Spontaneous Tension Research Articles

Pulmonary tuberculosis and secondary spontaneous tension pneumothorax in HIV patient: case report

Tuberculosis remains as one of the top 10 infectious diseases causing mortality worldwide. In year 2022, Tuberculosis has caused an estimated 1.30 million deaths with 1.13 million of death caused by tuberculosis alone, while 167000 cases in TB-HIV coinfection. Secondary Spontaneous Pneumothorax has been well known as a complication of Tuberculosis, although the incidence is quite rare, it could be life threatening especially if the pneumothorax progress to tension pneumothorax. Patient, male 19 years old came to the emergency room with a sudden shortness of breath for 3 hours prior to hospital admission. X-ray thorax examination showed collapse of the right lung with hyperlucent avascular findings on the right lung, which suggest secondary spontaneous tension pneumothorax. He was treated with chest tube insertion and WSD placement, 2 hours after WSD placement, he became pulseless. ACLS protocols were given and unfortunately, we were unable to achieve ROSC on him. Tuberculosis remains one of the deadliest infection diseases, but can still be treated with the DOTS regimen. Some condition can make tuberculosis difficult to treat, such as immunodeficiency patient like HIV/AIDS. Spontaneous Pneumothorax has been well known as a complication of tuberculosis, although the incidence rate of pneumothorax in tuberculosis are quite low, however it could be life-threatening if it develops into a tension pneumothorax, especially in the settings of advanced stage HIV patients. Spontaneous pneumothorax can be fatal especially when it develops to tension pneumothorax. Further research is needed to know what population who are at risk of developing pneumothorax.

Spontaneous Intraventricular Tension Pneumocephalus

Here, we report a very rare case of spontaneous intraventricular tension pneumocephalus. This case concerns a 40-year-old patient with medical history of a tumor of the pineal region and a secondary hydrocephalus treated by multiple ventriculoperitoneal shunts. He presented in the emergency room because of unusual headaches, nausea, and visual loss. In addition, he reported slight rhinorrhea in the past few weeks. The initial brain computed tomography scan revealed a spontaneous intraventricular tension pneumocephalus. There was no history of recent head trauma and no sign of disconnection of the shunt system. A complementary radiologic assessment including a thin-slice bone computed tomography scan and a radioisotope cisternography revealed an osseous defect and an isotope leakage at the junction between the tegmen tympani and the squamous part of the left temporal bone. A middle cranial fossa surgery was performed to repair the osteo-meningeal breach.

Spontaneous tension pneumothorax: a devastating consequence of pulmonary tuberculosis

Tuberculosis (TB) was the world’s second leading cause of death from a single infectious agent, with mortality reaching 50% in untreated cases. It has been acknowledged as a potential cause of secondary spontaneous pneumothorax. A 57-year-old male presented to emergency department due to shortness of breath since 12 hours before admission. He had a history of chronic cough along with significant weight loss. He was cachexic and fully alert, with normal blood pressure, tachypnea, and slight tachycardia. Decreased breath sounds on the right hemithorax was noted. Chest x-ray revealed right tension pneumothorax and active pulmonary TB. Emergency needle decompression was performed with 14-gauge intravenous catheter. Unfortunately, he died eight hours later following a cardiac arrest. Occurrence of spontaneous tension pneumothorax in TB involves several mechanisms such as pleural porosity, chronic inflammation, and alveolar rupture. Compensatory mechanisms including gradual tachycardia, respiratory rate elevation, along with increasingly negative contralateral intrathoracic pressures could preserve venous return, serving as protective factors against hypotension until the late stages. Late presentation of 12 hours after the first onset might contribute to enormous air leak that could not be effectively managed by needle decompression. Undiagnosed and untreated TB could lead to morbid consequence such as tension pneumothorax, highlighting the importance of TB detection within the community. Clinicians should be aware of variations in the clinical presentation of tension pneumothorax as compensatory mechanisms may hinder the diagnosis at initial presentation. Strategic approaches are imperative to reinforce our commitment to eliminate TB by 2030.

