The Cause of Acute Respiratory Failure Predicts the Outcome of Noninvasive Ventilation in Immunocompromised Children

BACKGROUND

Noninvasive ventilation (NIV) may be superior to conventional therapy in immunocompromised children with respiratory failure.

METHODS

Mortality, success rate, prognostic factors and side effects of NIV for acute respiratory failure (ARF) were investigated retrospectively in 41 in children with primary immunodeficiency, after stem cell transplantation or chemotherapy for oncologic disease.

RESULTS

In 11/41 (27%) children invasive ventilation was avoided and patients were discharged from ICU. In children with NIV failure ICU-mortality was 19/30 (63%). 8/11 (72%) children with NIV success had recurrence of ARF after 27 days. Only 4/11 (36%) children with first episode NIV success and 8/30 (27%) with NIV failure survived to hospital discharge. Lower FiO2, SpO2/FiO2 and blood culture positive bacterial sepsis were predictive for NIV success, while fungal sepsis or culture negative ARF were predictive for NIV failure. We observed catecholamine treatment in 14/41 (34%), pneumothorax in 2/41 (5%), mediastinal emphysema in 3/41 (7%), a life threatening nasopharyngeal hemorrhage and need for resuscitation during intubation in 5/41 (12%) NIV-episodes.

CONCLUSIONS

The prognosis of ARF in immunocompromised children remains guarded independent of initial success or failure of NIV due to a high rate of recurrent ARF. Reversible causes like bacterial sepsis had a higher NIV response rate. Relevant side effects of NIV were observed.

ICBP90 belongs to a new family of proteins with an expression that is deregulated in cancer cells

ICBP90 (Inverted CCAAT box Binding Protein of 90 kDa) is a recently identified nuclear protein that binds to one of the inverted CCAAT boxes of the topoisomerase IIalpha (TopoIIalpha) gene promoter. Here, we show that ICBP90 shares structural homology with several other proteins, including Np95, the human and mouse NIRF, suggesting the emergence of a new family of nuclear proteins. Towards elucidating the functions of this family, we analysed the expression of ICBP90 in various cancer or noncancer cell lines and in normal or breast carcinoma tissues. We found that cancer cell lines express higher levels of ICBP90 and TopoIIalpha than noncancer cell lines. By using cell-cycle phase-blocking drugs, we show that in primary cultured human lung fibroblasts, ICBP90 expression peaks at late G1 and during G2/M phases. In contrast, cancer cell lines such as HeLa, Jurkat and A549 show constant ICBP90 expression throughout the entire cell cycle. The effect of overexpression of E2F-1 is more efficient on ICBP90 and TopoIIalpha expression in noncancer cells (IMR90, WI38) than in cancer cells (U2OS, SaOs). Together, these results show that ICBP90 expression is altered in cancer cell lines and is upregulated by E2F-1 overexpression with an efficiency depending on the cancer status of the cell line.

Genomic structure and chromosomal mapping of the gene coding for ICBP90, a protein involved in the regulation of the topoisomerase IIalpha gene expression

We have recently identified a novel CCAAT box binding protein (ICBP90) involved in the regulation of topoisomerase IIalpha gene expression. We have observed that it is expressed in non-tumoral proliferating human lung fibroblast cells whereas in HeLa cells, a tumoral cell line, ICBP90 was still present even when cells were at confluence. In the present study, we have determined the ICBP90 gene structure by screening of a human placenta genomic library and PCR analysis. We report that the ICBP90 gene spans about 35.8 kb and contains six coding exons named A to F. In the 5' upstream sequence of the region containing the coding exons, two additional exons (I and II) were found. Additionally, an internal splicing site was found in exon A. A promoter region, including three putative Sp1 binding sites between exons I and A, was identified by transient transfection. Northern blot analysis of several cancer cell lines revealed the existence of two ICBP90 mRNA species of 5.1 and 4.3 kb that are transcribed from the gene. The relative amounts of these mRNAs depended on the cell type. In MOLT-4 cells and Burkitt's lymphoma Raji cells, the 4.3 kb or the 5.1 kb transcripts were mainly observed, respectively. In other cell lines, such as HL-60 cells, chronic myelogenous leukaemia K-562, lung carcinoma A549, HeLa or colorectal SW480, both 4.3 and 5.1 kb forms of ICBP90 mRNA could be detected. Interestingly, western blot analysis showed several ICBP90 protein bands in HeLa but only a single band in MOLT-4 cell extracts. Taken together our results are consistent with the ICBP90 gene exhibiting alternative splicing and promoter usage in a cell-specific manner.

