. This makes it possible to study the rheology of suspensions within this limit and therefore suspensions composed of large particles, in contrast to Couette flow cells which require small gaps.

Large genetic analysis of alcohol resistance and tolerance reveals an inverse correlation and suggests 'true' tolerance mutants

Tolerance occurs when, following an initial experience with a substance, more of the substance is required subsequently to induce the same behavioral effects. Tolerance is historically not well-understood, and numerous researchers have turned to model organisms, particularly Drosophila melanogaster, to unravel its mechanisms. Flies have high translational relevance for human alcohol responses, and there is substantial overlap in disease-causing genes between flies and humans, including those associated with Alcohol Use Disorder. Numerous Drosophila tolerance mutants have been described; however, approaches used to identify and characterize these mutants have varied across time and between labs and have mostly disregarded any impact of initial resistance/sensitivity to ethanol on subsequent tolerance development. Here, we have analyzed a large amount of data - our own published and unpublished data and data published by other labs - to uncover an inverse correlation between initial ethanol resistance and tolerance phenotypes. This inverse correlation suggests that initial resistance phenotypes can explain many 'perceived' tolerance phenotypes. Additionally, we show that tolerance should be measured as a relative increase in time to sedation between an initial and second exposure rather than an absolute change in time to sedation. Finally, based on our analysis, we provide a method for using a linear regression equation to assess the residuals of potential tolerance mutants. We show that these residuals provide predictive insight into the likelihood of a mutant being a 'true' tolerance mutant, and we offer a framework for understanding the relationship between initial resistance and tolerance.

Rheology of granular rafts

Rheology of macroscopic particle-laden interfaces, called "granular rafts," has been experimentally studied in the simple shear configuration. The shear-stress relation obtained from a classical rheometer exhibits the same behavior as a Bingham fluid, and the viscosity diverges with the surface fraction according to evolutions similar to 2D suspensions. The velocity field of the particles that constitute the granular raft has been measured in the stationary state. These measurements reveal nonlocal rheology similar to dry granular materials. Close to the walls of the rheometer cell, one can observe regions of large local shear rate while in the middle of the cell a quasistatic zone exists. This flowing region, characteristic of granular matter, is described in the framework of an extended kinetic theory showing the evolution of the velocity profile with the imposed shear stress. Measuring the probability density functions of the instantaneous local shear rate, we provide evidence of a balance between positive and negative instantaneous local shear rate. This behavior is the signature of a quasistatic region inside the granular raft.

Loss of the mitochondrial protein Abcb10 results in altered arginine metabolism in MEL and K562 cells and nutrient stress signaling through ATF4

Abcb10 is a mitochondrial membrane protein involved in hemoglobinization of red cells. Abcb10 topology and ATPase domain localization suggest it exports a substrate, likely biliverdin, out of mitochondria that is necessary for hemoglobinization. In this study we generated Abcb10 deletion cell lines in both mouse murine erythroleukemia (MEL) and human erythroid precursor human myelogenous leukemia (K562) cells to better understand the consequences of Abcb10 loss. Loss of Abcb10 resulted in an inability to hemoglobinize upon differentiation in both K562 and MEL cells with reduced heme and intermediate porphyrins and decreased levels of aminolevulinic acid synthase 2 activity. Metabolomic and transcriptional analyses revealed that Abcb10 loss gave rise to decreased cellular arginine levels, increased transcripts for cationic and neutral amino acid transporters with reduced levels of the citrulline to arginine converting enzymes argininosuccinate synthetase and argininosuccinate lyase. The reduced arginine levels in Abcb10 null cells gave rise to decreased proliferative capacity. Arginine supplementation improved both Abcb10 null proliferation and hemoglobinization upon differentiation. Abcb10 null cells showed increased phosphorylation of Eukaryotic Translation Initiation Factor 2 Subunit Alpha (eIF2A), increased expression of nutrient sensing transcription factor ATF4 and downstream targets DNA damage inducible transcript 3 (Chop), ChaC glutathione specific gamma-glutamylcyclotransferase 1 (Chac1) and arginyl-tRNA synthetase 1 (Rars). These results suggest that when the Abcb10 substrate is trapped in the mitochondria, the nutrient sensing machinery is turned on remodeling transcription to block protein synthesis necessary for proliferation and hemoglobin biosynthesis in erythroid models.

Successive reintrusions in a granular medium

We measure and analyze the drag force experienced by a rigid rod that penetrates vertically into a granular medium and partially withdraws before sinking again. The drag during the successive reintrusions is observed to be significantly smaller than the force experienced in the first run. Two force regimes are evidenced depending on how the reintrusion depth compares with the withdrawal distance Δ. These two regimes are characterized by a force curve of positive and negative curvature and are separated by an inflection point, which is characterized experimentally. We approach the difference between the first intrusion and the following reintrusions by considering a modification in the stress field of the granular material after the partial extraction of the rod. A theoretical model for the stress modification is proposed and allows to rationalize all the experiments realized for different withdrawal distances Δ. This framework introduces a crossover length λ above which the stress modification in the granular medium is maintained and that is shown to depend linearly on Δ. Finally, the model provides a prediction for the location of the inflection points in reasonable agreement with observations.