Impact of Two Different High-power Pain Threshold Static Ultrasound Techniques on Myofascial Trigger Points: A Pilot Study

Introduction: Myofascial Pain Syndrome (MPS) is a challenging musculoskeletal condition with a prevalence of upto 30% in certain populations seeking medical care. It is characterised by Trigger Points (TrPs) in muscle fibres, leading to spontaneous pain, referred pain, muscle tension, and restricted Range Of Motion (ROM). The integrated TrP hypothesis proposes that an energy crisis triggers TrPs through calcium release, prolonged muscle activity, and localised ischaemia. Vasoactive substances sensitise nociceptors and perpetuate the cycle. High-power Pain Threshold Ultrasound (HPPTUS-9), a novel Ultrasound (US) therapy, shows promise in reducing pain from active TrPs. The present study investigates the effects of HPPTUS-9 on Pressure Pain Threshold (PPT), subjective pain intensity, lateral flexion ROM, and disability in MPS patients. Aim: To determine the impact of two different HPPTUS techniques on MTrPs. Materials and Methods: A randomised clinical trial was conducted using a two-way mixed analysis of variance at the Department of Physiotherapy, GD Goenka University in Gurugram, Haryana, India, over a four-month period from April 2023 to August 2023. A total of 16 individuals with TrPs in the upper trapezius muscle, comprising seven males and nine females, were included. They were equally divided into two groups: the HPPTUS-9 group 1 and the HPPTUS group 2. Both groups received treatments over a six-session period spanning two weeks. The primary outcome measure was the PPT, which evaluated the pain threshold of TrPs in the upper trapezius muscle. The secondary outcome measures included ROM, Neck Pain Disability Index (NPDI), and subjective pressure pain intensity. Statistical analysis was conducted using paired t-tests. Results: Between-group analysis revealed that participants who underwent nine applications of HPPTUS experienced a significantly greater increase in PPT (p=0.001) and ROM (p=0.001) compared to the other group at the end of the two-week intervention. Additionally, both groups demonstrated a significant decrease in pain (p=0.002) within their respective treatments. Notably, no adverse effects were reported in either group. Conclusion: The present study demonstrates that nine applications of HPPTUS led to significant improvements in PPT and ROM compared to the alternative treatment group. Both groups showed a notable reduction in pain during their respective interventions. Importantly, no adverse effects were reported in either group throughout the two-week study period. These findings suggest that HPPTUS has the potential to be an effective and safe treatment option for addressing pain and mobility issues.

Effective cell membrane tension protects red blood cells against malaria invasion.

A critical step in how malaria parasites invade red blood cells (RBCs) is the wrapping of the membrane around the egg-shaped merozoites. Recent experiments have revealed that RBCs can be protected from malaria invasion by high membrane tension. While cellular and biochemical aspects of parasite actomyosin motor forces during the malaria invasion have been well studied, the important role of the biophysical forces induced by the RBC membrane-cytoskeleton composite has not yet been fully understood. In this study, we use a theoretical model for lipid bilayer mechanics, cytoskeleton deformation, and membrane-merozoite interactions to systematically investigate the influence of effective RBC membrane tension, which includes contributions from the lipid bilayer tension, spontaneous tension, interfacial tension, and the resistance of cytoskeleton against shear deformation on the progression of membrane wrapping during the process of malaria invasion. Our model reveals that this effective membrane tension creates a wrapping energy barrier for a complete merozoite entry. We calculate the tension threshold required to impede the malaria invasion. We find that the tension threshold is a nonmonotonic function of spontaneous tension and undergoes a sharp transition from large to small values as the magnitude of interfacial tension increases. We also predict that the physical properties of the RBC cytoskeleton layer-particularly the resting length of the cytoskeleton-play key roles in specifying the degree of the membrane wrapping. We also found that the shear energy of cytoskeleton deformation diverges at the full wrapping state, suggesting the local disassembly of the cytoskeleton is required to complete the merozoite entry. Additionally, using our theoretical framework, we predict the landscape of myosin-mediated forces and the physical properties of the RBC membrane in regulating successful malaria invasion. Our findings on the crucial role of RBC membrane tension in inhibiting malaria invasion can have implications for developing novel antimalarial therapeutic or vaccine-based strategies.

