Drop spreading and gelation of thermoresponsive polymers.

Spreading and solidification of liquid droplets are elementary processes of relevance for additive manufacturing. Here we investigate the effect of heat transfer on spreading of a thermoresponsive solution (Pluronic F127) that undergoes a sol-gel transition above a critical temperature Tm. By controlling the concentration of Pluronic F127 we systematically vary Tm, while also imposing a broad range of temperatures of the solid and the liquid. We subsequently monitor the spreading dynamics over several orders of magnitude in time and determine when solidification stops the spreading. It is found that the main parameter is the difference between the substrate temperature and Tm, pointing to a local mechanism for arrest near the contact line. Unexpectedly, the spreading is also found to stop below the gelation temperature, which we attribute to a local enhancement in polymer concentration due to evaporation near the contact line.

A reliable method to assess the water permeability of a dialysis system: the global ultrafiltration coefficient.

Background: Recent randomized controlled trials suggest that sufficiently high convection post-dilutional haemodiafiltration (HC-HDF) improves survival in dialysis patients, consequently this technique is increasingly being adopted. However, when performing HC-HDF, rigorous control systems of the ultrafiltration setting are required. Assessing the global ultrafiltration coefficient of the dialysis system [GKD-UF; defined as ultrafiltration rate (QUF)/transmembrane pressure] or water permeability may be adapted to the present dialysis settings and be of value in clinics. Methods: GKD-UF was determined and its reproducibility, variability and influencing factors were specifically assessed in 15 stable patients routinely treated by high-flux haemodialysis or HC-HDF in a single unit. Results: GKD-UF invariably followed a parabolic function with increasing QUF in dialysis and both pre- and post-dilution HC-HDF (R2 constantly >0.96). The vertex of the parabola, GKD-UF-max and related QUF were very reproducible per patient (coefficient of variation 3.9 ± 0.6 and 3.3 ± 0.3%, respectively) and they greatly varied across patients (31­42 mL/h−1/mmHg and 82­100 mL/min, respectively). GKD-UF-max and its associated QUF decreased during dialysis treatment (P < 0.01). The GKD-UF-max decrease was related to weight loss (R2 = 0.66; P = 0.0015). Conclusions: GKD-UF is a reliable and accurate method to assess the water permeability of a system in vivo. It varies according to dialysis setting and patient-related factors. It is an objective parameter evaluating the forces driving convection and identifies any diversion of the system during the treatment procedure. It is applicable to low- or high-flux dialysis as well as pre- or post-dilution HDF. Thus, it may be used to describe the characteristics of a dialysis system, is suitable for clinical use and may be of help for personalized prescription.

Dynamics of sessile and pendant drops excited by surface acoustic waves: Gravity effects and correlation between oscillatory and translational motions.

When sessile droplets are excited by ultrasonic traveling surface acoustic waves (SAWs), they undergo complex dynamics with both oscillations and translational motion. While the nature of the Rayleigh-Lamb quadrupolar drop oscillations has been identified, their origin and their influence on the drop mobility remains unexplained. Indeed, the physics behind this peculiar dynamics is complex with nonlinearities involved both at the excitation level (acoustic streaming and radiation pressure) and in the droplet response (nonlinear oscillations and contact line dynamics). In this paper, we investigate the dynamics of sessile and pendant drops excited by SAWs. For pendant drops, so-far unreported dynamics are observed close to the drop detachment threshold with the suppression of the translational motion. Away from this threshold, the comparison between pendant and sessile drop dynamics allows us to identify the role played by gravity or, more generally, by an initial or dynamically induced stretching of the drop. In turn, we elucidate the origin of the resonance frequency shift, as well as the origin of the strong correlation between oscillatory and translational motion. We show that for sessile drops, the velocity is mainly determined by the amplitude of oscillation and that the saturation observed is due to the nonlinear dependence of the drop response frequency on the dynamically induced stretching.

Universality of tip singularity formation in freezing water drops.

