Background The 6-minute walk test (6MWT) independently predicts congestive heart failure (CHF) severity, death and heart failure hospitalizations, but must be administered in clinic by qualified staff on a pre-measured course. As part of the Health eHeart Study we sought to develop and validate a self-administered 6MWT mobile application (SA-6MWTapp) for independent use at home by patients. Methods and Results We performed a validation study of a SA-6MWTapp in 103-participants. In phase one (n=52), we developed a distance estimation algorithm for the SA-6MWTapp by comparing step counts from an Actigraph and measured distance on a pre-measured 6MWT course to step counts and estimated distance obtained simultaneously from our SA-6MWTapp (best estimation algorithm, r = 0.89 [95% CI 0.78 – 0.99]). In phase two, 32 participants (including those with CHF and pHTN) used the SA-6MWTapp independently in clinic and the distance estimated by the SA-6MWTapp was compared to the measured distance (r = 0.83 [95% CI 0.79-0.92]). In phase three, 19 patients with CHF and pHTN consecutively enrolled from clinic, performed 3.2 ±1 SA-6MWTapp tests per week at home over 2 weeks. Distances estimated from the SA-6MWTapp during home 6MWTs were highly repeatable (coefficient of variation = 4.6%) and correlated with in-clinic measured distance (r = 0.88 [95% CI 0.87-0.89]). Usability surveys performed during the second (in-clinic) and third (at-home) phases demonstrated that the SA-6MWTapp was simple and easy to use independently. Conclusions A self-administered 6MWTapp is easy to use and yields accurate repeatable measurements in the clinic and at home.

Association between the nervous and immune system is well documented. Immune cells originate within the bone marrow that is innervated. Thermal injury induces adrenergic stimulation, augments monocytopoiesis and alters the β-adrenergic receptor (AR) profile of bone marrow monocyte committed progenitors. This provides an impetus to study AR expression in hematopoietic progenitors along myeloid lineage. Using FACS analysis and confocal microscopy, we report the expression of α1-, α2-and β2-AR in enriched populations of ER-MP20+ and ER-MP12+ myeloid progenitors, CD117+ and CD34+ multi-potential progenitors and more importantly pluripotent stem cells suggesting a plausible role for catecholamine in hematopoietic development.

Staged LAA ligation and PVI is feasible and decreases P-wave dispersion. Randomized studies are needed to assess the efficacy of LAA ligation as adjunctive therapy to PVI for maintaining sinus rhythm in patients with persistent AF.

Catamenial pneumothorax refers to the recurrent collapse of a lung in conjunction with the menstrual cycle. It is a common manifestation of thoracic endometriosis syndrome, a rare condition involving extra-pelvic endometrial lesions. We describe a case of catamenial pneumothorax that has not recurred after treatment with hysterectomy and bilateral salpingo-oophorectomy. A 37-year-old woman with abdominal endometriosis presented with five episodes of right pneumothorax, all of which coincided with the patient’s menstrual cycle. The diagnosis of catamenial pneumothorax was made, and the patient was referred for hysterectomy and bilateral salpingo-oophorectomy. Combined transdermal estrogen/progesterone treatment was also initiated to manage her symptoms of hot flashes, vaginal dryness, and dyspareunia. Since treatment, the patient has not had recurrent pneumothorax. Due to the rarity and acuity of catamenial pneumothoraces, management options are challenging. Recommendations on the duration of combined estrogen/progesterone treatment following bilateral oophorectomy are needed. A multidisciplinary team approach consisting of pulmonologists, thoracic surgeons, and gynecologists is essential for accurate diagnosis, optimal treatment, and successful outcomes in this rare but serious condition.