BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial ...BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.展开更多
I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload du...I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload due to elevated pulmonary vascular resistance,leading to right heart failure and death[1].Notably,ocular complications of pulmonary hypertension have been reported less frequently[2-5].Ophthalmologists need to increase the understanding of the disease so as to perform the proper treatment for these patients.Ethical Approval The study was conducted in accordance with the principles of the Declaration of Helsinki.Written informed consent was obtained from the patient for publication of the images and data included in this article.展开更多
BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique mani...BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.展开更多
BACKGROUND Although inflammatory diseases commonly affect the pleura and pleural space,their mechanisms of action remain unclear.The presence of several mediators emphasizes the concept of pleural inflammation.Adenosi...BACKGROUND Although inflammatory diseases commonly affect the pleura and pleural space,their mechanisms of action remain unclear.The presence of several mediators emphasizes the concept of pleural inflammation.Adenosine deaminase(ADA)is an inflammatory mediator detected at increased levels in the pleural fluid.AIM To determine the role of total pleural ADA(P-ADA)levels in the diagnosis of pleural inflammatory diseases.METHODS 157 patients with inflammatory pleural effusion(exudates,n=124,79%)and noninflammatory pleural effusion(transudates,n=33,21%)were included in this observational retrospective cohort study.The P-ADA assay was tested using a kinetic technique.The performance of the model was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.RESULTS The transudates included congestive heart failure(n=26),cirrhosis of the liver with ascites(n=3),chronic renal failure(n=3),and low total protein levels(n=1).The exudate cases included tuberculosis(n=44),adenocarcinoma(n=37),simple parapneumonic effusions(n=15),complicated parapneumonic effusions/empyema(n=8),lymphoma(n=7),and other diseases(n=13).The optimal cutoff value of P-ADA was≥9.00 U/L.The diagnostic parameters as sensitivity,specificity,positive and negative predictive values,positive and negative likelihood values,odds ratio,and accuracy were 77.69(95%CI:69.22-84.75);68.75(95%CI:49.99-83.88);90.38 and 44.90(95%CI:83.03-95.29;30.67-59.77);2.48 and 0.32(95%CI:2.21-11.2;0.27-0.51);7.65(95%CI:0.78-18.34),and 75.82(95%CI:68.24-82.37),respectively(χ^(2)=29.51,P=0.00001).An AUC value of 0.8107(95%CI:0.7174-0.8754;P=0.0000)was clinically useful.The Hosmer-Lemeshow test showed excellent discrimination.CONCLUSION P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.展开更多
Pleural effusion,characterized by the accumulation of fluid in the pleural space,poses significant challenges in clinical practice,especially in determining whether it belongs to the inflammatory exudates or non-infla...Pleural effusion,characterized by the accumulation of fluid in the pleural space,poses significant challenges in clinical practice,especially in determining whether it belongs to the inflammatory exudates or non-inflammatory transudates.Adenosine deaminase(ADA),an enzyme primarily produced by immune cells,particularly lymphocytes,increase in response to inflammatory conditions,including tuberculosis and malignancies.Elevated ADA levels in pleural have been shown to correlate with inflammatory exudates,making it a valuable biomarker for dif-ferentiating between inflammatory and non-inflammatory effusions.Moreover,numerous studies have demonstrated the treatment function of ADA in inflammation-related pleural effusion syndrome.Recently,research has established the values for the implication of ADA in diagnosing and managing pleural disease.Based on these findings,ADA becomes a reliable,non-invasive marker for early diagnosis and the appropriate treatment for pleural inflammation,ultimately improving patient outcomes.展开更多
