Paramecium, a Model to Study Ciliary Beating and Ciliogenesis: Insights From Cutting-Edge Approaches.

Cilia are ubiquitous and highly conserved extensions that endow the cell with motility and sensory functions. They were present in the first eukaryotes and conserved throughout evolution (Carvalho-Santos et al., 2011). Paramecium has around 4,000 motile cilia on its surface arranged in longitudinal rows, beating in waves to ensure movement and feeding. As with cilia in other model organisms, direction and speed of Paramecium ciliary beating is under bioelectric control of ciliary ion channels. In multiciliated cells of metazoans as well as paramecia, the cilia become physically entrained to beat in metachronal waves. This ciliated organism, Paramecium, is an attractive model for multidisciplinary approaches to dissect the location, structure and function of ciliary ion channels and other proteins involved in ciliary beating. Swimming behavior also can be a read-out of the role of cilia in sensory signal transduction. A cilium emanates from a BB, structurally equivalent to the centriole anchored at the cell surface, and elongates an axoneme composed of microtubule doublets enclosed in a ciliary membrane contiguous with the plasma membrane. The connection between the BB and the axoneme constitutes the transition zone, which serves as a diffusion barrier between the intracellular space and the cilium, defining the ciliary compartment. Human pathologies affecting cilia structure or function, are called ciliopathies, which are caused by gene mutations. For that reason, the molecular mechanisms and structural aspects of cilia assembly and function are actively studied using a variety of model systems, ranging from unicellular organisms to metazoa. In this review, we will highlight the use of Paramecium as a model to decipher ciliary beating mechanisms as well as high resolution insights into BB structure and anchoring. We will show that study of cilia in Paramecium promotes our understanding of cilia formation and function. In addition, we demonstrate that Paramecium could be a useful tool to validate candidate genes for ciliopathies.

[Emergency overcrowding and hospital organization: Causes and solutions]. / La saturation de la structure des urgences et le rôle de l'organisation hospitalière : réflexions sur les causes et les solutions.

Emergency Department (ED) overcrowding is a silent killer. Thus, several studies in different countries have described an increase in mortality, a decrease in the quality of care and prolonged hospital stays associated with ED overcrowding. Causes are multiple: input and in particular lack of access to lab test and imaging for general practitioners, throughput and unnecessary or time-consuming tasks, and output, in particular the availability of hospital beds for unscheduled patients. The main cause of overcrowding is waiting time for available beds in hospital wards, also known as boarding. Solutions to resolve the boarding problem are mostly organisational and require the cooperation of all department and administrative levels through efficient bed management. Elderly and polypathological patients wait longer time in ED. Internal Medicine, is the ideal specialty for these complex patients who require time for observation and evaluation. A strong partnership between the ED and the internal medicine department could help to reduce ED overcrowding by improving care pathways.

[Relevance of eosinopenia as marker of sepsis in the Emergency Department]. / Intérêt de l'éosinopénie dans le diagnostic de sepsis aux urgences.

BACKGROUND: Several studies in internal medicine departments and in intensive care units have shown the interest of eosinopenia in the diagnosis of infected patients. The aim of the present study was to test the value of this marker in the Emergency Department (ED), either alone or associated with other common sepsis markers. METHODS: We report on a retrospective and monocentric study. We reviewed the complete blood count (CBC) of all patients visiting the ED during one-week duration (in February 2014). Every element of the CBC and other inflammation markers (such as CRP) were analyzed. RESULTS: During the week of our study, 725 patients had a CBC (33 exclusions) and 692 patients were included for analysis. The median age was 59 years (IQR: 16-100). One hundred and twenty-five patients (18.1%) had a sepsis. The ROC curve demonstrated a cut off level of 10/mm3 eosinophils for which the specificity for sepsis was 91%. The association of eosinopenia (< 10/mm3) and white blood cells (WBC) or CRP elevation also showed a good specificity in patients with sepsis. CONCLUSION: In the ED, with a "simple" CBC, a profound eosinopenia appears to be very specific for sepsis, alone or in association with other markers of inflammation. Eosinopenia may become a helpful tool in our daily practice in the ED. Further studies are needed to further evaluate this marker.

[Relapse in schizophrenia: an exploratory study of the joint conceptions of patients, parents and caregivers]. / Regards croisés sur les signes précoces de rechute des sujets schizophrènes.