A RARE CASE OF BILATERAL SPONTANEOUS TENSION PNEUMOTHORAX IN A PATIENT WITH MUCORMYCOSIS

Mucormycosis is an invasive fungal infection seen in immunocompromised hosts. Here a rare case of mucormycosis with pulmonary involvement followed by bilateral spontaneous tension pneumothorax is described. Bilateral spontaneous tension pneumothorax is a rare and fatal condition. We present a case of 3 years old child, diagnosed case of acute Leukemia. During the course of induction chemotherapy, he was hospitalized with fever and diarrhea. He was being managed on lines of neutropenic colitis. During the hospital stay, the child developed sudden respiratory distress and seizures. Chest X-ray showed bilateral spontaneous tension pneumothorax. Immediate bilateral chest tubes insertions were done. He was also electively intubated. After successful lung expansion, the trial of weaning off the ventilator was given and patient was successfully extubated. CT Thorax after lung re-expansion showed few pneumatoceles with no bronchopleural fistulous communication. CT Brain and para nasal sinuses showed fungal rhinosinusitis with intracranial extension. Nasal endoscopy and debridement of necrotic tissue was done. Tissue cultures showed the growth of mucor species. The patient was also started on amphotericin B that was later changed to Posaconazole. He responded well to anti-fungal treatment and there was no recurrence of pneumothorax. Keywords: Mucormycosis, Tension pneumothorax, Bronchopulmonary fistula

Spontaneous Tension Pneumothorax is a Rare and Life-Threatening Complication of COVID-19 Infection: A Case Report and Literature Review

The coronavirus disease is a recent pandemic infection, with the first case being discovered in Wuhan, China, in December 2019. Iran is one of the countries that has been afflicted by this pandemic. A 34-year-old man with no history of pre-existing disease and smoking has been hospitalized in another hospital for the past two weeks due to COVID-19 infection and symptoms of fever, cough, and dyspnea. He received standard medical treatments in that hospital. After two weeks, he was discharged from the hospital with his consent. In the afternoon of the same day, he came to the emergency department of our hospital with severe dyspnea. Tension pneumothorax in the left hemithorax, pulmonary collapse, and shifting mediastinal elements to the contralateral side were observed in his chest x-ray. Tension pneumothorax is an unusual symptom in patients with SARS-CoV-2. Pneumothorax has been reported in 1% of COVID-19 patients who need hospitalization, 2% of those who need intensive care unit admission, and 1% of those who die from the infection. Spontaneous pneumothorax must be ruled out in COVID-19 patients with dyspnea and chest pain, tachycardia, tachypnea, or hypoxemia. It is critical to be familiar with these symptoms to make an accurate diagnosis and treatment plan. A thorough physical examination and serial chest X-rays can be helpful tools in the diagnosis and management of the disease.

Secondary Spontaneous Tension Pneumothorax: A Case Report of an Uncommon Presentation of Post-Tuberculosis Sequelae

Secondary Spontaneous Tension Pneumothorax: A Case Report of an Uncommon Presentation of Post-Tuberculosis Sequelae

Effects of Adrenomedullin on Atrial Electrophysiology and Pulmonary Vein Arrhythmogenesis.