Added-mass force in dry granular matter

From two-dimensional (2D) numerical simulations of the motion of a circular intruder into a dry granular packing, we provide evidence for a specific force term in the case of unsteady motion in addition to the force corresponding to a steady motion. We show that this additional term is proportional to the acceleration of the intruder relative to the grains as the added-mass force known for simple fluids. This force term corresponds to a variation in the kinetic energy of the surrounding flow and is characterized by a coefficient C_{AM} which is intrinsically linked to the nature of the granular media. An analytical calculation of the added-mass coefficient C_{AM} is developed based on the specific velocity field known for 2D granular flow around a cylinder. The theoretical value is shown to depend on the grain-cylinder size ratio, in good agreement with the measurements from our unsteady simulations.

The mitochondrial metal transporters mitoferrin1 and mitoferrin2 are required for liver regeneration and cell proliferation in mice

Mitochondrial iron import is essential for iron-sulfur cluster formation and heme biosynthesis. Two nuclear-encoded vertebrate mitochondrial high-affinity iron importers, mitoferrin1 (Mfrn1) and Mfrn2, have been identified in mammals. In mice, the gene encoding Mfrn1, solute carrier family 25 member 37 (Slc25a37), is highly expressed in sites of erythropoiesis, and whole-body Slc25a37 deletion leads to lethality. Here, we report that mice with a deletion of Slc25a28 (encoding Mfrn2) are born at expected Mendelian ratios, but show decreased male fertility due to reduced sperm numbers and sperm motility. Mfrn2 ^-/- mice placed on a low-iron diet exhibited reduced mitochondrial manganese, cobalt, and zinc levels, but not reduced iron. Hepatocyte-specific loss of Slc25a37 (encoding Mfrn1) in Mfrn2 ^-/- mice did not affect animal viability, but resulted in a 40% reduction in mitochondrial iron and reduced levels of oxidative phosphorylation proteins. Placing animals on a low-iron diet exaggerated the reduction in mitochondrial iron observed in liver-specific Mfrn1/2-knockout animals. Mfrn1 ^-/-/Mfrn2 ^-/- bone marrow-derived macrophages or skin fibroblasts in vitro were unable to proliferate, and overexpression of Mfrn1-GFP or Mfrn2-GFP prevented this proliferation defect. Loss of both mitoferrins in hepatocytes dramatically reduced regeneration in the adult mouse liver, further supporting the notion that both mitoferrins transport iron and that their absence limits proliferative capacity of mammalian cells. We conclude that Mfrn1 and Mfrn2 contribute to mitochondrial iron homeostasis and are required for high-affinity iron import during active proliferation of mammalian cells.

Nationwide survey on training and device utilization during tracheal intubation in French intensive care units

Background

Intubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20–40% of cases. Recent trials aimed to provide guidance about which medications, devices, and modalities maximize patient safety. Videolaryngoscopes are being offered in an increasing range of options and used in broadening indications (from difficult to unremarkable intubation). The objective of this study was to describe intubation practices and device availability in French ICUs.

Materials and methods

We conducted an online nationwide survey by emailing an anonymous 26-item questionnaire to physicians in French ICUs. A single questionnaire was sent to either the head or the intubation expert at each ICU.

Results

Of 257 ICUs, 180 (70%) returned the completed questionnaire. The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training (lectures and observation at the bedside). Among the participating ICUs, 94.4% had a difficult intubation trolley, 74.5% an intubation protocol, 92.2% a capnography device (used routinely to check tube position in 69.3% of ICUs having the device), 91.6% a laryngeal mask, 97.2% front-of-neck access capabilities, and 76.6% a videolaryngoscope. In case of difficult intubation, 85.6% of ICUs used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180). Use of a videolaryngoscope was reserved for difficult intubation in 84% of ICUs (154/180). Having a videolaryngoscope was significantly associated with having an intubation protocol (P = 0.043) and using capnography (P = 0.02). Airtraq^® was the most often used videolaryngoscope (39.3%), followed by McGrath^®Mac (36.9%) then by Glidescope^® (14.5%).

Conclusion

Nearly half the intubators in French ICUs are not fully proficient with OTI. Access to modern training methods such as simulation is inadequate. Most ICUs own a videolaryngoscope, but reserve it for difficult intubations.

Hysteresis of the drag force of an intruder moving into a granular medium

We numerically investigate the force-displacement relation of a moving intruder initially at rest into a granular medium. Our model granular medium is composed of one layer of coplanar polydisperse spheres subjected to a gravity field. The interactions between the grains are modelled by Hertzian contacts to which a viscous damping is applied. Moving it horizontally and with alternating positive and negative velocity, we recover a hysteresis of the force-displacement curve. Considering that the flow is plastic as the yield strength has been reached, we describe the transient part of the flow around the intruder. We show that the drag stress increases as its distance to an ultimate drag stress [Formula: see text] with a typical deformation [Formula: see text]: the drag stress-strains curve appears to exponentially decay as it saturates to this ultimate drag stress. This protocol of deformation highlights that the deformation of the grains is negligible compared to the deformation of the packing, i.e. related to the irreversible displacements of grains allowing the intruder to pass through. Simultaneously, the lift force is constant on average during the displacement of the intruder. We then give the different scaling laws of the yield strength, this ultimate drag stress, the characteristic deformation of the packing and the lift stress. Finally, we recover the complete hysteresis cycle of the drag force around the intruder.

