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A pneumothorax (a term for collapsed lung) occurs when air leaks into the space between your lungs and chest wall, creating pressure against the lung. Depending on the cause of the pneumothorax, your lung may only partially collapse, or it may collapse completely.

Causes

A pneumothorax can be caused by a chest injury, certain medical procedures involving your lung, lung disease, or it may occur for no obvious reason.

A small, uncomplicated pneumothorax may quickly heal on its own, but when the pneumothorax is larger, the excess air is usually removed by inserting a tube or needle between your ribs and slowly removing the air over a few days.

Symptoms

Signs and symptoms of a pneumothorax usually include:

If only a small amount of air enters the space between your lungs and your chest wall (pleural space), you may have few signs or symptoms. However, even a slightly collapsed lung is likely to cause some chest pain and some shortness of breath that slowly improves over a few hours to a day or so, even if there is no reduction in the size of the collapse.

See your doctor right away if you have sudden chest pain and trouble breathing of any kind. Many conditions other than pneumothorax can cause these symptoms, and most require an accurate diagnosis and prompt treatment. If your chest pain is severe or breathing becomes increasingly difficult, get immediate emergency care. Your lungs and chest wall are both elastic. As you inhale and exhale, your lungs recoil inward while your chest wall expands outward. The two opposing forces create a negative pressure in the space between your rib cage and lung. When air enters that space, either from inside or outside your lungs, the pressure it exerts can cause all or part of the affected lung to collapse.

There are several types of pneumothorax, defined according to what causes them:

Primary spontaneous pneumothorax: Primary spontaneous pneumothorax is thought to develop when a small air blister (bleb) on the top of the lung ruptures. Blebs are caused by a weakness in the lung tissue and can rupture from changes in air pressure when you're scuba diving, flying, mountain climbing or, according to some reports, listening to extremely loud music. Additionally, a primary spontaneous pneumothorax may occur while smoking marijuana, after a deep inhalation, followed by slow breathing out against partially closed lips that forces the smoke deeper into the lungs. But most commonly, blebs rupture for no obvious reason. Genetic factors may play a role in primary spontaneous pneumothorax because this condition may run in families. A primary spontaneous pneumothorax is usually mild because pressure from the collapsed portion of the lung may in turn collapse the bleb.

Secondary spontaneous pneumothorax: This develops in people who already have a lung disorder, especially emphysema, which progressively damages your lungs. Other conditions that can lead to secondary spontaneous pneumothorax include tuberculosis, pneumonia, cystic fibrosis and lung cancer. In these cases, the pneumothorax occurs because the diseased lung tissue is next to the pleural space.

Secondary spontaneous pneumothorax can be more severe and even life-threatening because diseased tissue may open a wider hole, allowing more air into the pleural space than does a small, ruptured bleb. Additionally, people with lung disease already have reduced lung reserves, making any reduction in lung function more serious. A secondary spontaneous pneumothorax almost always requires chest tube drainage for treatment.

Traumatic pneumothorax: Any blunt or penetrating injury to your chest can cause lung collapse. Knife and gunshot wounds, a blow to the chest, even a deployed air bag can cause a pneumothorax. So can injuries that inadvertently occur during certain medical procedures, such as the insertion of chest tubes, cardiopulmonary resuscitation (CPR), and lung or liver biopsies.

Tension pneumothorax: The most serious type of pneumothorax, this occurs when the pressure in the pleural space is greater than the atmospheric pressure, either because air becomes trapped in the pleural space or because the entering air is from a positive-pressure mechanical ventilator. The force of the air can cause the affected lung to collapse completely. It can also push the heart toward the uncollapsed lung, compressing both it and the heart. Tension pneumothorax comes on suddenly, progresses rapidly and is fatal if not treated quickly.

Treatment

The goal in treating a pneumothorax is to relieve the pressure on your lung, allowing it to re-expand, and to prevent recurrences. The best method for achieving this depends on the severity of the lung collapse and sometimes on your overall health:

If you have had more than one pneumothorax, you may have additional treatments to prevent further recurrences.

A common surgical procedure is called video-assisted thoracoscopy, which uses small incisions and a tiny video camera to guide the surgery. In this procedure, two or three tubes are placed between your ribs while you're under general anesthesia. Through one of the tubes, the surgeon can observe with a fiberscope, while through the other tube, the surgeon attempts to close the air leak with surgical instruments. Rarely, when this doesn't work, a surgical procedure with an incision is necessary.

The chest tube remains in as long as necessary until the air in the pleural space is gone and doesn't recur when the chest tube is clamped and checked with an X-ray. Video-assisted thoracoscopy leads to less pain and a shorter recovery time than other types of surgery do because the chest cavity can be accessed without breaking any ribs.

Prevention

Although it's often not possible to prevent a pneumothorax, stopping smoking is an important way to reduce your risk of a first pneumothorax and avoid a recurrence.

