Reversal of MYB-dependent suppression of MAFB expression overrides leukaemia phenotype in MLL-rearranged AML.

The transcription factor MYB plays a pivotal role in haematopoietic homoeostasis and its aberrant expression is involved in the genesis and maintenance of acute myeloid leukaemia (AML). We have previously demonstrated that not all AML subtypes display the same dependency on MYB expression and that such variability is dictated by the nature of the driver mutation. However, whether this difference in MYB dependency is a general trend in AML remains to be further elucidated. Here, we investigate the role of MYB in human leukaemia by performing siRNA-mediated knock-down in cell line models of AML with different driver lesions. We show that the characteristic reduction in proliferation and the concomitant induction of myeloid differentiation that is observed in MLL-rearranged and t(8;21) leukaemias upon MYB suppression is not seen in AML cells with a complex karyotype. Transcriptome analyses revealed that MYB ablation produces consensual increase of MAFB expression in MYB-dependent cells and, interestingly, the ectopic expression of MAFB could phenocopy the effect of MYB suppression. Accordingly, in silico stratification analyses of molecular data from AML patients revealed a reciprocal relationship between MYB and MAFB expression, highlighting a novel biological interconnection between these two factors in AML and supporting new rationales of MAFB targeting in MLL-rearranged leukaemias.

The value of lung ultrasound monitoring in H1N1 acute respiratory distress syndrome.

We present the case of a healthy young male who developed acute respiratory failure as a result of infection with influenza A/H1N1 of swine-origin and in whom ventilatory support was optimised and recovery of lung function was monitored by the use of sequential chest ultrasound examinations. The potential pivotal role of bedside lung ultrasonography in H1N1-induced respiratory failure is discussed.

[Complete neurologic recovery after prolonged cardiac arrest caused by refractory ventricular fibrillation. Clinical case]. / Completo recupero neurologico dopo arresto cardiaco prolungato da fibrillazione ventricolare refrattaria. Caso clinico.

The clinical case of a 45-year-old patient referred to us for chest pain and with clinical examination and ECG negative for ischaemic damage, is reported. The patient, hospitalised in a bed without an ECG monitor, presented heart failure due to ventricular fibrillation. He was re-examined first with ventilation and EMC and then with defibrillation. Reanimation continued for about 70 minutes. Administration of high doses of adrenalin (0.2 mg/kg) and 9 defibrillations failed to resolve the refractory VF; nor did i.v. lidocaine administration resolve the situation. Echocardiogram did not reveal cardiac tamponade. Administration of 4 g of magnesium sulphate followed by adrenalin and defibrillation, led to asystole with subsequent restoration of sinus rhythm. The patient was then transferred to Intensive Care where he was sedated and curarized for 48 hours. The clinical course was characterised from the start by positive aspects that excluded the need to carry out instrumental investigations such as evoked somatosensory potentials, in the formulation of a prognosis. The patient was transferred to the Hospital Cardiology Unit 72 hours after admission. Two weeks later the patient was discharged with a complete recovery of neurological functions and with no metabolic or thoracopulmonary changes. It can be concluded from this experience that prognosis during CPR may not be reliable. So the factors that should lead us to carry out prolonged reanimation are the age of the patient, his pre-existing clinical conditions, the speed of our actions and correct performance of reanimation.

Operational problems of an iron supplementation programme for pregnant women: an assessment of UNRWA experience.

Assessed is a large-scale iron supplementation programme for the 70 000 pregnant refugee women cared for by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). For this purpose, a retrospective survey of 1267 antenatal records was conducted in health centres located in the West Bank, Gaza, Syrian Arab Republic, Jordan, and Lebanon. The following operational problems were identified: late entry to antenatal care; high drop-out rate from antenatal care; low compliance in follow-up haemoglobin examinations; and misdirected continued testing of women who were not anaemic at registration. Routine iron supplementation of all pregnant women should be considered only in those countries where severe anaemia is prevalent and should always be coupled with additional interventions that are effective at improving iron deficiency anaemia in a given population. In most countries attention should be directed towards changing dietary habits to enhance the availability of local foodstuffs that are rich in iron. One initial haemoglobin test may help in focusing on the relatively few initially anaemic subjects who need further attention. Repeated testing during pregnancy is unwarranted.

PIP: The authors identified the following operational problems in their assessment of an iron supplementation program for the 70,000 pregnant refugee women cared for by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA): late entry to antenatal care, high drop-out rate from antenatal care, low compliance in follow-up hemoglobin examinations, and misdirected continued testing of women who were not anemic at registration. These findings are based upon data obtained through the retrospective survey of 1267 antenatal records in health centers located in the West Bank, Gaza, Syrian Arab Republic, Jordan, and Lebanon. The authors stress that routine iron supplementation of all pregnant women should be considered only in countries where severe anemia is prevalent and should always be coupled with additional interventions which are effective at improving iron deficiency anemia in a given population. In most countries, attention should be directed toward changing dietary habits to enhance the availability of local foodstuffs which are rich in iron. An initial hemoglobin test may help to identify the relatively few initially anemic subjects who need further attention. Repeated testing during pregnancy is not warranted.

[Propofol-midazolam in continuous infusion for sedation in intensive care]. / Propofol-midazolam in infusione continua per la sedazione in terapia intensiva.