1159. Influenza Symptoms in Vaccinated Healthcare Workers in an H3N2-Dominant Season

Background

Influenza vaccination of healthcare workers is an important component of keeping patients safe, but must be paired with exclusion of ill healthcare workers (HCW) from work. CDC recommends exclusion from work until afebrile for 24 hours, but not all HCW with influenza develop fever and may still be a risk for spreading. Half of HCW with influenza in an H1N1-dominant season (2013–2014) at our institution were afebrile.

Methods

From 1/31–4/24/18 (H3N2-dominant season), HCW with fever or cough were screened for influenza and respiratory syncytial virus by polymerase chain reaction of flocked nasopharyngeal swabs. Additional HCW were tested by their primary care providers. We collected influenza vaccination status and symptoms and calculated the proportion of influenza-positive HCWs with fever or cough. Infection control practitioners (ICPs) contacted each influenza-positive HCW to identify potential patient or HCW exposures 24 hours prior to symptom onset and offered oseltamivir prophylaxis to exposed patients and HCW.

Results

Of 186 HCW tested by UCM, 49 (26%) tested positive for influenza (35 with influenza A; 14 with influenza B) and 11 (6%) tested positive for RSV. Forty-eight HCW (98%) received influenza vaccination. Fever was reported in only 19 (54%) HCW with influenza A and three (21%) HCW with influenza B. Cough was present in the majority of HCW (34 (97%) with influenza A and 12 (86%) with influenza B). An additional 55 HCW were diagnosed with influenza by their primary care providers. ICPs performed contact investigations for 43 HCW who reported exposure to patients or other HCW between 24 hours before symptom onset through the time of diagnosis. Occupational medicine provided 138 courses of prophylactic oseltamivir to HCW.

Conclusion

Afebrile influenza illness is common; current workforce guidelines are insufficient to prevent exposure in the healthcare setting. Expanding employee influenza screening to include fever OR cough doubled the number influenza positive HCW identified. Despite excellent influenza vaccination rates, vigilance is critical to prevent influenza transmission in the hospital. HCW screening for influenza based on fever OR cough, exclusion from work, and identification of potential exposures can help keep patients and colleagues safe.

Disclosures

All authors: No reported disclosures.

526. An EMR-Based Diagnostic Stewardship Intervention for GI mPCR Aimed at Reducing Inappropriate C. difficile Tests

Background

Diagnostic stewardship is an emerging tool that can be used to prevent overuse of diagnostics. Because GI mPCR (GI multiplex PCR panel) tests can be ordered on formed stool, the test has lower pre-test probability for Clostridium difficile (C. difficile) infection than traditional singleplex PCR. Furthermore, after 48hours of admission, most other targets on the GI mPCR are no longer clinically relevant. Any C. difficile testing on inappropriate specimens may increase the rate of Lab ID events (positive C. difficile tests after 3 days of admission) without improving detection of true infections.

Methods

In January 2018, our 700-bed academic medical center implemented an informatics-based intervention that restricted ordering of the GI mPCR to the first 48 hours of hospitalization. After 48 hours, providers were required to contact microbiology to request an exception (see Figure 1). Singleplex PCR testing for C. difficile was available throughout admission. Orders for the GI mPCR test require the provider to note whether the patient had >3 loose stools in the previous day. Statistical analysis performed with STATA software.

Results

A total of 282 late (after 48 hours of admission) GI mPCR tests were ordered in the 104 days before restriction and 210 late tests were ordered in the 104 days after. Late GI mPCR tests (before and after restriction) resulted in diagnoses other than C. difficile less than 5% of the time (20 of 492 tests). 11.7% (24 of 210) of late GI mPCR tests were ordered for patients who did not have >3 loose stools in the previous day. Prior to restriction, 15% (41 of 282) of Lab ID events from GI mPCR were for patients who had already tested positive for C. difficile earlier in the same admission. Following the intervention, there was a decreased proportion of GI mPCR tests that were positive for C. difficile (from 14.5% to 11.3%, P = 0.26), as well as a significantly decreased rate of Lab ID events detected by GI mPCR, from 7.2/10,000 patient days to 4.0/10,000 patient days (P = 0.01).

Conclusion

Accurate diagnosis of C. difficile infection is important for treatment and prevention efforts, yet these data show that many rapid GI mPCR tests are inappropriately ordered on patients who may not have loose stools and who are unlikely to have an alternate diagnosis. EMR-based restriction on the GI mPCR ordering time reduced Lab ID events of C. difficile infection without missing important alternate diagnoses.

Disclosures

All authors: No reported disclosures.

Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

BACKGROUND

Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure.

METHODS

Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs.

RESULTS

A total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44-67] years. MP was the causative agent for 76 (73%) patients and CP for 28 (27%) patients. Co-infection was documented for 18 patients (viruses for 8 [47%] patients). Median number of involved quadrants on chest X-ray was 2 [1-4], with alveolar opacities (n = 61, 75%), interstitial opacities (n = 32, 40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75 (72%) patients and vasopressors for 41 (39%) patients. ICU length of stay was 16.5 [9.5-30.5] days, and 11 (11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6 (8%) vs. 17 (22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP. MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation.

CONCLUSION

In this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia.