Adrenomedullin, a peptide with vasodilatory, natriuretic, and diuretic effects, may be a novel agent for treating heart failure. Heart failure is associated with an increased risk of atrial fibrillation (AF), but the effects of adrenomedullin on atrial arrhythmogenesis remain unclear. This study investigated whether adrenomedullin modulates the electrophysiology of the atria (AF substrate) or pulmonary vein (PV; AF trigger) arrhythmogenesis. Conventional microelectrode or whole-cell patch clamps were used to study the effects of adrenomedullin (10, 30, and 100 pg/mL) on the electrical activity, mechanical response, and ionic currents of isolated rabbit PV and sinoatrial node tissue preparations and single PV cardiomyocytes. At 30 and 100 pg/mL, adrenomedullin significantly reduced the spontaneous beating rate of the PVs from 2.0 ± 0.4 to 1.3 ± 0.5 and 1.1 ± 0.5 Hz (reductions of 32.9% ± 7.1% and 44.9 ± 8.4%), respectively, and reduced PV diastolic tension by 12.8% ± 4.1% and 14.5% ± 4.1%, respectively. By contrast, adrenomedullin did not affect sinoatrial node beating. In the presence of L-NAME (a nitric oxide synthesis inhibitor, 100 μM), adrenomedullin (30 pg/mL) did not affect the spontaneous beating rate or diastolic tension of the PVs. In the single-cell experiments, adrenomedullin (30 pg/mL) significantly reduced the L-type calcium current (ICa-L) and reverse-mode current of the sodium-calcium exchanger (NCX). Adrenomedullin reduces spontaneous PV activity and PV diastolic tension by reducing ICa-L and NCX current and thus may be useful for treating atrial tachyarrhythmia.

Spontaneous Tension Hemothorax in a Patient with Asbestosis.

A 75-year-old man with a history of asbestosis presented to the emergency department with sudden-onset dyspnea and hemoptysis, triggered by coughing. The patient was hemodynamically unstable and in respiratory distress. Computed tomography revealed a massive hemothorax on the left side and compression of the descending thoracic aorta. He underwent emergency surgical exploration after decompression by chest tube insertion. The hemothorax was caused by tears in the pleural adhesions due to asbestosis and induced by coughing. Spontaneous hemothorax is a rare subtype of hemothorax. There have been only a few case reports of spontaneous tension hemothorax. In addition to its typical findings, compression of the thoracic descending aorta was observed in our patient. We hypothesize that severely diminished pulmonary compliance contributed to the extremely high intrathoracic pressure, which led to this unusual finding.

Positive chronotropic action of HCN channel antagonism in human collecting lymphatic vessels.

Spontaneous action potentials precede phasic contractile activity in human collecting lymphatic vessels. In this study, we investigated the expression of hyperpolarization‐activated cyclic nucleotide‐gated (HCN) channels in human collecting lymphatics and by pharmacological inhibition ex vivo tested their potential role in controlling contractile function. Spontaneous and agonist‐evoked tension changes of isolated thoracic duct and mesenteric lymphatic vessels—obtained from surgical patients with informed consent—were investigated by isometric myography, and ivabradine, ZD7288 or cesium were used to inhibit HCN. Analysis of HCN isoforms by RT‐PCR and immunofluorescence revealed HCN2 to be the predominantly expressed mRNA isoform in human thoracic duct and mesenteric lymphatic vessels and HCN2‐immunoreactivity confirmed protein expression in both vessel types. However, in functional experiments ex vivo the HCN inhibitors ivabradine, ZD7288, and cesium failed to lower contraction frequency: conversely, all three antagonists induced a positive chronotropic effect with concurrent negative inotropic action, though these effects first occurred at concentrations regarded as supramaximal for HCN inhibition. Based on these results, we conclude that human collecting vessels express HCN channel proteins but under the ex vivo experimental conditions described here HCN channels have little involvement in regulating contraction frequency in human collecting lymphatic vessels. Furthermore, HCN antagonists can produce concentration‐dependent positive chronotropic and negative inotropic effects, which are apparently unrelated to HCN antagonism.