A drop of water deposited on a cold plate freezes into an ice drop with a pointy tip. While this phenomenon clearly finds its origin in the expansion of water upon freezing, a quantitative description of the tip singularity has remained elusive. Here we demonstrate how the geometry of the freezing front, determined by heat transfer considerations, is crucial for the tip formation. We perform systematic measurements of the angles of the conical tip, and reveal the dynamics of the solidification front in a Hele-Shaw geometry. It is found that the cone angle is independent of substrate temperature and wetting angle, suggesting a universal, self-similar mechanism that does not depend on the rate of solidification. We propose a model for the freezing front and derive resulting tip angles analytically, in good agreement with the experiments.

Survival of patients with ANCA-associated vasculitis on chronic dialysis: data from the French REIN registry from 2002 to 2011.

BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) can lead to end-stage renal disease in patients with renal involvement. OBJECTIVE: This study evaluated the survival of AAV patients on chronic dialysis in France. METHODS: Between 2002 and 2011, a total of 425 AAV patients started chronic dialysis and were registered in the Renal Epidemiology and Information Network. We analysed survival censored for renal transplantation, recovery of renal function and loss to follow-up. AAV patients were compared with 794 matched non-AAV patients on chronic dialysis. RESULTS: A total of 166 (39%) patients with microscopic polyangiitis and 259 (61%) patients with granulomatosis with polyangiitis were registered. Within a median follow-up of 23 months, 58 (14%) patients received a renal allograft and 19 (4%) recovered renal function. Median survival on dialysis was 5.35 years (95% CI, 4.4-6.3) and survival rates at 3 months, 1, 3 and 5 years were 96%, 85%, 68% and 53%, respectively. A total of 143 (41%) patients died after a median of 16 months. Causes of death were cardiovascular (29%), infections (20%), malnutrition (13%), malignancies (4%), AAV relapse (2%), miscellaneous (14%) and unknown (18%). Multivariate logistic regression identified three independent risk factors associated with AAV patients' mortality: age (HR = 1.05/year, P < 0.001), peripheral artery disease (HR = 2.62, P = 0.003) and frailty (HR = 2.43, P < 0.001). Survival of AAV patients did not differ from non-AAV controls, but infectious mortality was higher in AAV patients (20% vs. 8%, P < 0.001). CONCLUSION: Survival of AAV patients in chronic dialysis, although poor, was comparable to survival of non-AAV controls on dialysis. There was a similar burden of cardiovascular mortality, but higher infectious mortality.

[Access to the waiting list and renal transplantation]. / Accès à la liste d'attente et à la greffe rénale.

This chapter provides a set of indicators related to Renal Transplantation access in France. It describes patient outcomes and reports on cumulative incidence rates of wait-listing and renal transplantation according to main patient of characteristics and regions. The REIN registry integrates kidney transplant and dialysis data. It provides a comprehensive view on waiting list and renal transplantation access to the patients, nephrologists, and national or regional health authorities. Access to the waiting list is evaluated on a cohort of 51,845 new patients who started dialysis between 2002 and 2011 in 25 regions. The probability of first wait-listing was of 3.7% at the start of dialysis (pre-emptive registrations), 15% at 12, 22% at 36 and 24% to 60 months. The probability of being registered was strongly related to age, diabetes and region. Patient older than 60 had a very poor access to the waiting list, whatever their diabetes status was. Probability of first wait-listing was much lower (36.5% at 60 months) in type 2 diabetic-40 to 59 years old patients. Among 13,653 patients less than 60 years old, the probability of being registered was 11% at the start of dialysis, 43% to 12 months, 62% to 36 months and 66% to 60 months (median dialysis duration: 16 months). Seventeen regions with up to 5 years follow-up show an increase of 8 to 15% in pre-emptive registrations between 2007 and 2001, without change at 1 year. Access to kidney transplant is evaluated on a cohort of 53,301 new patients who started a renal replacement therapy (dialysis or pre-emptive renal transplant) between 2002 and 2011 in 25 regions. The probability of first kidney transplant was of 7% at 12, 17% at 36 and 21% at 60 months. 8,633 patients (16,2%) had received a first renal transplant within 14.7 month median time; 1,455 (2.7%) had received a pre-emptive graft [male: 58%, median age: 48.7y]. Among the 14,770 new patients less than 60 years old, the probability of being transplanted was of 21% at 12, 46% at 36 and 58% at 60 months (median dialysis duration: 42 months). When pre-emptive graft were excluded, the probability of being transplanted was of 5% at 12, 15% to 36 and 19% to 60 months Insofar as kidney transplant is regarded as the most efficient treatment, access to the waiting list and renal transplant are sensitive issues.