Buckling of a rod penetrating into granular media

We investigate experimentally the possible buckling of a thin rod when penetrating downwards into a granular packing. When its bottom end reaches a specific depth, the rod may start buckling provided that the embrace is not enough to stop that phenomenon. The critical rod depth z_{c} at buckling is observed to scale with the rod length L either as 1/L or 1/L^{2}. These two scalings are shown to arise from the two resistant force terms that come into play during the rod penetration: a pressure force at the bottom of the rod that increases linearly with depth and a frictional force on the rod side that increases quadratically with depth. At the buckling point, the destabilizing force corresponds to the expected value given from conventional Euler's critical load for a rod bottom end considered as fixed in the granular clutch. Finally, we draw a buckling-nonbuckling phase diagram in a parameter space given by the rod aspect ratio and a rod-to-grain stress ratio.

Drag force in a cold or hot granular medium

We measure experimentally and analyze the resisting force exerted by a bidimensional packing of small disks on a larger intruder disk dragged horizontally at constant velocity V_{0}. Depending on the vibration level of the packing that leads to a granular "cold" or "hot" packing, two force regimes are observed. At low vibration level ("cold" granular medium), the drag force F does not depend on V_{0}, whereas for high vibrations ("hot" granular medium), the drag force increases linearly with V_{0}. Both regimes can be understood by the balance of two "granular temperatures" that can be defined in the system: a bulk temperature T_{b} imposed by the external vibration to the overall packing and a local temperature T_{0} induced by the own motion of the intruder disk in its vicinity. All experimental data obtained for different sizes and velocities of the intruder disk are shown to be governed by the temperature ratio T_{0}/T_{b}. A critical velocity V_{0c}, above which the system switches from "hot" to "cold," can be obtained in this frame. Finally, we discuss how these two "viscous" regimes should be followed by an inertial regime where the drag force F should increase as V_{0}^{2} at high enough velocity values, for V_{0} greater than a critical value V_{0i} corresponding to high enough Reynolds or Froude number.

Reductions in the mitochondrial ABC transporter Abcb10 affect the transcriptional profile of heme biosynthesis genes

ATP-binding cassette subfamily B member 10 (Abcb10) is a mitochondrial ATP-binding cassette (ABC) transporter that complexes with mitoferrin1 and ferrochelatase to enhance heme biosynthesis in developing red blood cells. Reductions in Abcb10 levels have been shown to reduce mitoferrin1 protein levels and iron import into mitochondria, resulting in reduced heme biosynthesis. As an ABC transporter, Abcb10 binds and hydrolyzes ATP, but its transported substrate is unknown. Here, we determined that decreases in Abcb10 did not result in protoporphyrin IX accumulation in morphant-treated zebrafish embryos or in differentiated Abcb10-specific shRNA murine Friend erythroleukemia (MEL) cells in which Abcb10 was specifically silenced with shRNA. We also found that the ATPase activity of Abcb10 is necessary for hemoglobinization in MEL cells, suggesting that the substrate transported by Abcb10 is important in mediating increased heme biosynthesis during erythroid development. Inhibition of 5-aminolevulinic acid dehydratase (EC 4.2.1.24) with succinylacetone resulted in both 5-aminolevulinic acid (ALA) accumulation in control and Abcb10-specific shRNA MEL cells, demonstrating that reductions in Abcb10 do not affect ALA export from mitochondria and indicating that Abcb10 does not transport ALA. Abcb10 silencing resulted in an alteration in the heme biosynthesis transcriptional profile due to repression by the transcriptional regulator Bach1, which could be partially rescued by overexpression of Alas2 or Gata1, providing a mechanistic explanation for why Abcb10 shRNA MEL cells exhibit reduced hemoglobinization. In conclusion, our findings rule out that Abcb10 transports ALA and indicate that Abcb10's ATP-hydrolysis activity is critical for hemoglobinization and that the substrate transported by Abcb10 provides a signal that optimizes hemoglobinization.

[A case of mediastinum actinomycosis by Aggregatibacter actinomycetemcomitans]

The actinomycosis is a suppurative infection due to an anaerobic and microaerophillic bacteria called actinomyces. Only few case reports are described for the mediastinal locations of this rare entity. We report a new case of inflammatory pseudotumor in the mediastinum due to Aggregatibacte actinomycetemcomitans revealed by hemoptysis. The mediastinoscopy procedure with biopsy was needed to confirm the definitive bacteriological diagnosis by a positive culture. During the postoperative course, a cutaneous fistula was found which had a favourable evolution after appropriate antibiotherapy. Through this case report, the authors insist upon the importance of considering the diagnosis of mediastinal actinomycosis when facing non-specfic mediastinal mass symptoms and also about the interest of systematic bacterioscopic examination and histopathologic examination on nodes' biopsies to avoid to be lost on pathology of mediastinal tumor or tuberculosis. In practise, we caution the non-expert during biopsies because of this lesion's invasive characteristic especially in the confined space of the mediastinum.

Experimental Evidence of the Gardner Phase in a Granular Glass

Analyzing the dynamics of a vibrated bidimensional packing of bidisperse granular disks below jamming, we provide evidence of a Gardner phase deep into the glass phase. To do so, we perform several compression cycles within a given realization of the same glass and show that the particles select different average vibrational positions at each cycle, while the neighborhood structure remains unchanged. The separation between the cages obtained for different compression cycles plateaus with an increasing packing fraction, while the mean square displacement steadily decreases. This phenomenology is strikingly similar to that reported in recent numerical observations when entering the Gardner phase, for a mean-field model of glass as well as for hard spheres in finite dimension. We also characterize the distribution of the cage order parameters. Here we note several differences from the numerical results, which could be attributed to activated processes and cage heterogeneities.