Clinico-pathological analysis of a rare case of pulmonary nocardiosis under the mask of disseminated tuberculosis

Nocardiosis is a rare infectious disease caused by bacteria of the genus Nocardia and characterized by the development of foci of purulent-necrotic inflammation of the lungs, brain, and internal organs. Clinical diagnosis of nocardiosis has objective difficulties. The aim of the study is to highlight a rare clinical case of pulmonary nocardiosis, to analyze mistakes in the clinical diagnostics of the main disease, to discuss the differential diagnosis of nocardiosis. Materials and methods. A clinico-pathological analysis of an inpatient and outpatient medical record card, and the results of an autopsy of a 58-year-old patient who died in an anti-tuberculosis institution from pulmonary nocardiosis has been carried out. Results. According to the anamnesis, the patient suffered from COPD and chronic polyposis rhinitis with hypertrophy of the nasal turbinates for many years. Polypectomy and submucosal resection of the nasal septum were performed in the otolaryngology department. Wegener's granulomatosis was suspected during the intravital pathomorphological examination of nasal polyps, and glucocorticoids were prescribed in the hospital. Histological preparations and biological material of the patient were examined in clinics in Berlin, the diagnosis of “Wegener's granulomatosis” was not confirmed, however, domestic doctors recommended Medrol, which the patient received continuously for 5 years at a dose of 12 mg/day. After 5 years, the patient was admitted to the hospital of a specialized anti-tuberculosis institution in serious condition with a clinical diagnosis: newly diagnosed disseminated tuberculosis of both lungs with disintegration, right-sided spontaneous tension pneumothorax, respiratory insufficiency of the III degree. According to urgent indications, thoracentesis and drainage of both pleural cavities were performed. Despite intensive therapy, the condition worsened, and biological death occurred 11 days after hospitalization. During the post-mortem pathological examination, signs of tuberculosis of both lungs were not detected, nocardiosis of both lungs was diagnosed, which pathomorphologically manifested as multiple foci of purulent-necrotic bronchopneumonia with disintegration. Pathological diagnosis was confirmed by bacteriological and PCR examination of the post-mortem material. The disease developed on the background of wrongly prescribed long-term glucocorticosteroid therapy, which was carried out for the misdiagnosis “Wegener's granulomatosis”. No signs of Wegener's granulomatosis were found at autopsy. The direct cause of death was acute respiratory failure. Conclusion. Thus, pulmonary nocardiosis was not diagnosed in the hospital, the reason for the misdiagnosis was the rarity of the disease and the objective difficulties of diagnostics. A decisive role in the development of nocardiosis was played by erroneously prescribed long-term glucocorticosteroid therapy, which should be considered as a pathology of the therapy

Influence of conditioned media from glial cell cultures on contractility of uterine in rats of different ages

Background. The physiological regulation of the uterine contractile activity changes with age, which leads to an increased number of prolonged labor and emergency caesarean sections in women giving birth at the age of 35+. One of the modern approaches to correct the function of the reproductive system is the use of from cell cultures. CM from glial cell culture contains neurotrophic factors that play an important role in maintaining the contractile function of the uterus. Current cell culture technologies include cryopreservation.Objective: to research experimentally the effect of CM obtained from intact and cryopreserved cultures of glial cells on the contractile activity of the uterus in rats of different reproductive ages.Materials and methods. The monolayer cell culture was obtained from the dorsal root ganglia of neonatal piglets and cryopreserved in the presence of cryoprotectant dimethyl sulfoxide. CM from native and cryopreserved cultures were collected for 28 days, after which fractions with a molecular weight of < 30 kDa were obtained from them by ultrafiltration. Rats at the age of 6 and 14 months, which corresponds to reproductive age and late reproductive age (LRA), were intraperitoneally injected with 0.2 ml of media from intact (ICM) or cryopreserved (CCM) cultures for 9 days. On the 30th – 32nd day after the end of the administration of CM animals were slaughtered and the uterine contractile activity was determined by the organ bath method, the relative area of myometrium and density of myocytes by histological method, the average area of labeling with specific antibodies to smooth muscle actin by immunohistochemical method. The statistical significance of differences was assessed by the Mann–Whitney test.Results. It was found that spontaneous, OT-, and KCl-induced tension of isometric contraction of the uterus in intact LRA rats decreased by 19, 20, and 14%, respectively, compared with intact reproductive aged animals. After the introduction of ICM and CCM in LRA animals, normalization of isometric contraction parameters was observed. This effect was realized against the background of an increase in the area of the myometrium, the density of myocytes, and actin expression.Conclusions. Intra-abdominal administration of CM from glial cell culture increases the uterine contractile activity in LRA rats. This effect is realized by increasing the relative area of the myometrium, the density of myocytes, and the area of expression of smooth muscle actin. The effect of media from intact and cryopreserved cultures on the contractile activity of the uterus was similar, which makes it possible to use low-temperature culture storage technologies to obtain CM without losing its biological effect.