[Cinacalcet treatment for secondary hyperparathyroidism in dialysis patients in real-world clinical practice - the ECHO observational study: French experience]. / Efficacité du cinacalcet en pratique clinique chez les patients dialysés présentant une hyperparathyroïdie secondaire : observatoire ECHO - Expérience française.

UNLABELLED: In chronic kidney disease patients with secondary hyperparathyroidism (SHPT), the recommended K/DOQI™ target serum levels of parathyroid hormone (PTH), calcium (Ca) and phosphorus (P) are difficult to reach and maintain stable. We present the results of the French cohort from the European study ECHO which investigated the use and effectiveness of cinacalcet in real-world clinical practice. METHODS: An observational study of the SHPT management in dialysis patients, partially retrospective (from 6 months prior to cinacalcet initiation) and partially prospective (up to 12 months of cinacalcet treatment). RESULTS: Four hundred and eighty-five French patients were enrolled from 44 centres. Cinacalcet was given in combination with active vitamin D treatment (39%) and phosphate binders (87%). After 12 months, the proportion of patients reaching recommended K/DOQI™ target levels had increased from 2.5% to 28.8% for PTH, from 46.8% to 50.1% for Ca, from 40.0% to 49.9% for P and 54.8% to 77.7% for the CaxP product. The proportions of patients using active vitamin D and sevelamer decreased by 6% and 20% respectively. Adverse events were reported in 37 (7.6%) patients, mainly nausea (2.1%), vomiting (2.1%) and dyspepsia (1.2%). CONCLUSIONS: The results of this study are consistent with data from controlled and randomized studies showing that cinacalcet increases the proportion of patients achieving the K/DOQI™ targets for PTH, Ca, P and CaxP in real-world clinical practice.

[Type 2N von Willebrand disease (Normandy)]. / La maladie de Willebrand de type 2N "Normandie". À propos d'une observation.

Willebrand disease is the most common constitutional abnormality of hemostasis. It reflects a qualitative or quantitative abnormality of von Willebrand factor (vWF) responsible for hemorrhagic syndrome, mainly mucosal, of variable expression. Type 2N (Normandy) is a rare form of von Willebrand disease due to a qualitative abnormality of vWF that disrupts its ability to bind to factor VIII. The disease biologically combines APTT prolongation, a lower level of factor VIII, and a normal or subnormal rate of vWF, which may suggest a mild form of hemophilia A. This confusion can lead not only to a misdiagnosis but also to inappropriate treatment.

Electrowetting and droplet impalement experiments on superhydrophobic multiscale structures.

The reversible actuation of droplets on superhydrophobic surfaces under ambient conditions is currently an important field of research due to its potential applicability in microfluidic lab-on-a-chip devices. We have recently shown that Si-nanowire (NW) surfaces allow for reversible actuation provided that the surface structures show certain characteristics. In particular it appears that, for such surfaces, the presence of structures with multiple specific length scales is indeed needed to have a robust reversibility of contact angle changes. Here we report on electrowetting (EW) and impalement experiments on double-scale structured surfaces prepared by a combination of silicon micropillars prepared by an association of optical lithography and silicon etching, and nanowire growth on top of these surfaces. We show that while micropillar surfaces have a low impalement threshold and irreversible EW behaviour, a surface with double-scale texture can show both a very high resistance to impalement and a limited reversibility under EW, provided that the roughness of the micro-scale is large enough--i.e. that the pillars are tall enough. The optimal performance is obtained for a space between pillars that is comparable to the height of the nanostructure.