Two groups of 11 ICU respiratory patients ventilated with PSV have been sedated with propofol (group I) or with midazolam (group II). After the endovenous administration of the induction dose (propofol 1.5 mg/kg; midazolam 0.15 mg/kg) sedation was obtained with continuous infusion of the drugs (propofol 2 mg/kg/h; midazolam 0.24 mg/kg/h). In this setting the Authors evaluated the level of sedation (Ramsey scale) and the side effect of the two drugs. At induction midazolam caused a reduction of tidal volume for some minutes and a greatest sedation in comparison with propofol, while propofol caused reduction of MAP (p < 0.01) and transitory apnoea. Even if during the infusion of propofol the level of sedation decreased with time (p < 0.05; y = -0.0357 x + 3.07) it was more stable in comparison with that registered during continuous infusion of midazolam (p < 0.01; y = -0.2018 x + 5.19.

[Unilateral pulmonary edema caused by heart failure. Report of 2 clinical cases]. / Edema polmonare unilaterale da scompenso cardiaco. Presentazione di 2 casi clinici.

The authors present two case reports of cardiogenic unilateral pulmonary edema. The information provided by hemodynamic monitoring have not been essential for diagnosis which was bases on clinical, radiological and echocardiographic findings and confirmed by the clinical response to a specific treatment. The authors briefly review the mechanisms which may cause the atypical distribution of the cardiogenic pulmonary edema.

[Gastric tonometry. Experience of a polyvalent intensive care unit]. / Tonometria gastrica. Esperienza di una TI polivalente.

Tonomitor NG tube was positioned in the stomach of 11 critical ill patients during their stay in ICU and 48 measurements of intramucosal pH (pHi) have been performed. In 7 patients haemodynamic measurement were performed in concomitance with each pHi measure. The Authors looked for statistical relations between pHi and SAPS, pHa, HCO3-a, MAP, DO2/BSA, VO2/BSA, SvO2, diuresis and outcome. A good correlation was found between pHi and MAP (r = 0.47). Dividing the considered parameters into 2 groups in agreement with pHi values < or = and > 7.32 significant relations (p < 0.05) results between pHi and SAPS, MAP, pHa. More significant relations were found between pHi and outcome (p = 0.0015) and between the mean of the pHi values obtained from each patient (pHi-m) and outcome (p = 0.0005). The pHi-m of the surviving patients was always > 7.32 while the pHi-m of the deceased patients was always < 7.32. This results confirm the importance of the pHi measured during the stay in ICU as a prognostic index and suggest that the MAP may be the most important haemodynamic parameter which correlate with pHi values.

[The use of Opticath in the correct measurement of the pulmonary capillary wedge pressure]. / L'uso dell'Opticath nella corretta misura della pressione di incuneamento (PCWP).

The Authors assess the utility of the on-line monitoring of SvO2 during 156 measurements of pulmonary capillary wedge pressure (PCWP) done on 52 Intensive Care Unit patients. The measurement was always right when the SvO2 increased more than 90%. The Authors found a good correlation between the SvO2 monitored during the measurement of the PCWP and the saturation of pulmonary capillary blood measured by cooximeter. These data suggest that the complex procedure to confirm the reliability of the measurement recommended by Gardner can be simplified by the observation of the trend of SvO2 on the monitor oximetrix. This allows to obtain saving time for the staff, saving blood for the patients, reduction of risk for the transmission of infective diseases due to the handling of blood and guarantees a further routinary control of reliability on the measure of PCWP.

[Usefulness of monitoring the mixed venous blood saturation (SvO2) in the diagnosis of heart rupture. A clinical case]. / Utilità del monitoraggio della saturazione del sangue venoso misto (SvO2) nell'iter diagnostico di rottura del cuore. Caso clinico.

We describe a case report of acute left ventricular free wall rupture during acute myocardial infarction in a sedated and curarised patient. Continuous monitoring of SvO2 was very useful on early diagnosis.

[Tetanus disease. Experience with 2 intensive treatments during 13 years]. / Malattia tetanica. Esperienza di due terapie intensive nell'arco di 13 anni di attività.

The Authors present a retrospective analysis of 58 cases of tetanus hospitalized in two ICU in 13 years of activity. The mortality reported (39.7%) is comparable to other Authors or statistical analysis but it is better if correlated to patient age. Patients of the highest classes (III and IV classes of Edmonson e Flowers) had the highest mortality but no significant variation was seen between patients of the III and IV class. The most frequent cause of death has been cardiac arrhythmia. Cardiac arrhythmias happened in most cases in the first 15 days of hospitalization. 37.9% of patients developed pneumonia: prolonged hospitalization (more than 15 days) and high classes of the disease have been the most important risk factors for Hospital-acquired pneumonia in tetanic patients.

[Hypoxia and oxygen content during dialysis]. / Ipossia e contenuto di ossigeno durante dialisi.

In a study of 72 patients treated with acetate and bicarbonate dialysis, the Authors verified if hypoxic hypoxia caused by dialysis depends on a deficit in oxygen content with an inherent risk of tissue hypoxia. PO2uv (uncompensated venous oxygen partial pressure) and CQ (cardiac compensation factor) derived from the oxygen absorption curve were studied by a new Ole Siggard-Andersen algorithm. The results do not show a risk of tissue hypoxia in the postdialytic period.

[Anoxic-ischemic encephalopathy and myoclonic status epilepticus]. / Encefalopatia anossico-ischemica e stato di male epilettico mioclonico.

The Authors present a case of post-anoxic coma accompanied by myoclonic status. They describe the clinical picture and instrumental data. The outcome seems to be determined by the serious anoxic-pathological damage rather than the myoclonic jerks. They discuss the problem concerning preventive treatment by use of thiopental sodium (T.P.S.) in such cases.