Brane world creation from flat or almost flat space in dynamical tension string theories

There is great interest in the construction of brane worlds, where matter and gravity are forced to be effective only in a lower dimensional surface, the brane . How these could appear as a consequence of string theory is a crucial question and this has been widely discussed. Here we will examine a distinct scenario that appears in dynamical tension theories and where string tension is positive between two surfaces separated by a short distance and at the two surfaces themselves the string tensions become infinite, therefore producing an effective confinement of the strings and therefore of all matter and gravity to the space between these to surfaces, which is in fact a new type of stringy brane world scenario. The basic formulation for obtaining this scenario consist of assuming two types of strings characterized by a different constant of integration related to the spontaneous string tension generation. These string tension multiplied by the embedding metric define conformally related metrics that both satisfy Einsteins equation. The braneworlds appear very naturally when these two metrics are both flat spaces related by a special conformal transformation. The two types of string tensions are determined and they blow up at two close expanding surfaces. A puzzling aspect appears then: the construction is based on flat spaces, but then there are also strings with very large tension near the boundaries of the braneworld,so can the back reaction from the infinite tension strings destroy the flat space background? Fortunatelly that can be resolved using the mechanism Universe creation from almost flat (or empty) spaces, which incorporates a gas of very large string tensions in a membrane, studied before in 1+1 membranes in a 2+1 embedding space and now is generalized for a 1+(D-2) membrane moving in a 1+(D-1) space.

Diagnosis of spontaneous secondary tension pneumothorax following apparent recovery from coronavirus disease 2019 pneumonitis: a case report

BackgroundCoronavirus disease 2019 has been associated with a plethora of different manifestations of systems affected (including pulmonary, gastrointestinal, and thrombotic disease) and time to presentation of complications. Pneumothorax has been established as a complication in the literature. However, tension pneumothorax remains a rare presentation with higher mortality. We report a case of secondary tension pneumothorax in a patient following apparent recovery from coronavirus disease 2019 pneumonitis.Case presentationEight days after resolution of coronavirus disease 2019 pneumonitis symptoms, a 51-year-old Caucasian man with no pre-existing pulmonary disease was brought into the emergency department following 48 hours of progressive shortness of breath. Further clinical assessment revealed reduced breath sounds in the right lung, blood pressure was 116/95 mmHg, and jugular venous pressure was not elevated. Chest x-ray showed right-sided tension pneumothorax with mediastinal shift. Insertion of a chest drain led to rapid resolution of symptoms, and the patient was discharged following full re-expansion of the lung.ConclusionsThe period of recovery from coronavirus disease 2019 is variable. Clinicians should consider tension pneumothorax as a possible complication of coronavirus disease 2019 pneumonitis in patients presenting with type 1 respiratory failure, even after resolution of pneumonitis symptoms and a considerable time period following initial contraction of coronavirus disease 2019.

A case of spontaneous idiopathic tension pneumoperitoneum successfully managed with bedside pig-tail catheter.

We present a 67-year-old gentleman with a high perioperative mortality and morbidity risk who presented with spontaneous idiopathic tension pneumoperitoneum that was successfully managed with bedside pig-tail catheter insertion. Here we also discuss other potential non-surgical aetiologies of pneumoperitoneum.