Droplet displacements and oscillations induced by ultrasonic surface acoustic waves: a quantitative study.

We present an experimental study of a droplet interacting with an ultrasonic surface acoustic wave. Depending on the amplitude of the wave, the drop can either experience an internal flow with its contact line pinned, or (at higher amplitude) move along the direction of the wave also with internal flow. Both situations come with oscillations of the drop free surface. The physical origins of the internal mixing flow as well as the drop displacement and surface waves are still not well understood. In order to give insights of the underlying physics involved in these phenomena, we carried out an experimental and numerical study. The results suggest that the surface deformation of the drop can be related to a combination between acoustic streaming effect and radiation pressure inside the drop.

Levels of circulating endothelial progenitor cells are related to uremic toxins and vascular injury in hemodialysis patients.

BACKGROUND: Patients suffering from chronic kidney diseases (CKD) exhibit cardiovascular diseases and profound endothelial dysfunction. CKD patients have reduced numbers of endothelial progenitor cells, but little is known about the factors influencing these numbers. OBJECTIVES: Among these factors, we hypothesized that uremic toxins and vascular injury affect endothelial progenitor cells. PATIENTS/METHODS: Thirty-eight hemodialysis patients were investigated and compared with 21 healthy controls. CD34+CD133+ immature progenitors, CD34+KDR+ endothelial progenitors cells (EPC) and myeloid EPC (mEPC) were counted in peripheral blood. Levels of uremic toxins beta(2)-microglobulin, indole-3 acetic acid, indoxylsulfate, p-cresylsulfate and homocysteine were measured. Vascular injury was assessed in hemodialysis (HD) patients by measuring aortic pulse wave velocity and plasma levels of endothelial microparticles. In vitro experiments were performed to study the effect of uremic toxins on apoptosis of progenitor cells. RESULTS AND CONCLUSIONS: CD34+CD133+ immature progenitor cell number was negatively correlated with the levels of uremic toxins beta(2)-microglobulin and indole-3 acetic acid. In vitro, indole-3 acetic acid induced apoptosis of CD133+ cells. These data indicate uremic toxins have a deleterious role on progenitor cells, early in the differentiation process. Moreover, mEPC number was positively correlated with markers of vascular injury-pulse wave velocity and endothelial microparticle levels. This suggests that vascular lesions could stimulate progenitor cell mobilization, even in a context of reduced EPC induced by CKD. In conclusion, uremic toxins and vascular injury appear to affect endothelial progenitor cell biology in CKD.

Contact allergies in haemodialysis patients: a prospective study of 75 patients.

BACKGROUND: Haemodialysis exposes patients to many potentially sensitizing allergens. OBJECTIVES: The primary objective of this study was to evaluate the prevalence of delayed hypersensitivity in a population of haemodialysis patients. Secondary objectives were to identify the possible risk factors for contact sensitization and to propose a series of skin tests adapted to haemodialysis patients. METHODS: A prospective monocentric study was carried out in a nonselected population of haemodialysis patients. For each patient, medical history of atopy and allergic contact dermatitis, ongoing treatments (including topical ones), presence of eczema at the site of vascular access for haemodialysis were recorded. Allergological investigation included delayed hypersensitivity tests (European Environmental and Contact Dermatitis Research Group battery, tests GERDA, additional list and a battery of antiseptics and other dialysis-specific allergens) and latex skin prick test. RESULTS: Seventy-five patients (41 men, 34 women, mean age of 65 years old), with a mean 3.8 years under dialysis, were included. Nineteen patients (25%) had at least one positive skin test and 13 (17%) a positive patch test to at least one allergen relative to dialysis process including eight tests to lidocaine-prilocaine cream and three to povidone-iodine. Tests results seemed clinically relevant since nine patients had localized pruritus at the fistula site and six patients active eczema around it. CONCLUSION: Contact sensitizations are frequent in haemodialysis patients and are linked to vascular access conditioning especially the use of lidocaine-prilocaine cream. Designing a specific test battery could help to diagnose the potential allergens and subsequently to give advice to avoid contact with sensitizing agents.