Clustering and flow around a sphere moving into a grain cloud

A bidimensional simulation of a sphere moving at constant velocity into a cloud of smaller spherical grains far from any boundaries and without gravity is presented with a non-smooth contact dynamics method. A dense granular "cluster" zone builds progressively around the moving sphere until a stationary regime appears with a constant upstream cluster size. The key point is that the upstream cluster size increases with the initial solid fraction [Formula: see text] but the cluster packing fraction takes an about constant value independent of [Formula: see text]. Although the upstream cluster size around the moving sphere diverges when [Formula: see text] approaches a critical value, the drag force exerted by the grains on the sphere does not. The detailed analysis of the local strain rate and local stress fields made in the non-parallel granular flow inside the cluster allows us to extract the local invariants of the two tensors: dilation rate, shear rate, pressure and shear stress. Despite different spatial variations of these invariants, the local friction coefficient μ appears to depend only on the local inertial number I as well as the local solid fraction, which means that a local rheology does exist in the present non-parallel flow. The key point is that the spatial variations of I inside the cluster do not depend on the sphere velocity and explore only a small range around the value one.

Local rheological measurements in the granular flow around an intruder

The rheological properties of granular matter within a two-dimensional flow around a moving disk is investigated experimentally. Using a combination of photoelastic and standard tessellation techniques, the strain and stress tensors are estimated at the grain scale in the time-averaged flow field around a large disk pulled at constant velocity in an assembly of smaller disks. On the one hand, one observes inhomogeneous shear rate and strongly localized shear stress and pressure fields. On the other hand, a significant dilation rate, which has the same magnitude as the shear strain rate, is reported. Significant deviations are observed with local rheology that justify the need of searching for a nonlocal rheology.

A Yeast/Drosophila Screen to Identify New Compounds Overcoming Frataxin Deficiency

Friedreich's ataxia (FA) is a rare neurodegenerative disease which is very debilitating for the patients who progressively lose their autonomy. The lack of efficient therapeutic treatment of the disease strongly argues for urgent need to search for new active compounds that may stop the progression of the disease or prevent the appearance of the symptoms when the genetic defect is diagnosed early enough. In the present study, we used a yeast strain with a deletion of the frataxin homologue gene as a model of FA cells in a primary screen of two chemical libraries, a fraction of the French National Chemical Library (5500 compounds) and the Prestwick collection (880 compounds). We ran a secondary screen on Drosophila melanogaster flies expressing reduced levels of frataxin during larval development. Half of the compounds selected in yeast appeared to be active in flies in this developmental paradigm, and one of the two compounds with highest activities in this assay partially rescued the heart dilatation phenotype resulting from heart specific depletion of frataxin. The unique complementarity of these two frataxin-deficient models, unicellular and multicellular, appears to be very efficient to select new compounds with improved selectivity, bringing significant perspectives towards improvements in FA therapy.

Cardiac troponin-I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center

BACKGROUND

Cardiac involvement is a major cause of mortality in patients with thrombotic thrombocytopenic purpura (TTP). However, diagnosis remains underestimated and delayed, owing to subclinical injuries. Cardiac troponin-I measurement (cTnI) on admission could improve the early diagnosis of cardiac involvement and have prognostic value.

OBJECTIVES

To assess the predictive value of cTnI in patients with TTP for death or refractoriness.

PATIENTS/METHODS

The study involved a prospective cohort of adult TTP patients with acquired severe ADAMTS-13 deficiency (< 10%) and included in the registry of the French Reference Center for Thrombotic Microangiopathies. Centralized cTnI measurements were performed on frozen serum on admission.

RESULTS

Between January 2003 and December 2011, 133 patients with TTP (mean age, 48 ± 17 years) had available cTnI measurements on admission. Thirty-two patients (24%) had clinical and/or electrocardiogram features. Nineteen (14.3%) had cardiac symptoms, mainly congestive heart failure and myocardial infarction. Electrocardiogram changes, mainly repolarization disorders, were present in 13 cases. An increased cTnI level (> 0.1 μg L(-1) ) was present in 78 patients (59%), of whom 46 (59%) had no clinical cardiac involvement. The main outcomes were death (25%) and refractoriness (17%). Age (P = 0.02) and cTnI level (P = 0.002) showed the greatest impact on survival. A cTnI level of > 0.25 μg L(-1) was the only independent factor in predicting death (odds ratio [OR] 2.87; 95% confidence interval [CI] 1.13-7.22; P = 0.024) and/or refractoriness (OR 3.03; 95% CI 1.27-7.3; P = 0.01).

CONCLUSIONS

A CTnI level of > 0.25 μg L(-1) at presentation in patients with TTP appears to be an independent factor associated with a three-fold increase in the risk of death or refractoriness. Therefore, cTnI level should be considered as a prognostic indicator in patients diagnosed with TTP.

