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BioMed Research International 2019As cell-free DNA levels in the pleural fluid and serum of parapneumonic pleural effusion (PPE) patients have not been thoroughly explored, we evaluated their diagnostic... (Clinical Trial)
Clinical Trial
OBJECTIVE
As cell-free DNA levels in the pleural fluid and serum of parapneumonic pleural effusion (PPE) patients have not been thoroughly explored, we evaluated their diagnostic potential.
METHODS
Twenty-two PPE and 16 non-PPE patients were evaluated. Serum and pleural fluids were collected, and cell-free DNA was quantified. All biomarkers were assessed for correlation with days after admission. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic accuracy and optimal cut-off point.
RESULTS
Nuclear and mitochondrial DNA levels in the pleural fluid and nuclear DNA levels in serum of PPE patients were significantly higher than in those of the non-PPE patients. However, only cell-free DNA levels in pleural fluid correlated with days after admission among PPE patients (r= 0.464, 0.538, respectively). ROC curve analysis showed that nuclear and mitochondrial DNA in pleural fluid had AUCs of 0.945 and 0.889, respectively. With cut-off values of 134.9 and 17.8 ng/ml for nuclear and mitochondrial DNA in pleural fluid, respectively, 96% sensitivity and 81% specificity were observed for PPE diagnosis.
CONCLUSION
Nuclear and mitochondrial DNA in pleural fluid possess PPE diagnostic potential and correlated with disease severity. Serum nuclear DNA could also be used to distinguish freshly admitted PPE patients (Day 1) from non-PPE patients, but with less accuracy.
Topics: Aged; Cell-Free Nucleic Acids; DNA, Mitochondrial; Female; Humans; Male; Middle Aged; Pleura; Pleural Effusion; Pneumonia
PubMed: 30949501
DOI: 10.1155/2019/5028512 -
Radiographics : a Review Publication of... 2022Pleural fistula is an abnormal communication between the pleural cavity and an adjacent structure. The interplay of anatomic and physiologic factors including proximity...
Pleural fistula is an abnormal communication between the pleural cavity and an adjacent structure. The interplay of anatomic and physiologic factors including proximity to various intrathoracic structures, deep pleural recesses, and negative pleural pressures makes the pleura an easy victim of fistulization. Iatrogenic creation followed by necrotizing infections and malignancies are the most common causes. While the overall incidence and size of postsurgical pleural fistulas are decreasing with increased adoption of vascularized flaps for high-risk resections, the smaller fistulas that develop in the setting of post-radiation therapy changes, with necrotizing infections in immunosuppressed patients, and with use of newer antiangiogenic chemotherapies can be challenging to visualize directly. Imaging signs in clinical practice are often subtle and indirect. Multimodality imaging and biochemical pleural fluid analysis can offer important adjunctive information when a diagnosis is only suggested with the first imaging study. Certain pleural fistulas are inconsequential, some spontaneously close with or without diversion of flow or use of positive-pressure ventilation, while others carry a higher risk of complications or recurrence. Estimated fistula size, factors that impair healing, and the possibility of diversion are important considerations when deciding between endoscopic or surgical closure. The authors have tailored this article for a general imager or clinical practitioner and review 10 types of pleural fistulas, ranging from routine to rare, with regard to their etiology, pathophysiology, clinical cues, imaging features, nuances of pleural fluid analysis, and management options available today. RSNA, 2022.
Topics: Humans; Pleural Diseases; Fistula; Pleura; Surgical Flaps
PubMed: 36269669
DOI: 10.1148/rg.220083 -
Clinical Radiology Jun 2021To determine the prevalence of pleural abnormalities and describe the computed tomography (CT) features observed in a well-characterised population of patients with...
AIM
To determine the prevalence of pleural abnormalities and describe the computed tomography (CT) features observed in a well-characterised population of patients with pleural infection.
MATERIALS AND METHODS
A retrospective study of a subgroup of patients from the Second Multi-centre Intra-pleural Sepsis Trial (MIST 2) trial was carried out. Patients were diagnosed with pleural infection on robust clinical criteria. CT examinations were assessed by three observers independently for the presence of predefined features. Planned subgroup comparisons of patients with and without evidence of parenchymal infection were performed.
RESULTS
Eighty-one patients were included. Parietal pleural thickening and enhancement were seen in 98.7% of patients. Visceral pleural changes were observed in most, including several previously undescribed features. Consolidation was observed in 61.7% of patients and there was a significant association of parenchymal consolidation with CT evidence of small airways infection (p<0.001) and visceral pleural thickening and enhancement (p<0.05). Features of parenchymal infection were absent in one third of patients.