This editorial underscores the importance of Maranhão et al’s study,which investigates pleural adenosine deaminase(P-ADA)as a biomarker for inflammatory pleural effusions.Despite advances in imaging,distinguishi...This editorial underscores the importance of Maranhão et al’s study,which investigates pleural adenosine deaminase(P-ADA)as a biomarker for inflammatory pleural effusions.Despite advances in imaging,distinguishing between inflammatory and non-inflammatory causes of pleural effusion remains a diagnostic challenge.The authors conducted a rigorous retrospective cohort analysis of 157 patients(124 with inflammatory exudates and 33 with non-inflammatory transudates),establishing a robust cutoff value of P-ADA≥9.00 U/L for diagnosing inflammatory diseases using receiver operating characteristic curve analysis and internal statistical calibration.This is the first study to define a standardized PADA threshold in a Brazilian cohort,addressing previous inconsistencies in cutoff values.Furthermore,the authors delved into the pathophysiological mechanisms underlying elevated P-ADA,linking it to purinergic signaling pathways and immune cell activation,particularly emphasizing the role of ADA2 isoforms in macrophages and lymphocytes.Their findings support P-ADA as a non-invasive,cost-effective biomarker for early diagnosis,treatment stratification,and minimizing the need for invasive procedures such as thoracentesis.This has particular relevance in resource-limited settings,where streamlined diagnostics can reduce healthcare costs and improve patient outcomes.Future studies must prioritize global validation,explore the integration of adenosine deaminase with additional biomarkers(e.g.,interleukin 6,C-reactive protein),and support the development of point-of-care technologies.展开更多
BACKGROUND Traumatic subdural effusion is a common complication of traumatic brain injury,especially after decompressive craniectomy(DC).For neurosurgeons,early diagnosis and timely treatment are particularly importan...BACKGROUND Traumatic subdural effusion is a common complication of traumatic brain injury,especially after decompressive craniectomy(DC).For neurosurgeons,early diagnosis and timely treatment are particularly important,which can help improve patient prognosis and enhance quality of life.CASE SUMMARY A 47 year old male underwent DC for traumatic brain herniation.After surgery,he developed stubborn subdural effusion(SDE)on the contralateral side and underwent multiple subdural drilling and drainage surgeries,but only temporarily improved the patient’s symptoms.After the final cranioplasty,the contralateral SDE completely disappeared.The patient did not experience any new contralateral neurological dysfunction,and the Glasgow prognostic score was 11 points(E4V1M6).CONCLUSION For neurosurgeons,accurate assessment of the condition is necessary when treating patients with stubborn SDE after DC surgery,and timely cranioplasty can be performed to avoid multiple surgeries.This is a safe and effective surgical method for treating traumatic subdural effusion.展开更多
Double-wall effusion cooling coupled with thermal barrier coating(TBC)is an important way of thermal protection for gas turbine vanes and blades of next-generation aero-engine,and formation of discrete crater holes by...Double-wall effusion cooling coupled with thermal barrier coating(TBC)is an important way of thermal protection for gas turbine vanes and blades of next-generation aero-engine,and formation of discrete crater holes by TBC spraying is an approved design.To protect both metal and TBC synchronously,a recommended geometry of crater is obtained through a fully automatic multi-objective optimization combined with conjugate heat transfer simulation in this work.The length and width of crater(i.e.,L/D and W/D)were applied as design variables,and the area-averaged overall effectiveness of the metal and TBC surfaces(i.e.,Φ_(av) and τ_(av))were selected as objective functions.The optimization procedure consists of automated geometry and mesh generation,conjugate heat transfer simulation validated by experimental data and Kriging surrogated model.The results showed that the Φ_(av) and τ_(av) are successfully increased respectively by 9.1%and 6.0%through optimization.Appropriate enlargement of the width and length of the crater can significantly improve the film coverage effect,since that the beneficial anti-CRVP is enhanced and the harmful CRVP is weakened.展开更多