Shear modulus and dilatancy softening in granular packings above jamming

We investigate experimentally the mechanical response to shear of a monolayer of bidisperse frictional grains across the jamming transition. We inflate an intruder inside the packing and use photoelasticity and tracking techniques to measure the induced shear strain and stresses at the grain scale. We quantify experimentally the constitutive relations for strain amplitudes as low as 10(-3) and for a range of packing fractions within 2% variation around the jamming transition. At the transition strong nonlinear effects set in: both the shear modulus and the dilatancy shear soften at small strain until a critical strain is reached where effective linearity is recovered. The scaling of the critical strain and the associated critical stresses on the distance to jamming are extracted. We check that the constitutive laws, together with mechanical equilibrium, correctly predict to the observed stress and strain profiles. These profiles exhibit a spatial crossover between an effective linear regime close to the inflater and the truly nonlinear regime away from it. The crossover length diverges at the jamming transition.

Diagnostic contribution from pulmonary biopsies in hematology patients with acute respiratory failure from undetermined etiology

BACKGROUND

In about 20% of patients with malignancies with acute respiratory failure (ARF), no etiology can be determined, whatever the diagnostic strategy used. Lung biopsy could then be a precious diagnostic tool leading to therapeutic adaptations and increasing chances for cure. The aim of this study was to assess the diagnostic contribution of lung biopsy in patients for whom a complete diagnosis strategy failed to identify ARF etiology.

METHODS

All hematology patients admitted for ARF to our ICU between 1995 and 2011, and for whom lung biopsy was performed were included in the study. Lung biopsies were surgical, CT guided, or post-mortem. Histological findings were compared to prebiopsy diagnosis and classified into specific or non-specific diagnosis. Therapeutic impact (or Goldman-class in post-mortem biopsies) was also recorded.

RESULTS

Among the 1440 hematology patients with ARF managed during the study period, 21 (1%) biopsies were performed, including 10 post-mortem biopsies. Histological diagnoses were specific in 10 biopsies, non specific in 8 biopsies and lung parenchyma was normal in three patients. In 8/11 (72.7%) alive patients, lung biopsy had lead to therapeutic modifications, including treatment implementation in 5 patients and treatment withdrawal in 3 patients. One out of 10 (10%) patients had minor complications. For the 10 dead patients, only one Goldman-type 1 error was found.

CONCLUSION

Diagnostic lung biopsy is rarely needed in hematology patients with ARF. But, it has a 73% therapeutic impact and has overall no major complications. Contribution from post-mortem biopsies seems less relevant.

Experimental velocity fields and forces for a cylinder penetrating into a granular medium

We present here a detailed granular flow characterization together with force measurements for the quasi-bidimensional situation of a horizontal cylinder penetrating vertically at a constant velocity in dry granular matter between two parallel glass walls. In the velocity range studied here, the drag force on the cylinder does not depend on the velocity V(0) and is mainly proportional to the cylinder diameter d. While the force on the cylinder increases with its penetration depth, the granular velocity profile around the cylinder is found to be stationary with fluctuations around a mean value leading to the granular temperature profile. Both mean velocity profile and temperature profile exhibit strong localization near the cylinder. The mean flow perturbation induced by the cylinder decreases exponentially away from the cylinder on a characteristic length λ that is mainly governed by the cylinder diameter for a large enough cylinder/grain size ratio d/d(g): λ~d/4+2d(g). The granular temperature exhibits a constant plateau value T(0) in a thin layer close to the cylinder of extension δ(T(0))~λ/2 and decays exponentially far away with a characteristic length λ(T) of a few grain diameters (λ(T)~3d(g)). The granular temperature plateau T(0) that scales as V(0)(2)d(g)/d is created by the flow itself from the balance between the "granular heat" production by the shear rate V(0)/λ over δ(T(0)) close to the cylinder and the granular dissipation far away.

Mitochondrial Atpif1 regulates haem synthesis in developing erythroblasts

Defects in the availability of haem substrates or the catalytic activity of the terminal enzyme in haem biosynthesis, ferrochelatase (Fech), impair haem synthesis and thus cause human congenital anaemias. The interdependent functions of regulators of mitochondrial homeostasis and enzymes responsible for haem synthesis are largely unknown. To investigate this we used zebrafish genetic screens and cloned mitochondrial ATPase inhibitory factor 1 (atpif1) from a zebrafish mutant with profound anaemia, pinotage (pnt (tq209)). Here we describe a direct mechanism establishing that Atpif1 regulates the catalytic efficiency of vertebrate Fech to synthesize haem. The loss of Atpif1 impairs haemoglobin synthesis in zebrafish, mouse and human haematopoietic models as a consequence of diminished Fech activity and elevated mitochondrial pH. To understand the relationship between mitochondrial pH, redox potential, [2Fe-2S] clusters and Fech activity, we used genetic complementation studies of Fech constructs with or without [2Fe-2S] clusters in pnt, as well as pharmacological agents modulating mitochondrial pH and redox potential. The presence of [2Fe-2S] cluster renders vertebrate Fech vulnerable to perturbations in Atpif1-regulated mitochondrial pH and redox potential. Therefore, Atpif1 deficiency reduces the efficiency of vertebrate Fech to synthesize haem, resulting in anaemia. The identification of mitochondrial Atpif1 as a regulator of haem synthesis advances our understanding of the mechanisms regulating mitochondrial haem homeostasis and red blood cell development. An ATPIF1 deficiency may contribute to important human diseases, such as congenital sideroblastic anaemias and mitochondriopathies.