Lanoteplase Genetics Institute

Lanoteplase, a modified form of a tissue plasminogen activator (t-PA) lacking fibronectin finger-like and epidermal growth factor domains, was developed by the Genetics Institute for the potential treatment of thromboembolic disorders. Suntory, the Japanese licensee, has filed an NDA in Japan for the treatment of acute myocardial infarction (MI) [301222]. It was also licensed to Bristol-Myers Squibb (BMS) for worldwide development (excluding Japan, China, South Korea and Taiwan) [178225]. BMS conducted phase III trials for acute MI [272490] but discontinued development and returned the license to Genetics Institute during 1999 [359688]. In February 1999, Lehman Brothers predicted the drug had a 60% probability of reaching market, with an estimated first launch date in 2000. The analysts predicted peak sales would occur in 2006, with peak sales of $200 million in the US and US $100 million in the rest of the world at that time [319225].

ICBP90, a novel human CCAAT binding protein, involved in the regulation of topoisomerase IIalpha expression

The one-hybrid system with an inverted CCAAT box as the DNA target sequence was used to identify proteins acting on key DNA sequences of the promoter of the topoisomerase IIalpha gene. Screening of cDNA libraries from the leukemia Jurkat cell line and from the adult human thymus resulted in the isolation of a novel protein of 793 amino acids (89,758 Da). This protein has in vitro CCAAT binding properties and has been called ICBP90. Adult thymus, fetal thymus, fetal liver, and bone marrow, known as active tissues in terms of cell proliferation, are the tissues richest in ICBP90 mRNA. In contrast, highly differentiated tissues and cells such as the central nervous system and peripheral leukocytes are free of ICBP90 mRNA. Western blotting experiments showed a simultaneous expression of topoisomerase IIalpha and ICBP90 in proliferating human lung fibroblasts. Simultaneous expression of both proteins has also been observed in HeLa cells, but in both proliferating and confluent cells. Overexpression of ICBP90 in COS-1-transfected cells induced an enhanced expression of endogenous topoisomerase IIalpha. Immunohistochemistry experiments showed that topoisomerase IIalpha and ICBP90 were coexpressed in proliferating areas of paraffin-embedded human appendix tissues and in high-grade breast carcinoma tissues. We have identified ICBP90, which is a novel CCAAT binding protein, and our results suggest that it may be involved in topoisomerase IIalpha expression. ICBP90 may also be useful as a new proliferation marker for cancer tissues.

[Experiences with replantation of large limbs]

From November 1975 to August 1978 26 limb replantations were performed. All 5 lower extremities had to be reamputated. Of the 21 replanted arms 15 healed without major complications, 9 have regained sufficient function up to now; 3 others show signs of reinnervation.

[Surgical treatment of cerebral ischemia. Indications for surgery in carotid artery stenosis (author's transl)]

Reconstruction of carotid arteries should preferably be a prophylactic measure and only in exceptional cases a therapeutic procedure. The best results are seen in stage I (asymptomatic) or in stage II (transient ischemic attacks). Surgical intervention in acute cerebral vascular insufficiency is indicated only with a conscious patient with a negative brain scan and without progressing symptoms (stage III a). In stage IIIb (progressive stroke) and stage IVa (acute completed stroke) operative treatment is contraindicated because of a high mortality rate. In accidents with persisting neurologic symptoms (completed stroke more than 2 weeks old) necessary reconstruction of the contralateral vessel is indicated.

[New methods in vascular surgery. Intraoperative transluminal catheter-recanalization using Dotter's technic]

The combination of vascular operative procedures and transluminal recanalization with a Dotter-catheter is recommended. According to own results this has been proven to be very successful, especially in old patients or in patients in a reduced physical state. The main advantage is a shorter duration of the surgical procedures and a reduction of the operative stress situation compared to other surgical methods. For the application of the Dotter-technique, however, it is necessary to observe the indications carefully.