Risk factors for pneumothorax include:

Observation
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» 3 Tips to Determine Proper Sequencing of Late Effects Codes

Kinnser Blog

by Kristi Wheeler

"A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury. Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the late effect is sequenced first. The late effect code is sequenced second.

An exception to the above guidelines are those instances where the code for late effect is followed by a manifestation code identified in the Tabular List and title, or the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s). The code for the acute phase of an illness or injury that led to the late effect is never used with a code for the late effect."

To simplify, there are three methods for coding late effects codes.

1) Problem followed by the cause. "The condition or nature of the late effect is sequenced first. The late effect code is sequenced second."

Example: The patient has paraplegia due to a spinal cord injury 1st 344.1 Paraplegia (current problem) 2nd 907.2 Late Effect of Spinal Cord injury (late effect code or cause of the problem)

2) "...the code for late effect is followed by a manifestation code identified in the Tabular List and title."

When the nature of the condition (problem) is a manifestation only code, this code must be preceded by the late effects code since manifestation codes can never be coded .

Example: The patient has lumbar scoliosis as a result of polio 1st 138 Late Effects of poliomyelitis 2nd 737.43 Scoliosis

In this case, 737.43 Scoliosis is a manifestation only code. Manifestation codes can't be coded first, therefore, in this case, the late effects code must be coded before the problem.

3) Cases where the code includes both the problem and the cause, e.g., some Late Effects of CVA codes. In these instances, "the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s)."

Example 1: The patient has hemiplegia of the dominant side as a result of CVA 438.21 Late effect of CVA with hemiplegia dominant side.

Some CVA late effects codes require additional codes to further explain the late effect.

Example 2: The patient has dysphagia, pharyngeal phase as a result of a CVA three years ago. 1st 438.82 Dysphagia (late effect of CVA) 2nd 787.23 Dysphagia, pharyngeal phase

Example 3: The patient has generalized muscle weakness as a result of a CVA. 1st 438.89 Other late effects CVA 2nd 728.87 Muscle Weakness (generalized)

Always consult your ICD-9 coding manual alphabetical index and the tabular list to determine if the proper code(s) have been selected for your patient. Taking steps to properly assign ICD-9 codes is crucial to ensuring that agencies are receiving proper reimbursement and risk adjustment for the patient population they serve, and for maintaining compliance with the ICD-9-CM Official Guidelines for Coding and Reporting.

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ICAT is a policy forum mandated by the UN General Assembly to improve coordination among UN agencies and other relevant international organizations to facilitate aholistic and comprehensive approach to preventing and combating trafficking in persons, including protection and support for victims of trafficking.

ICAT functions are: To provide a platform for exchange of information, experiences and good practices on anti-trafficking activities; tosupportthe activities of the UN and other international organizations with the aim of ensuring a full and comprehensive implementation of all international instruments and standards of relevance for the prevention and combating of trafficking in persons and protection of and support for victims of trafficking; to work towards a comprehensive, coordinated and holistic approach to human trafficking, which is gender and age-sensitive and grounded in a human rights based-approach; and topromote effective and efficient use of existing resources, using, to the extent possible, mechanisms already in place at the regional and national level.

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This report provides an overview of ICAT’s accomplishments since it was created a decade ago.

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This paper provides an up-to-date overview of the mandates of ICAT organizations, reflecting evolutions in their mandates, as well as in the international response to trafficking in persons.

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ICAT Issue Brief 05, 04/2018

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looks at the context specifically related to the three Sustainable Development Goal (SDG) targets related to trafficking in persons, Targets 5.2, 8.7, and 16.2.

ICAT is a policy forum mandated by the UN General Assembly to improve coordination among UN agencies and other relevant international organizations to facilitate an holistic and comprehensive approach to preventing and combating trafficking in persons.

After collection, embryos were sorted and dead eggs and those past the two-cell stage were removed. Chorion projections were removed from three to six of the remaining embryos with forceps (when possible) and embedded in 1.5% SeaPlaque low gelling temperature agarose in a Petri dish. While the agar was still molten, eggs were put on the bottom of the dish and oriented, so that the developing blastodisc (animal pole) was parallel to the dish floor. Time lapse images were captured using a Leica M80 stereomicroscope placed in a temperature-controlled room held at 26°C. Magnification ranged between 25 and 45 times, depending on species. Photos were acquired every two to five minutes, depending on species, with a Nikon Digital Sight DS-Fi1 camera using Nikon Elements F 3.0 software or with a Zeiss AxioCam ERc5s camera using ZEN software. Photos from a single acquisition session were opened with Fiji ImageJ as an image sequence, synchrony between eggs of the same experiment was evaluated and timings at which the different cell divisions occurred were noted.