Extreme resistance of superhydrophobic surfaces to impalement: reversible electrowetting related to the impacting/bouncing drop test.

The paper reports on the comparison of the wetting properties of superhydrophobic silicon nanowires (NWs), using drop impact impalement and electrowetting (EW) experiments. A correlation between the resistance to impalement on both EW and drop impact is shown. From the results, it is evident that when increasing the length and density of NWs (i) the thresholds for drop impact and EW irreversibility increase and (ii) the contact-angle hysteresis after impalement decreases. This suggests that the structure of the NW network could allow for partial impalement, hence preserving the reversibility, and that EW acts the same way as an external pressure. The most robust of our surfaces shows a threshold to impalement higher than 35 kPa, while most of the superhydrophobic surfaces tested so far have impalement thresholds smaller than 10 kPa.

Vibration-induced climbing of drops.

We report an experimental study of liquid drops moving against gravity, when placed on a vertically vibrating inclined plate, which is partially wetted by the drop. The frequency of vibrations ranges from 30 to 200 Hz, and, above a threshold in vibration acceleration, drops experience an upward motion. We attribute this surprising motion to the deformations of the drop, as a consequence of an up or down symmetry breaking induced by the presence of the substrate. We relate the direction of motion to contact angle measurements. This phenomenon can be used to move a drop along an arbitrary path in a plane, without special surface treatments or localized forcing.

Stabilized Kuramoto-Sivashinsky equation: a useful model for secondary instabilities and related dynamics of experimental one-dimensional cellular flows.

We report numerical simulations of one-dimensional cellular solutions of the stabilized Kuramoto-Sivashinsky equation. This equation offers a range of generic behavior in pattern-forming instabilities of moving interfaces, such as a host of secondary instabilities or transition toward disorder. We compare some of these collective behaviors to those observed in experiments. In particular, destabilization scenarios of bifurcated states are studied in a spatially semi-extended situation, which is common in realistic patterns, but has been barely explored so far.

The uremic solute indoxyl sulfate induces oxidative stress in endothelial cells.

BACKGROUND: Endothelial dysfunction and oxidative stress are matters of concern in patients with chronic renal failure (CRF). Uremic solutes retained in these patients could be involved in these processes. Notably, the protein-bound uremic solute indoxyl sulfate induces endothelial dysfunction in vitro, and has shown pro-oxidant effects. OBJECTIVE: To demonstrate that indoxyl sulfate is a potential mediator of oxidative stress in endothelial cells in vitro. METHODS: Indoxyl sulfate-induced oxidative stress in human umbilical vein endothelial cells (HUVEC) was studied by measuring reactive oxygen specie (ROS) production by cytofluorimetry, by analyzing the involvement of the pro-oxidative enzymes NAD(P)H oxidase, xanthine oxidase, and NO synthase, and by measuring the levels of the non-enzymatic antioxidant glutathione. RESULTS: We showed that indoxyl sulfate induced a significant production of ROS in HUVEC, with or without human serum albumin. We then investigated the role of pro-oxidative enzymes and measured the levels of the antioxidant glutathione. The NAD(P)H oxidase inhibitors, DPI, and apocynin, inhibited ROS production, whereas inhibitors of xanthine oxidase, NO synthase, and mitochondrial ROS had no effect. Interestingly, indoxyl sulfate strongly decreased the levels of glutathione, one of the most active antioxidant systems of the cell. In addition, the ROS production mediated by indoxyl sulfate was inhibited by the antioxidants vitamin C, vitamin E, and NAC. CONCLUSION: The uremic solute indoxyl sulfate enhances ROS production, increases NAD(P)H oxidase activity, and decreases glutathione levels in endothelial cells. Thus, indoxyl sulfate induces oxidative stress by modifying the balance between pro- and antioxidant mechanisms in endothelial cells.