Bilateral pneumothorax with pneumomediastinum under anaesthesia in a healthy female

A case of bilateral pneumothorax and Pneumomediastinum developing under general anaesthesia without apparent cause is reported. Possible aetiologic factors and mechanisms of the condition are outlined. Clinical signs and the immediate management of pneumothorax and Pneumomediastinum are discussed.     

A Case of Catamenial Pneumothorax with Diaphragmatic Fenestrations

Background: Considerable controversy exists with regards to the physiopathogenesis of catamenial pneumothorax. The rarity of catamenial pneumothorax makes understanding of its pathophysiology and verification of etiological mechanisms difficult. Objective: To contribute evidence to the knowledge base on the pathogenesis of catamenial pneumothorax. Case Report: We describe a case of catamenial pneumothorax with images that substantiate the pore hypothesis as a cause of recurrence of air in the pleural cavity in this patient. Conclusion: Our case report contributes evidence that transperitoneal migration of endometrial implants may occur through diaphragmatic fenestrations. Surgical options may be more viable to prevent recurrent pneumothoraces in such patients.     

How do eating disorders affect thyroid function?

Thyroid function tests are routinely ordered in evaluating patients with eating disorders, and quite often, indexes are low. This does not usually indicate a pathologic condition in these patients, however, since a low serum triiodothyronine level is common in starvation states. The authors review three cases of altered thyroid function associated with anorexia nervosa and bulimia that normalized after two to three weeks of adequate nutritional intake.     

TGR5 activation induces cytoprotective changes in the heart and improves myocardial adaptability to physiologic,inotropic, and pressure‐induced stress in mice

Introduction

Administration of cholic acid, or its synthetic derivative, 6‐alpha‐ethyl‐23(S)‐methylcholic acid (INT‐777), activates the membrane GPCR, TGR5, influences whole body metabolism, reduces atherosclerosis, and benefits the cardiovascular physiology in mice. Direct effects of TGR5 agonists, and the role for TGR5, on myocardial cell biology and stress response are unknown.

Methods

Mice were fed chow supplemented with 0.5% cholic acid (CA) or 0.025% INT‐777, a specific TGR5 agonist, or regular chow for 3 weeks. Anthropometric, biochemical, physiologic (electrocardiography and echocardiography), and molecular analysis was performed at baseline. CA and INT‐777 fed mice were challenged with acute exercise‐induced stress, acute catecholamine‐induced stress, and hemodynamic stress induced by transverse aortic constriction (TAC) for a period of 8 weeks. In separate experiments, mice born with constitutive deletion of TGR5 in cardiomyocytes (CM‐TGR5^del) were exposed to exercise, inotropic, and TAC‐induced stress.

Results

Administration of CA and INT‐777 supplemented diets upregulated TGR5 expression and activated Akt, PKA, and ERK1/2 in the heart. CA and INT‐777 fed mice showed improved exercise tolerance, improved sensitivity to catecholamine and attenuation in pathologic remodeling of the heart under hemodynamic stress. In contrast, CM‐TGR5^del showed poor response to exercise and catecholamine challenge as well as higher mortality and signs of accelerated cardiomyopathy under hemodynamic stress.

Conclusions

Bile acids, specifically TGR5 agonists, induce cytoprotective changes in the heart and improve myocardial response to physiologic, inotropic, and hemodynamic stress in mice. TGR5 plays a critical role in myocardial adaptability, and TGR5 activation may represent a potentially attractive treatment option in heart failure.

     

Momentary pain and coping in temporomandibular disorder pain: Exploring mechanisms of cognitive behavioral treatment for chronic pain

The purpose of this study was to determine whether cognitive–behavioral treatment (CBT) operates by effecting changes in cognitions, affects, and coping behaviors in the context of painful episodes. Patients were 54 men and women with temporomandibular dysfunction-related orofacial pain (TMD) enrolled in a study of brief (6 weeks) standard conservative treatment (STD) or standard treatment plus CBT (STD + CBT). Momentary affects, pain, and coping processes were recorded on a cell phone keypad four times per day for 7 days prior to treatment, and for 14 days after treatment had finished, in an experience sampling paradigm. Analyses indicated no treatment effects on general retrospective measures of pain, depression, or pain-related interference with lifestyle at post-treatment. However, mixed model analyses on momentary pain and coping recorded pre- and post-treatment indicated that STD + CBT patients reported greater decreases in pain than did STD patients, significantly greater increases in the use of active cognitive and behavioral coping, and significantly decreased catastrophization. Analyses of experience sampling data indicated that post-treatment momentary pain was negatively predicted by concurrent active coping, self-efficacy, perceived control over pain, and positive-high arousal affect. Concurrent catastrophization was strongly predictive of pain. Active behavioral coping and self-efficacy reported at the prior time point (about 3 h previously) were also protective, while prior catastrophization and negative-high arousal mood were predictive of momentary pain. The results suggest that CB treatment for TMD pain can help patients alter their coping behaviors, and that these changes translate into improved outcomes.     