Human mitochondrial ferritin improves respiratory function in yeast mutants deficient in iron-sulfur cluster biogenesis, but is not a functional homologue of yeast frataxin

We overexpressed human mitochondrial ferritin in frataxin-deficient yeast cells (Δyfh1), but also in another mutant affected in [Fe-S] assembly (Δggc1). Ferritin was correctly processed and expressed in the mitochondria of these cells, but the fraction of total mitochondrial iron bound to ferritin was very low, and most of the iron remained in the form of insoluble particles of ferric phosphate in these mitochondria, as evidenced by gel filtration analysis of the mitochondrial matrix (fast protein liquid chromatography [FPLC]) and by Mössbauer spectroscopy. Mutant cells in which ferritin was overexpressed still accumulated iron in the mitochondria and remained deficient in [Fe-S] assembly, suggesting that human mitochondrial ferritin is not a functional homologue of yeast frataxin. However, the respiratory function was improved in these mutants, which correlates with an improvement of cytochrome and heme synthesis. Overexpression of mitochondrial ferritin in [Fe-S] mutants resulted in the appearance of a small pool of high-spin ferrous iron in the mitochondria, which was probably responsible for the improvement of heme synthesis and of the respiratory function in these mutants.

[Surgical lung biopsy: Indications and therapeutic implications]

Surgical biopsy of lung parenchyma can be used to establish a diagnosis in interstitial lung disease both of acute and chronic presentation. The present article summarizes the current indications, the therapeutic implications, the different surgical techniques and postoperative complications of the procedure. Common controversies and problems related to surgical lung biopsy are also presented.

Regulation of ribonucleotide reductase during iron limitation

In this issue of Molecular Cell, Sanvisens et al. (2011) report a new mechanism for regulation of yeast ribonucleotide reductase activity that occurs during iron deprivation.

Dexamethasone in patients with acute lung injury from acute monocytic leukaemia

The use of steroids is not required in myeloid malignancies and remains controversial in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). We sought to evaluate dexamethasone in patients with ALI/ARDS caused by acute monocytic leukaemia (AML FAB-M5) via either leukostasis or leukaemic infiltration. Dexamethasone (10 mg every 6 h until neutropenia) was added to chemotherapy and intensive care unit (ICU) management in 20 consecutive patients between 2005 and 2008, whose data were compared with those from 20 historical controls (1994-2002). ICU mortality was the primary criterion. We also compared respiratory deterioration rates, need for ventilation and nosocomial infections. 17 (85%) patients had hyperleukocytosis, 19 (95%) had leukaemic masses, and all 20 had severe pancytopenia. All patients presented with respiratory symptoms and pulmonary infiltrates prior to AML FAB-M5 diagnosis. Compared with historical controls, dexamethasone-treated patients had a significantly lower ICU mortality rate (20% versus 50%; p = 0.04) and a trend for less respiratory deterioration (50% versus 80%; p = 0.07). There were no significant increases in the rates of infections with dexamethasone. In conclusion, in patients with ALI/ARDS related to AML FAB-M5, adding dexamethasone to conventional chemotherapy seemed effective and safe. These results warrant a controlled trial of dexamethasone versus placebo in AML FAB-M5 patients with noninfectious pulmonary infiltrates.

Dense granular flow around a penetrating object: experiment and hydrodynamic model

We present in this Letter experimental results on the bidimensional flow field around a cylinder penetrating into dense granular matter, together with drag force measurements. A hydrodynamic model based on extended kinetic theory for dense granular flow reproduces well the flow localization close to the cylinder and the corresponding scalings of the drag force, which is found to not depend on velocity, but linearly on the pressure and on the cylinder diameter and weakly on the grain size. Such a regime is found to be valid at a low enough "granular" Reynolds number.

Co-precipitation of phosphate and iron limits mitochondrial phosphate availability in Saccharomyces cerevisiae lacking the yeast frataxin homologue (YFH1)

Saccharomyces cerevisiae cells lacking the yeast frataxin homologue (Δyfh1) accumulate iron in the mitochondria in the form of nanoparticles of ferric phosphate. The phosphate content of Δyfh1 mitochondria was higher than that of wild-type mitochondria, but the proportion of mitochondrial phosphate that was soluble was much lower in Δyfh1 cells. The rates of phosphate and iron uptake in vitro by isolated mitochondria were higher for Δyfh1 than wild-type mitochondria, and a significant proportion of the phosphate and iron rapidly became insoluble in the mitochondrial matrix, suggesting co-precipitation of these species after oxidation of iron by oxygen. Increasing the amount of phosphate in the medium decreased the amount of iron accumulated by Δyfh1 cells and improved their growth in an iron-dependent manner, and this effect was mostly transcriptional. Overexpressing the major mitochondrial phosphate carrier, MIR1, slightly increased the concentration of soluble mitochondrial phosphate and significantly improved various mitochondrial functions (cytochromes, [Fe-S] clusters, and respiration) in Δyfh1 cells. We conclude that in Δyfh1 cells, soluble phosphate is limiting, due to its co-precipitation with iron.