This study aims to investigate the impact of middle ear effusion(MEE)on sound transmission in the human ear and its potential diagnostic significance.Firstly,the material properties of specific structures were adjuste...This study aims to investigate the impact of middle ear effusion(MEE)on sound transmission in the human ear and its potential diagnostic significance.Firstly,the material properties of specific structures were adjusted based on the existing human ear finite element(FE)model,and the accuracy of the model was validated using experimental data.Secondly,six FE models were developed to simulate varying degrees of MEE by systematically altering the material properties of the middle ear cavity(MEC)at different anatomical locations.Finally,the effects of these six FE models,representing varying degrees of MEE,on sound transmission characteristics and energy absorption(EA)rate in the human ear were systematically analyzed.When the degree of MEE is less than 50%of the MEC volume,its impact on the sound transmission characteristics of the human ear remains minimal,resulting in an estimated hearing loss of approximately 3 dB,with EA rate remaining close to normal levels.Once the effusion exceeds 50%of the MEC volume,a significant deterioration in acoustic transmission is observed,accompanied by a flattening of the EA curve and a drop in EA rates to below 20%.When the effusion completely fills the MEC,the maximum hearing loss reaches 46.47 dB,and the EA rate approaches zero across the entire frequency range.These findings provide theoretical insights into the biomechanical effects of MEE on human auditory transmission and offer a reference for clinical diagnosis and evaluation.展开更多
BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy w...BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy with tympanostomy tube.While both procedures aim to improve hearing outcomes,the efficacy of these approaches has been a subject of ongoing research and debate.AIM To compare the efficacy of myringotomy alone and myringotomy with tympa-nostomy tube.METHODS In this comparative study,66 patients diagnosed as OME meeting the inclusion criteria were selected via ear,nose and throat department.They were divided into two groups randomly,each of 33 patients.In the first group(Group A)myrin-gotomy alone was performed while in the second group(Group B)myringotomy with tympanostomy tube placement was performed.We observed hearing outcome by pure tone audiogram(PTA)pre operatively.Patients were followed up and re-assessed in outdoor patient department at 4th week postoperatively again by PTA.RESULTS The mean age of the patients in Group A was 10.96±2.76 SD but the mean age of the patients in Group B was 10.22±2.73 SD(P=0.1056).In Group A,males were 63.6%and females were 36.3%.Also in Group B,males were 63.6%and females were 36.3%(P=1.0).In group A,post operative hearing gain using pure tone audiometry at one month was 20.45±3.78 SD while in group B,post operative hearing gain using pure tone audiometry at one month was 23.84±3.69 SD(P=0.00005).However,ear discharge was noted in 3.03%cases in group A and 15.15%cases in group B(P=0.035).By applying independent t-test,the P<0.05 indicated that there is a significant association between Group B and hearing improvement at 4th week.CONCLUSION Our study concluded that myringotomy with tympanostomy tube seems to have better hearing results than myringotomy alone in treatment of OME.展开更多
Dear Editor,We reported the case of idiopathic uveal effusion syndrome(IUES)with increased intraocular pressure.IUES is a disease caused by an abnormal increase in serous exudation of the choriocapillaris in the eye f...Dear Editor,We reported the case of idiopathic uveal effusion syndrome(IUES)with increased intraocular pressure.IUES is a disease caused by an abnormal increase in serous exudation of the choriocapillaris in the eye for unknown reasons;it accumulates in the choroid and subretinal space,leading to choroidal and ciliary body detachment and nonrhegmatogenous retinal detachment[1].The diagnosis of IUES requires the exclusion of other causes of uveal effusion,such as choroidal tumors,uveitis,and surgical causes[2-3].展开更多
Background:The diagnosis of tuberculous pleurisy(TP)presents a significant challenge due to the low bacterial load in pleural effusion(PE)samples.Cell-free Mycobacterium tuberculosis DNA(cf-TB)in PE samples is conside...Background:The diagnosis of tuberculous pleurisy(TP)presents a significant challenge due to the low bacterial load in pleural effusion(PE)samples.Cell-free Mycobacterium tuberculosis DNA(cf-TB)in PE samples is considered an optimal biomarker for diagnosing TP.This study aimed to evaluate the applicability of cf-TB testing across diverse research sites with a relatively large sample size.Methods:Patients suspected of TP and presenting with clinical symptoms and radiological evidence of PE were consecutively enrolled by treating physicians from 11 research sites across 6 provinces in China between April 2020 and August 2022.Following centrifugation,sediments obtained from PE were used for Xpert MTB/RIF(Xpert)and mycobacterial culture,while the supernatants were subjected to