Parental factors and adolescents' smoking behavior: an extension of The theory of planned behavior

BACKGROUND: The aim of the present study is to investigate whether general parenting factors (i.e., quality parent-child relationship, psychological control, strict control, parental knowledge) and parental smoking add to The theory of planned behaviour [Organ Behav. Hum. Dec. 50 (1991) 179] in predicting the onset of smoking. A mediation model is applied in which parental factors affect smoking behavior indirectly by affecting smoking cognitions (i.e., attitude, self-efficacy, and social norm). METHODS: The model was tested in a longitudinal study on 1,070 adolescents, aged 10-14 years old. Structural equation models (SEM) on current and on future smoking behavior were tested. RESULTS: The findings showed that the quality of the parent-child relationship and parental knowledge affected adolescents' smoking behavior indirectly, while parental smoking behavior had a direct effect. Strict control and psychological control were found to be unrelated to adolescents' smoking onset. CONCLUSIONS: In prevention campaigns, parents should be informed of the extent to which they exert influence on their child's smoking behavior and should be given advice and information on how they can prevent their children from starting to smoke.     

Correspondence between proxy and self-reports on smoking in a full family study

OBJECTIVES: The present study investigated the reliability of proxy reports obtained from family members with self-reports on adolescent and parental lifetime and current smoking status. METHODS: Data were assessed from 416 families, consisting of both biological parents and two adolescent siblings aged 13-17 years. These families were assessed at baseline and 1 year later. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to test whether proxy reports corresponded with self-reports. RESULTS: Mothers scored higher than fathers on most measures on lifetime and current smoking status of both children. The sensitivity was low for parental reports, but moderate to high for children's reports. Specificity and positive predictive value were high in all proxy reports. The negative predictive value was moderate (parents as proxy reporters) to low (children as proxy reporters) on lifetime smoking, but high on current smoking. CONCLUSIONS: Adolescents, aged 13-17 years, can be used as a reliable source to assess the smoking status of their mothers and fathers. Parents, however, appeared to accurately identify the smoking status of their adolescent children less reliably.     

Imitation of cigarette smoking: an experimental study on smoking in a naturalistic setting

AIMS: Examine whether smokers imitate smoking behaviour of strangers and to what extent this is moderated by the nature of social interactions. DESIGN AND PARTICIPANTS: An experiment with a three (heavy smoking, light smoking, or no smoking condition) by two (warm versus cold social interaction condition) factorial design. Daily smoking young adults were exposed to same-gender confederates and were observed in a bar laboratory. MEASUREMENTS: Smoking and social behaviour were observed and coded during a 30-min break between two tasks, consisting of rating television advertisements. FINDINGS: Participants imitated the smoking behaviour of confederates. After controlling for young people's craving, confederate's smoking explains 35% of the variance in the number of cigarettes smoked. Participants are more likely to smoke and to continue smoking in the warm social interaction condition. Lighting up the first cigarette was affected by confederate's smoking and participant's urges to smoke. Lighting up a second was affected by the heavy smoking condition and warm social interaction condition. Lighting up a third cigarette was affected only by the heavy smoking condition. CONCLUSION: Imitation largely explains why individuals light up a cigarette and continue to smoke.     

Perspectives on microbes as oncogenic infectious agents and implications for breast cancer

Cancer management is partly based on weighing risk factors attributed to noninfectious agents, human genes and epigenetic factors. Infectious disease causation has largely been restricted to genes directly responsible for causing cancer after sustaining damage i.e. oncogenes. Lately, evidence has emerged linking infectious agents to a number of chronic diseases. These studies have recognized the influence that acute, atypical, latent and chronic infections may play in tricking the immune system and affecting disease etiology. Similar evidence is emerging in model systems with respect to the role of infectious agents in gastrointestinal, liver and lung cancers. Although viruses have been found in association with breast cancer, skepticism remains about a role for other infectious agents, notably microbes in the disease etiology. Improved experimental designs employed in different cancer studies and a less rigid definition of infectious causation may aid in confirming or refuting a microbe-breast cancer connection. Cancer recurrence could potentially be minimized and treatment options further tailored on a case by case basis if microbes/microbial components/strain variants associated with breast cancer are identified; probiotics are employed to reduce treatment side-effects and if microbes could effectively be harnessed in immunotherapy.