Friedreich ataxia: molecular mechanisms, redox considerations, and therapeutic opportunities

Mitochondrial dysfunction and oxidative damage are at the origin of numerous neurodegenerative diseases like Friedreich ataxia and Alzheimer and Parkinson diseases. Friedreich ataxia (FRDA) is the most common hereditary ataxia, with one individual affected in 50,000. This disease is characterized by progressive degeneration of the central and peripheral nervous systems, cardiomyopathy, and increased incidence of diabetes mellitus. FRDA is caused by a dynamic mutation, a GAA trinucleotide repeat expansion, in the first intron of the FXN gene. Fewer than 5% of the patients are heterozygous and carry point mutations in the other allele. The molecular consequences of the GAA triplet expansion is transcription silencing and reduced expression of the encoded mitochondrial protein, frataxin. The precise cellular role of frataxin is not known; however, it is clear now that several mitochondrial functions are not performed correctly in patient cells. The affected functions include respiration, iron-sulfur cluster assembly, iron homeostasis, and maintenance of the redox status. This review highlights the molecular mechanisms that underlie the disease phenotypes and the different hypothesis about the function of frataxin. In addition, we present an overview of the most recent therapeutic approaches for this severe disease that actually has no efficient treatment.

Evidence that yeast frataxin is not an iron storage protein in vivo

Yeast cells deficient in the yeast frataxin homolog (Yfh1p) accumulate iron in their mitochondria. Whether this iron is toxic, however, remains unclear. We showed that large excesses of iron in the growth medium did not inhibit growth and did not decrease cell viability. Increasing the ratio of mitochondrial iron-to-Yfh1p by decreasing the steady-state level of Yfh1p to less than 100 molecules per cell had very few deleterious effects on cell physiology, even though the mitochondrial iron concentration greatly exceeded the iron-binding capacity of Yfh1p in these conditions. Mössbauer spectroscopy and FPLC analyses of whole mitochondria or of isolated mitochondrial matrices showed that the chemical and biochemical forms of the accumulated iron in mitochondria of mutant yeast strains (Deltayfh1, Deltaggc1 and Deltassq1) displayed a nearly identical distribution. This was also the case for Deltaggc1 cells, in which Yfh1p was overproduced. In these mitochondria, most of the iron was insoluble, and the ratio of soluble-to-insoluble iron did not change when the amount of Yfh1p was increased up to 4500 molecules per cell. Our results do not privilege the hypothesis of Yfh1p being an iron storage protein in vivo.

Overexpression of the yeast frataxin homolog (Yfh1): contrasting effects on iron-sulfur cluster assembly, heme synthesis and resistance to oxidative stress

Friedreich's ataxia is generally associated with defects in [Fe-S] cluster assembly/stability and heme synthesis and strong susceptibility to oxidative stress. We used the yeast (Saccharomyces cerevisiae) model of Friedreich's ataxia to study the physiological consequences of modulating the expression of the frataxin gene (YFH1). We show that the number of frataxin molecules per wild-type cell varies from less than 200 to 1500 according to the iron concentration in the medium. Cells overexpressing YFH1 on a plasmid (2muYFH1; about 3500 molecules Yfh1/cell) took up more iron than wild-type cells and displayed defective [Fe-S] cluster assembly/stability in vivo. By contrast, endogenous mitochondrial iron was more available to ferrochelatase in 2muYFH1 cells than in wild-type cells, resulting in higher levels of heme synthesis in vitro. Frataxin overproduction resulted in a shift from frataxin trimers to frataxin oligomers of higher molecular mass in the mitochondrial matrix. Much fewer carbonylated proteins were present in 2muYFH1 cells, and these cells were more resistant to oxidizing agents than wild-type cells, which probably resulted from the lower production of hydrogen peroxide by the mitochondria of 2muYFH1 cells compared to wild-type cells. To our knowledge, this work is the first description where major frataxin-related phenotypes ([Fe-S] cluster assembly and heme synthesis) can be split in vivo, suggesting that frataxin has independent roles in both processes, and that the optimal conditions for these independent roles are different.

[Old Monteggia lesions in children. Apropos of 14 cases]

Fourteen patients between the ages of 3.5 years and 11 years, with an old Monteggia lesion were managed in the Orthopaedics department between 1968 and 1997. Dislocation of the radial head was not diagnosed at the time of the initial trauma in 9 out of 14 cases and the diagnosis was made an average of 14 months after the trauma (range: 5 weeks to 84 months). Twelve of the 14 patients underwent surgical reduction of chronic dislocation of the radial head, mostly associated with proximal ulnar osteotomy and/or a procedure on the extensor retinaculum. The mean follow-up is 4 years 9 months. There were 66% excellent and good results, 25% of moderate results and 9% of poor results. Due to the difficulty of surgery of neglected lesions, the authors report their experience and emphasize the importance of the initial diagnosis.

The theatre: an effective tool for health promotion

In Africa and in North America, in both rural and urban settings, theatre can be an effective means of health promotion. Projects on women's health, care for patients with mental disorders, and AIDS prevention show the usefulness of this medium for community action programmes.

[The territorial dimension of Quebec's international immigration]

"This paper is devoted to the spatial distribution of Quebec's international immigrants, and to the main territorial stakes related to this type of migration. After analysing international immigration as a flow (distribution of the cohorts of immigrants who entered Quebec during a given period) as well as a stock (distribution of all immigrants surviving in Quebec and their redistribution through internal migration), a critical analysis of the territorial stakes as defined by various agents (active at different levels) is proposed." (SUMMARY IN ENG)