cf-TB testing.This study employed a composite reference standard to definite TP,which was characterized by any positive result for Mycobacterium tuberculosis(MTB)through either PE culture,PE Xpert,or pleural biopsy.Results:A total of 1412 participants underwent screening,and 1344(95.2%)were subsequently enrolled in this study.Data from 1241(92.3%)participants were included,comprising 284 with definite TP,677 with clinically diagnosed TP,and 280 without TP.The sensitivity of cf-TB testing in definite TP was 73.6%(95%CI 68.2%-78.4%),significantly higher than both Xpert(40.8%,95%CI 35.3%-46.7%,P<0.001)and mycobacterial culture(54.2%,95%CI 48.4%-59.9%,P<0.001).When clinically diagnosed TP was incorporated into the composite reference standard for sensitivity analysis,cf-TB testing showed a sensitivity of 46.8%(450/961,95%CI 43.7%-50.0%),significantly higher than both Xpert(12.1%,116/961,95%CI 10.2%-14.3%,P<0.001)and mycobacterial culture(16.0%,154/961,95%CI 13.8%-18.5%,P<0.001).The specificities of cf-TB testing,Xpert,and mycobacterial culture were all 100.0%.Conclusions:The performance of cf-TB testing is significantly superior to that of Xpert and mycobacterial culture methods,indicating that it can be considered as the primary diagnostic approach for improving TP detection.Trial registration:The trial was registered on Chictr.org.cn(ChiCTR2000031680,https://www.chictr.org.cn/showproj.html?proj=49316).展开更多
This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was f...This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was formed by combining 28,309 samples from the ChestX-ray14,PadChest,and CheXpert databases,with 10,287,6022,and 12,000 samples representing Pleural Effusion,Pulmonary Edema,and Normal cases,respectively.Consequently,the preprocessing step involves applying the Contrast Limited Adaptive Histogram Equalization(CLAHE)method to boost the local contrast of the X-ray samples,then resizing the images to 380×380 dimensions,followed by using the data augmentation technique.The classification task employs a deep learning model based on the EfficientNet-V1-B4 architecture and is trained using the AdamW optimizer.The proposed multiclass system achieved an accuracy(ACC)of 98.3%,recall of 98.3%,precision of 98.7%,and F1-score of 98.7%.Moreover,the robustness of the model was revealed by the Receiver Operating Characteristic(ROC)analysis,which demonstrated an Area Under the Curve(AUC)of 1.00 for edema and normal cases and 0.99 for effusion.The experimental results demonstrate the superiority of the proposedmulti-class system,which has the potential to assist clinicians in timely and accurate diagnosis,leading to improved patient outcomes.Notably,ablation-CAM visualization at the last convolutional layer portrayed further enhanced diagnostic capabilities with heat maps on X-ray images,which will aid clinicians in interpreting and localizing abnormalities more effectively.展开更多
BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung diseas...BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.展开更多
BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory an...BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.展开更多
Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effu...Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.展开更多
Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LU...Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.展开更多
Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria invol...Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria involved in effusion fluid infections in paediatrics in order to improve the choice of probabilistic antibiotics therapy. Methods: A cross-sectional, descriptive study was used in children aged 0 to 15 years from 2017 to 2020 at the Charles De Gaulle Pediatric University Hospital Center (CHUP-CDG) in Ouagadougou. Classical bacteriology methods such as macroscopy, Gram staining, identification galleries and antibiotics susceptibility testing were used. Results: Of 231 samples, 64 bacteria were isolated. The most common bacterial strains of pleural fluid were Staphylococcus aureus (25%) and 40% for Enterobacteriaceae. Of the peritoneal fluid, 77% were Enterobacteriaceae with 57% Escherichia coli;and from joint fluid, 33% were S. aureus and 22% for P. aeruginosa. The overall susceptibility profile showed 29% extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), 10% methicillin-resistant S. aureus (MRSA), and 8% carbapenemases. Conclusion: Bacteriological profile is characterized by ESBL-producing Enterobacteriaceae and MRSA. The most active antibiotics were macrolides, aminoglycosides, and cefoxitin (methicillin) for Gram-positive cocci, carbapenems, and aminoglycosides for Gram-negative bacilli. Then, the monitoring of antibiotics resistance must be permanent.展开更多