INTRODUCTION: The question of the course of schizophrenia relapses, is of considerable interest in different clinical and social areas such as prognosis, quality of life, therapeutic relationship, psychoeducation, rehabilitation and so on. The more the schizophrenic relapses, the higher the level of handicap. Although there is a widespread agreement that it is essential to detect early signs of relapses in order to prevent them, there still remain theoretical and methodological difficulties in identifying these signs because they are personal, heterogeneous and not always specific to psychosis. That is why the notion of "relapse signature" seems relevant by taking into account differentiated and personal assessment of early signs of relapse. This implies the consideration of the different visions of relapse given by patients, parents and caregivers. OBJECTIVE: We propose a qualitative study of the joint appraisal of patients, patients' parents and medical staff. The aim of this study is to regroup the expertises in order to further our understanding of the early signs of relapse. We assume that patients and parents are able to describe signs that are not considered as pathological symptoms, but refer to a personal manner of initiating the relapse process. This should then help in designing early intervention and provide reinforced therapeutic alliance and more positive responses to psychoeducation programs. METHOD: We have interviewed 30 subjects divided in three groups: 10 schizophrenic patients, 10 caregivers (including physicians, psychologists and nurses) and 10 parents of schizophrenics. The patients met the following criteria: patients with a diagnosis of schizophrenia (DSM IV criteria), under neuroleptic treatment, and stabilized. The mean duration of illness was 15 years. The patients as well as caregivers were recruited in two external hospital structures. All the subjects gave their written consent for this study and its methods. We did not recruit parents who were not living with their schizophrenic child or who did not see or have frequent contact with him or her for this study. We conducted a semistructured interview and analysed the transcripts of the narratives provided by our three groups on the definition of relapse and early signs of relapse. Recorded interviews were processed using the Alceste Method, a computer program of textual analysis that identifies the word patterns most frequently used by the subjects. Alceste creates classes of words using a hierarchical descending classification. The description of each class is presented in the form of a word list (with the value of the word's Chi(2) association in this class). We assessed the awareness of problems using the 8-Q. RESULTS: The three groups described relapses as a distressed, even traumatic experience. This experience is shared by the patients' siblings who sometimes mention violent situations and difficulties at home. The analysis showed that each group uses a compartmentalized universe of speech. This raises the question of the communication and the sharing of information between the different groups. Parents who didn't live the relapse of their children and the caregivers gave prepsychotic or psychotic symptoms of relapse. Conversely, parents who had lived relapse(s) of their children gave nonspecific and very personalized signs of relapse (e.g., "When she relapses, our daughter eats much more cheese than usually"). The patients with a low level of awareness of his/her problem were able to describe early signs of relapse. They described mood and sleep disturbances. This is an unexpected result and calls for a debate on the need or not to have good insight in order to follow a psychoeducation program. CONCLUSION: This study insists on the complementarity of different conceptions of all persons involved in schizophrenic relapse in order to identify as accurately as possible the "relapse signature" of patients. According to us, and in order to promote suitable subjective data to increase insight, compliance and therapeutic alliance, psychoeducation programs should rely on these personal criteria rather than propose systematic programs. Then the relapse signature could be the first step to the appropriation of the course of illness and control of psychotic symptoms by schizophrenic patients.

Simplified calibration system for stereoradiography in scoliosis.

Stereoradiography is a well known method to obtain 3D images of the spine and the thorax. The main algorithm used is the DLT, which is a very general one yielding to 11 implicit parameters per view. In order to calibrate the geometrical configuration of the stereoradiographic setup with this algorithm, there is a need of a wide calibrating object, leading to systems hard to use in clinical practice. The aim of this work was to modify the algorithm in order to simplify the calibration object. We used assumptions related to the specific case of stereoradiography, which reduced the problem of calibration to only 6 independent explicit parameters. A geometrical calibration performed plane by plane enabled to design a singular calibration object composed of steel balls along two vertical lines and three horizontal ones. A simulation of real configuration both for the previous method and the current algorithm associated to the singular calibrating object give for thirty 3D points a 2 RMS (95% confidence interval) error of reconstruction of respectively 0.6 and 0.3 mm. This study yielded to the transfer in clinics of two simplified systems of calibration which will be easier to use in clinical practice.

Idiopathic scoliosis in three dimensions: a succession of two-dimensional deformities?

STUDY DESIGN: A geometric analysis of computerized three-dimensional (3-D) reconstructions of the spine of adolescents with idiopathic scoliosis. OBJECTIVES: To analyze and describe the 3-D location of scoliotic curves with respect to the global frontal, sagittal, and transverse planes of each subject. SUMMARY OF BACKGROUND DATA: Clinical two-dimensional (2-D) measurements cannot fully describe the 3-D deformity of a scoliotic spine because they are done in the 2-D frontal or sagittal plane projection of a subject and do not correspond to the actual deformity. METHODS: The spinal deformity from T1 to L5 of 50 adolescents with thoracic idiopathic scoliosis was reconstructed in 3-D using a multiplanar digital radiographic technique allowing the visualization of the vertebral line of the spine in any projection using auto CAD software. The curvature was segmented in three distinct curves for each subject: a high thoracic, a thoracic, and a lumbar. A regional plane passing through the two end-vertebrae and the apical vertebra was defined, and a series of geometric manipulations were performed to realign each regional plane with the global axis system of each subject. RESULTS: A total of 91% of the 147 curves studied were found to be entirely contained within its 2-D regional plane, and all scoliotic curves were found to be oriented in a 3-D location different from the classic frontal, sagittal, and transverse orthogonal planes of each subject. CONCLUSION: In thoracic idiopathic scoliosis the deformity of the spine is 3-D, but the regional deformity of each high thoracic, thoracic, or lumbar curve is almost always 2-D. The orientation in space of each 2-D plane is such that it cannot be seen in its true frontal or sagittal projection using standard frontal or sagittal radiologic views of the subject.