CONCLUSION
This study provides a comprehensive account of the parietal pleural, visceral pleural, and parenchymal changes of pleural infection on CT. Parenchymal infection is absent in a significant proportion of patients with pleural infection, suggesting that a pneumonic process may not be necessary for the development of pleural infection.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Male; Middle Aged; Pleura; Pleural Diseases; Retrospective Studies; Sepsis; Tomography, X-Ray Computed
PubMed: 33820639
DOI: 10.1016/j.crad.2020.12.017 -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2019
Topics: Adolescent; Ambulatory Care; Child; Child, Preschool; Critical Care; Emergency Service, Hospital; Female; Humans; Infant; Lung; Male; Pleura; Pleuropneumonia; Sensitivity and Specificity; Thoracic Diseases; Thoracic Wall; Ultrasonography
PubMed: 31430775
DOI: 10.1055/a-0943-1123 -
Frontiers in Cellular and Infection... 2022is well-known for causing Glässer's disease, which costs the worldwide swine industry millions of dollars each year. It has been reported the symptom of pleural...
is well-known for causing Glässer's disease, which costs the worldwide swine industry millions of dollars each year. It has been reported the symptom of pleural thickening during Glässer's disease but this symptom has received little attention. And there is no research on the elements which promote pleural thickening. In this study, pleural thickening was discovered to be associated with increased collagen fibers and elastic fibers. Furthermore, collagen-I and elastin were found to be up-regulated and concentrated in the pleura at the mRNA and protein levels following infection. To summarize, our findings add to the theoretical understanding of Glässer's disease and provide strong support for further research into the pathogenic mechanism of and the program's target treatment.
Topics: Animals; Collagen; Elastin; Haemophilus Infections; Haemophilus parasuis; Swine; Swine Diseases
PubMed: 36034702
DOI: 10.3389/fcimb.2022.952377 -
Heart & Lung : the Journal of Critical... 2021COVID-19-related pleural effusions are frequently described during the ongoing pandemic.
BACKGROUND
COVID-19-related pleural effusions are frequently described during the ongoing pandemic.
OBJECTIVES
We described the incidence, characteristics, and outcomes of COVID-19-related pleural effusions based on the current evidence available in the literature.
METHODS
We searched MEDLINE, Pubmed, and Google Scholar databases using keywords of "coronavirus disease 2019 (COVID-19)," "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)," "pleural effusion," "pleural fluid," and "pleura" from January 1st, 2020 to January 31st, 2021.
RESULTS
The incidence of pleural effusions was low at 7.3% among the 47 observational studies. Pleural effusions were commonly observed in critically ill patients and had Multisystem Inflammatory Syndrome (MIS). COVID-19-related pleural effusions were identified 5-7 days and 11 days, after hospital admission and onset of COVD-19 symptoms. The characteristic findings of pleural fluid were exudative, lymphocytic or neutrophilic-predominant pleural fluid with markedly elevated lactate dehydrogenase (LDH) levels and pleural fluid to serum LDH ratio.
CONCLUSION
A well-designed study is required to assess the significance of COVID-19-related pleural effusions during this current pandemic.
Topics: COVID-19; Humans; Incidence; Pleural Effusion; Pneumonia; SARS-CoV-2
PubMed: 33831700
DOI: 10.1016/j.hrtlng.2021.02.015 -
Zentralblatt Fur Chirurgie Oct 2015Parapneumonic pleural effusions arise from pneumonia and may develop into pleural empyema (PE). PE is defined as collection of pus in the pleural space with secondary... (Review)
Review
INTRODUCTION
Parapneumonic pleural effusions arise from pneumonia and may develop into pleural empyema (PE). PE is defined as collection of pus in the pleural space with secondary inflammation of the visceral and parietal pleura. This review article describes the current treatment strategies for para- and postpneumonic PE both in children and adults.
MATERIAL AND METHODS
Selective literature research via Medline (key words: pleural empyema, pleural empyema in children, thoracic empyema) and presentation of our own clinical experience with therapy recommendations.
RESULTS
The incidence of postpneumonic PE is increasing in both children and adults. PE is associated with a high morbidity and mortality if it is not treated early and adequate. Progression of PE follows a characteristic morphological course, which is classified in three stages: the exsudative, fibrinopurulent, and organizing phase. Treatment should be adapted to these three phases including systemic antibiotic therapy and drainage of the pleural space. Intrapleural fibrinolysis can be performed with good success independent of age in the transition of stage 1 and 2. In persistent PE (stage 2), thoracoscopic decortication is recommended to avoid progression into the organizing phase (stage 3) with the need of an open decortication. In debilitated elderly patients the increasing use of intrathoracic vacuum therapy (Mini-VAC/Mini-VAC-instill) offers an effective and less invasive therapy option.
CONCLUSION
Para- and postpneumonic PE requires an individualized and stage adapted therapy using a combination of medical and surgical treatment strategies with the aims of removing the source of infection and ensuring re-establishment of lung expansion.