RARE CASE OF PAZOPANIB-ASSOCIATED BILATERAL PNEUMOTHORACES IN A PATIENT WITH METASTATIC SYNOVIAL SARCOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bilateral pneumothoraces are a rare occurrence, comprising 1.4% to 7.6% of cases [1]. Secondary causes of pneumothorax include bullous emphysema, cystic parenchymal lung disease and tuberculous lung disease [2]. Malignancy is a rare cause of pneumothorax, yet sarcomas have been associated with pneumothorax in 2% of patients [3]. Pazopanib, a tyrosine kinase inhibitor used in the treatment of metastasized sarcoma, has been shown to have a 3.3% risk of developing pneumothorax [4]. CASE PRESENTATION: A 24-year-old previously healthy Yemeni female initially presented with left-sided groin pain and swelling. Computed tomography of the pelvis showed a large heterogeneous mass in the proximal left thigh. Biopsy was consistent with synovial sarcoma. Staging via chest computed tomography showed multiple pulmonary nodules concerning for metastasis. Over the course of two years, she failed multiple lines of chemotherapy and had progression of disease with new and enlarging bilateral pulmonary nodules. She was started on fourth-line chemotherapy with pazopanib (Votrient) 400 mg daily. Two months later, she presented with shortness of breath, found to be tachypneic, tachycardic and hypoxemic. Chest x-ray revealed bilateral pneumothoraces with left mediastinal shift concerning for tension pneumothorax. Two tube thoracostomies were placed; however, course was complicated by persistent air leak bilaterally, requiring video-assisted thoracoscopic surgery with bullectomy and surgical talc pleurodesis. Patient had a slow resolution of pneumothorax and subsequently discharged home without recurrence. DISCUSSION: Bilateral pneumothoraces can be life-threatening and are associated with poor long term prognosis, especially in patients with poor underlying lung function [5]. Pneumothorax is seen in approximately 2% of sarcoma patients with pulmonary metastases. In patients with sarcoma and pulmonary metastases, 41.6% of pneumothoraces were bilateral, and typically associated with multiple lung nodules, cystic or cavitary lesions, or presence of pleural nodules or thickening [3]. Additionally, cytotoxic agents have been shown to induce cavitation in pulmonary lesions and increase the risk of pneumothorax development [6]. Per the PALETTE trial which led to the approval of pazopanib for use in sarcoma, there was a 3.3% risk for pneumothorax development [4], comparable to the baseline rate of pneumothorax development in patients with sarcoma. Nevertheless, bilateral pneumothoraces carry potentially fatal consequences. CONCLUSIONS: In patients with sarcoma undergoing treatment with pazopanib, a bilateral pneumothorax, though rare, may be life threatening and should be acutely suspected. REFERENCE #1: TG Rim, JS Bae, YS Yuk. Life-Threatening Simulatenous Bilateral Spontaneous Tension Pneumothorax - A case report. Korean J Thorac Cardiovasc Surg. 2011 Jun; 44(3): 253-256.2. Mason RJ, Braoddus VC, Murray JF, Nadel JA. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Elsevier Saunders (2005); Vol 2, Chapter 81. Philadelphia, PA. REFERENCE #2: Hoag JB, Sherman M, Fasihuddin Q, Lund ME. A comprehensive review of spontaneous pneumothorax complicating sarcoma. CHEST. 2010 Sep; 138(3);510-8.4. Van der Graaf WT, Blay JY, Chawla SP, Kim DW, et al. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2012 May 19; 379(9829):1879-86. REFERENCE #3: Graf-Deuel E, Knoblauch, A. Simultaneous bilateral spontaneous pneumothorax. CHEST. 1994 Apr; 105(4):1142-6.6. Interiano RB, McCarville MB, Wu J, Davidoff AM, Sandoval J, Navid F. Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors. J Pediatr Surg. 2015 Sep; 50(9):1484-9. DISCLOSURES: No relevant relationships by Sally Askar, source=Web Response No relevant relationships by Owais Nadeem, source=Web Response

Curvature-driven ac-assisted creep dynamics of magnetic domain walls

The dynamics of micrometer-sized magnetic domains in ultra-thin ferromagnetic films is so dramatically slowed down by quenched disorder that the spontaneous elastic tension collapse becomes unobservable at ambient temperature. By magneto-optical imaging we show that a weak zero-bias AC magnetic field can assist such curvature-driven collapse, making the area of a bubble to reduce at a measurable rate, in spite of the negligible effect that the same curvature has on the average creep motion driven by a comparable DC field. An analytical model explains this phenomenon quantitatively.