Background: Malignant pleural effusion (MPE) is the most common complication of advanced NSCLC. Infusion chemotherapy is currently one of the most common intracavitary treatments for MPE. Unfortunately, there is no de...Background: Malignant pleural effusion (MPE) is the most common complication of advanced NSCLC. Infusion chemotherapy is currently one of the most common intracavitary treatments for MPE. Unfortunately, there is no definitive consensus on which intracavitary infusion drug has the best effect on the treatment. The use of de-platinum-based thoracic perfusion therapy can offer several advantages, such as reducing drug toxicity and contributing to an improvement in patients’ physical condition. Therefore, this study was to investigate the clinical efficacy and safety of de-platinum-based pleural perfusion bevacizumab combined with Brucea Javanica Oil Emulsion Injection (BJOEI) in the treatment of malignant pleural effusion in advanced lung adenocarcinoma. Methods: A total of 60 patients diagnosed with lung adenocarcinoma and malignant pleural effusion were selected from Binzhou People’s Hospital, Shandong Provincial Cancer Hospital, and Binzhou Central Hospital between June 2022 and May 2024, with 30 cases treated in each group. The study was divided into two groups: the treatment group received bevacizumab injection perfusion in combination with intravenous infusion of Brucea Javanica Oil Emulsion Injection (BJOEI), while the control group received bevacizumab injection combined with cisplatin perfusion. To analyze the data and evaluate their efficacy and adverse reactions, such as disease control rate (DCR), overall response rate (ORR), Karnofsky Performance Status (KPS), vascular endothelial growth factor (VEGF), and so forth. Results: Following the treatment, the quality of life scores in both groups exhibited an increase compared to pre-treatment levels. Moreover, the enhancement observed in the treatment group was deemed statistically significant (P = 0.007). Following treatment, The expression of VEGF in the pleural effusion of both groups of patients was significantly decreased, and the disparity within the same group was found to be statistically significant (P P χ2 = 0.317, P = 0.573;χ2 = 0.218, P = 0.640). A stratified analysis of factors influencing the ORR revealed that the ORR in both groups exhibited statistical significance when the previous KPS score was below 70 (χ2 = 5.850, P = 0.016). The main adverse reactions in both groups included nausea, vomiting, gastrointestinal reactions, fatigue, and hematological toxicity. Among them, there was a statistically significant difference in the occurrence of gastrointestinal reactions and fatigue between the two groups (χ2 = 8.148, P = 0.004;χ2 = 6.696, P = 0.010). Conclusion: Bevacizumab, when combined with Brucea Javanica Oil Emulsion Injection (BJOEI), demonstrates noteworthy efficacy in treating malignant pleural effusion. This combination therapy reduces VEGF expression, in which the reduction supports the efficacy of thoracic perfusion and is associated with minimal adverse reactions, contributing to an improvement in patients’ physical condition and overall clinical tolerability, especially for the poor physique, especially in the elderly and KPS score is less than 70. Therefore, it can be considered a recommended approach for managing malignant pleural effusion, offering significant clinical value.展开更多
In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of m...In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.展开更多
文摘BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.
基金Supported by Shaanxi Science and Technology Project(No.2022SF-434)Xi’an Science and Technology Project(No.21YXYJ0044).
文摘I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload due to elevated pulmonary vascular resistance,leading to right heart failure and death[1].Notably,ocular complications of pulmonary hypertension have been reported less frequently[2-5].Ophthalmologists need to increase the understanding of the disease so as to perform the proper treatment for these patients.Ethical Approval The study was conducted in accordance with the principles of the Declaration of Helsinki.Written informed consent was obtained from the patient for publication of the images and data included in this article.
文摘BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.