Topics: Adult; Aged; Anti-Bacterial Agents; Child; Combined Modality Therapy; Cross-Sectional Studies; Empyema, Pleural; Humans; Pleura; Pneumonia, Bacterial; Survival Rate; Thoracentesis; Thoracoscopy; Thrombolytic Therapy
PubMed: 26351760
DOI: 10.1055/s-0035-1557771 -
Experimental Lung Research 2019Although the isolation of rat and mouse mesothelial cells has previously been reported, most mesothelial cells used for experimental studies are obtained from...
Although the isolation of rat and mouse mesothelial cells has previously been reported, most mesothelial cells used for experimental studies are obtained from peritoneal cells. Here, we describe an optimized method for the isolation and propagation of rodent pleural mesothelial cells without the requirement for specialized surgical techniques. To harvest pleural mesothelial cells, the pleural space of 8-9-week-old rats or older mice was filled with 0.25% trypsin in ethylenediaminetetraacetic acid (EDTA) buffer for 20 min at 37 °C. Cells were then harvested, and incubated at 37 °C in a humidified atmosphere with 5% CO. Immunofluorescence analysis of plated pleural mesothelial cells was performed using Alexa 546 (calretinin). To investigate optimal proliferation conditions, medium enriched with various concentrations of fetal calf serum (FCS) was used for pleural mesothelial cell proliferation. By day 10, confluent cell cultures were established, and the cells displayed an obvious cobblestone morphology. Immunofluorescence analysis of the cells demonstrated that all stained positive for Alexa 546 (calretinin) expression. Mesothelial cells grew better in medium containing 20% FCS than with 10% FCS. This is a simple procedure for the efficient collection of primary pleural mesothelial cells, which were obtained in defined culture conditions from the euthanized rodent thoracic cavity using trypsin-EDTA treatment. The ability to easily culture and maintain identifiable pleural mesothelial cells from rodents will be helpful for future experiments using these cells.
Topics: Animals; Mice; Pleura; Primary Cell Culture; Rats
PubMed: 31250673
DOI: 10.1080/01902148.2018.1511002 -
Expert Review of Respiratory Medicine Nov 2020Invasive pneumococcal disease is seasonal and associated with influenza, but the same is uncertain for pleural infection. We set out to investigate whether pleural...
OBJECTIVES
Invasive pneumococcal disease is seasonal and associated with influenza, but the same is uncertain for pleural infection. We set out to investigate whether pleural infection referrals similarly correlate with the seasonal variation in influenza burden and whether the microbiologic etiology varies according to certain factors.
METHODS
Cases of pleural infection were retrieved from the database of a Pleural Unit in a tertiary hospital in the UK. The rate of referrals for pleural infection was compared to contemporary national rates of influenza hospitalizations and primary care presentation with influenza like illnesses.
RESULTS
Between August 2015 and December 2019, 157 cases of pleural infection were diagnosed. The monthly rate of referrals with pleural infections was 3.8 cases/month, but this varied between months [range 0-6 cases]. No clear increase in pleural infection referrals coinciding or falling after peak influenza diagnosis was observed. However, the rate of infection referrals correlated positively with the overall monthly volume of pleural referrals (β 0.035, = 0.004). Gram negative bacteria seemed more common during the hotter months, in hospital-acquired infections and in younger adults. Young adults were more commonly infected with pneumococci than older adults, who were more vulnerable to anaerobic infections.
CONCLUSION
Direct association between the rate of pleural infection cases and influenza activity was not identified. Pleural infection microbiology appears to differ according to age and environmental temperatures.
Topics: Aged; Aged, 80 and over; Communicable Diseases; Cross Infection; England; Female; Hospitalization; Humans; Male; Middle Aged; Pleural Diseases; Referral and Consultation; Respiratory Tract Infections; Retrospective Studies; Risk Factors; Seasons
PubMed: 32736488
DOI: 10.1080/17476348.2020.1804874 -
The Clinical Respiratory Journal Feb 2019Thoracoscopy in the endoscopy suite, has a high diagnostic yield of undiagnosed pleural effusions with minimal and mild complications. Whereas relatively minimal... (Review)
Review
Thoracoscopy in the endoscopy suite, has a high diagnostic yield of undiagnosed pleural effusions with minimal and mild complications. Whereas relatively minimal invasive techniques, such as thoracentesis, image-guided pleural biopsy or blind pleural biopsy, can yield sufficient cell or tissue material to establish the diagnosis of the underlying condition, more definite invasive diagnostic and therapeutic procedure, such as thoracoscopy, may be required for accurate sampling and diagnosis, and further provide real-time treatment options in same procedure. If thoracoscopy is considered the gold standard for the diagnosis is a fact in case. The current review aims to provide informations on thoracoscopy indications in benign pleural diseases according to up to date publications.
Topics: Chylothorax; Cost-Benefit Analysis; Humans; Image-Guided Biopsy; Pleura; Pleural Effusion; Sensitivity and Specificity; Thoracentesis; Thoracoscopy; Tuberculosis, Pleural
PubMed: 30578625
DOI: 10.1111/crj.12983