Effects of phosphodiesterase-1 inhibitor on pulmonary vein electrophysiology and arrhythmogenesis.

Phosphodiesterase (PDE) isoform inhibitors have mechanical and electrical effects on the heart. Inhibition of PDE-1 enzymes is a novel strategy for treating heart failure. However, the electrophysiological effects of PDE-1 inhibition on the heart remain unclear. This study explored the effects of PDE-1 inhibition using ITI-214 on electrical activity in the pulmonary vein (PV), the most common trigger of atrial fibrillation, and investigated the underlying ionic mechanisms. Conventional microelectrodes or whole-cell patch clamps were employed to study the effects of ITI-214 (0.1-10μM) on PV electrical activity, mechanical responses and ionic currents in isolated rabbit PV tissue specimens and isolated single PV cardiomyocytes. ITI-214 at 1μM and 10μM (but not 0.1μM) significantly reduced PV spontaneous beating rate (10±2% and 10±3%, respectively) and PV diastolic tension (11±3% and 17±3%, respectively). ITI-24 (1μM) significantly reduced late sodium current (INa-Late ), L-type calcium current (ICa-L ) and the reverse mode of the sodium-calcium exchanger (NCX), but it did not affect peak sodium currents. ITI-214 reduces PV spontaneous activity and PV diastolic tension by reducing INa-Late , ICa-L and NCX current. Considering its therapeutic potential in heart failure, targeting PDE-1 inhibition may provide a novel strategy for managing atrial arrhythmogenesis.

Die prähospitale Therapie eines Spannungspneumothorax bei Kindern – welche Entscheidungen treffen wir?

The preclinical treatment of atraumatic or spontaneous tension pneumothorax remains aparticular challenge in pediatric patients. Currently recommended interventions for decompression are either finger thoracostomy or needle decompression. Due to the tiny intercostal spaces, finger thoracostomy may not be feasible in small children and surgical preparation may be necessary. In needle decompression, the risk of injuring underlying vital structures is increased because of the smaller anatomic structures. As most emergency physicians do not regularly work in pediatric trauma care, decompression of tension pneumothorax is associated with significant uncertainty; however, in this rare emergency situation, consistent and goal-oriented action is mandatory and lifesaving. An assessment of pre-existing experience and commonly used techniques therefore seems necessary to deduce the need for future education and training. In this study an online survey was created to evaluate the experience and the favored prehospital treatment of tension pneumothorax in children among German emergency physicians. An online survey was conducted with 43questions on previous experience with tension pneumothorax in children, favored decompression technique and anatomical structures in different age groups. Surveyed were the emergency physicians of the ground-based emergency medical service of the University Medical Center Mannheim, the German Air Rescue Service (DRF) and the pediatric emergency medical service of the City of Munich. More than half of all respondents stated that there was uncertainty about the procedure of choice. Needle decompression was favored in smaller children and mini-thoracostomy in older children. In comparison with the literature, the thickness of the chest wall was mostly estimated correctly by the emergency medical physicians. The depth of the vital structures was underestimated at most of the possible insertion sites in all age groups. At the lateral insertion sites on the left hemithorax, however, the distance to the left ventricle was overestimated. The caliber of the needle selected for decompression tended to be too large, especially in younger children. Even though having interviewed an experienced group of prehospital emergency physicians, the experience in decompression of tension pneumothorax in children is relatively scant. Knowledge of chest wall thickness and depth to vital structures is sufficient, the choice of needle calibers tends to be too large but still reasonable. For many providers alarge amount of uncertainty about the right choice of technique and equipment arises from the challenge of decompressing atension pneumothorax in children and therefore further theoretical education and regular training are required for safe performance of the procedure.