FUCCI reporter constructs used were previously optimized in for zebrafish []. Geminin-azami green and cdt1-kusabira orange were extracted from plasmids pT2KXIG using BamHI and ClaI and sub-cloned in a PcS2 expression vector under the control of an SP6 promoter. Synthetic RNAs were transcibed using mMESSAGE mMACHINE® SP6 Transcription Kit, Ambion: 1 nl of both RNAs (final concentration 400 pg/nl each) was injected intracellularly in one-cell-stage embryos using a Tritech microINJECTOR™. Injected embryos were then embedded in 2% low melting agar in a wilkon dish, oriented and left for 1 hour at 25°C while the agar was hardening.

Fluorescence images were acquired using a Leica TCS SP2 confocal microscope; 250 to 350 μm were scanned and an image was taken every 6 μm (40 to 60 images per embryo in total) for each time point. Acquisitions were performed every 13 minutes for almost 24 hours at room temperature (RT, using 488 and 543 emission lasers. Single images were reconstructed from stacks using Fiji imageJ. All images were edited with GIMP. Colors, contrast, brightness and sharpness were adjusted in order to optimize the contrast of the images. All videos were edited with Sony Vegas™. A sequence of images from a single embryo was chosen, oriented, cropped and saved as a new image sequence. This sequence of images was imported as a continuous video in Sony Vegas™.

Figure 2

Early cleavage time-lapse. Non-annual species (dashed boxes) are compared with annual species (solid boxes) by brightfield time lapse imaging. Early cleavage stages are shown for each species and the average time at which they occur is indicated. There is a large difference in early cell division rates between annual and non-annual species.

Figure 3

Early division rates greatly differ between annual and non-annual species. Time-lapses videos were plotted, with developmental stages on the x-axis and time of occurrence on y-axis. Data are means of three independent experiments. Error bars represent standard deviations. Dashed lines indicates confidence intervals of the regressions. The slopes of the lines clearly show the great difference between annual and non-annual early division times.

Figure 4

Early cleavage time-lapse. Non-annual species (dashed boxes) are compared with annual species (solid boxes) by brightfield time-lapse imaging. Early cleavage stages are shown for each species and the time at which they occur is indicated. There is a large difference in early division rate between annual and non-annual species.

Additional file 2: Annual and non-annual time lapse: comparison between the division rate of annual ( Nothobranchius furzeri ) and non-annual ( Aphyosemion striatum ). Cells divide at the animal pole (top part, above the yolk) and the time at which they cleave is greatly different between the annual and the non-annual species. (WMV 14 MB)

Figure 5

Difference between annual and non-annual division rate is conserved in Aplocheloidei. All species followed with time-lapses videos were plotted. Developmental stages are shown on the x-axis and time at which they occur on the y-axis. Dashed lines indicate non-annual species, solid lines annual species and color codes the geographic clade. For each species only one individual embryo is plotted.

Figure 6

Cell cycle during early cleavage. Cell cycle progression in was visualized by fluorescent ubiquitination-based cell cycle indicator (FUCCI). From (A) to (H) the last synchronus division (fourth) is shown, all nuclei are yellow and cells perfectly synchronized in cycling. (I) Represents the first division where asynchrony starts. (J) last synchronous dark stage. (K-L) later stages when cells are clearly asynchronous and cells in different phases can be recognized at the same time point.

Figure 7

Cell cycle during epiboly and dispersed phase. Cell cycle progression in was visualized by fluorescent ubiquitination-based cell cycle indicator (FUCCI). Green cells in the S-/G phase, red cells are G-phase cells. Cells divide for the first days of development at the animal pole (A-B) and then just migrate in G1 onto the embryo surface during late epiboly and the dispersed cell phase (C-D) .

The results of the FUCCI imaging indicate that the slowness of the cell cycle in annual killifish species is not due to the presence of a G 1 phase, but rather to a retardation of the S- and M-phases. Further, the first signs of asynchrony are observed already between the fifth and sixth divisions. This is considerably earlier than the tenth division, as originally reported for D rerio in correspondence to the mid blastula transition [ Davids Bridal Embellished Dyeable Low Heel Sandal Style RILEYWHITE White Ne08s
], and is in line with recent results obtained in O latipes, where the desynchronization is observed between the fifth and the sixth division [ LifeStride Womens Drama Flat Bronze SQZwf3o
]. In medaka and also in zebrafish, however, the first signs of transcription from the zygotic genome are observed around the sixth division [ Show Shine Womens Fashion Mesh Peep Toe Loafers Shoes Light Blue jkpEnsrhyA
, adidas Mens Freak X Carbon Mid Baseball Shoe Power Red/White/Metallic Silver 12 Medium US UrYP9Yy80G
] and are defined as pre-MBT transcription. It is possible that in annual fish as well, the activation of the very first zygotic genes corresponds to the first signs of asynchrony.

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