文摘BACKGROUND Although inflammatory diseases commonly affect the pleura and pleural space,their mechanisms of action remain unclear.The presence of several mediators emphasizes the concept of pleural inflammation.Adenosine deaminase(ADA)is an inflammatory mediator detected at increased levels in the pleural fluid.AIM To determine the role of total pleural ADA(P-ADA)levels in the diagnosis of pleural inflammatory diseases.METHODS 157 patients with inflammatory pleural effusion(exudates,n=124,79%)and noninflammatory pleural effusion(transudates,n=33,21%)were included in this observational retrospective cohort study.The P-ADA assay was tested using a kinetic technique.The performance of the model was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.RESULTS The transudates included congestive heart failure(n=26),cirrhosis of the liver with ascites(n=3),chronic renal failure(n=3),and low total protein levels(n=1).The exudate cases included tuberculosis(n=44),adenocarcinoma(n=37),simple parapneumonic effusions(n=15),complicated parapneumonic effusions/empyema(n=8),lymphoma(n=7),and other diseases(n=13).The optimal cutoff value of P-ADA was≥9.00 U/L.The diagnostic parameters as sensitivity,specificity,positive and negative predictive values,positive and negative likelihood values,odds ratio,and accuracy were 77.69(95%CI:69.22-84.75);68.75(95%CI:49.99-83.88);90.38 and 44.90(95%CI:83.03-95.29;30.67-59.77);2.48 and 0.32(95%CI:2.21-11.2;0.27-0.51);7.65(95%CI:0.78-18.34),and 75.82(95%CI:68.24-82.37),respectively(χ^(2)=29.51,P=0.00001).An AUC value of 0.8107(95%CI:0.7174-0.8754;P=0.0000)was clinically useful.The Hosmer-Lemeshow test showed excellent discrimination.CONCLUSION P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.
文摘Pleural effusion,characterized by the accumulation of fluid in the pleural space,poses significant challenges in clinical practice,especially in determining whether it belongs to the inflammatory exudates or non-inflammatory transudates.Adenosine deaminase(ADA),an enzyme primarily produced by immune cells,particularly lymphocytes,increase in response to inflammatory conditions,including tuberculosis and malignancies.Elevated ADA levels in pleural have been shown to correlate with inflammatory exudates,making it a valuable biomarker for dif-ferentiating between inflammatory and non-inflammatory effusions.Moreover,numerous studies have demonstrated the treatment function of ADA in inflammation-related pleural effusion syndrome.Recently,research has established the values for the implication of ADA in diagnosing and managing pleural disease.Based on these findings,ADA becomes a reliable,non-invasive marker for early diagnosis and the appropriate treatment for pleural inflammation,ultimately improving patient outcomes.
文摘This editorial underscores the importance of Maranhão et al’s study,which investigates pleural adenosine deaminase(P-ADA)as a biomarker for inflammatory pleural effusions.Despite advances in imaging,distinguishing between inflammatory and non-inflammatory causes of pleural effusion remains a diagnostic challenge.The authors conducted a rigorous retrospective cohort analysis of 157 patients(124 with inflammatory exudates and 33 with non-inflammatory transudates),establishing a robust cutoff value of P-ADA≥9.00 U/L for diagnosing inflammatory diseases using receiver operating characteristic curve analysis and internal statistical calibration.This is the first study to define a standardized PADA threshold in a Brazilian cohort,addressing previous inconsistencies in cutoff values.Furthermore,the authors delved into the pathophysiological mechanisms underlying elevated P-ADA,linking it to purinergic signaling pathways and immune cell activation,particularly emphasizing the role of ADA2 isoforms in macrophages and lymphocytes.Their findings support P-ADA as a non-invasive,cost-effective biomarker for early diagnosis,treatment stratification,and minimizing the need for invasive procedures such as thoracentesis.This has particular relevance in resource-limited settings,where streamlined diagnostics can reduce healthcare costs and improve patient outcomes.Future studies must prioritize global validation,explore the integration of adenosine deaminase with additional biomarkers(e.g.,interleukin 6,C-reactive protein),and support the development of point-of-care technologies.
文摘BACKGROUND Traumatic subdural effusion is a common complication of traumatic brain injury,especially after decompressive craniectomy(DC).For neurosurgeons,early diagnosis and timely treatment are particularly important,which can help improve patient prognosis and enhance quality of life.CASE SUMMARY A 47 year old male underwent DC for traumatic brain herniation.After surgery,he developed stubborn subdural effusion(SDE)on the contralateral side and underwent multiple subdural drilling and drainage surgeries,but only temporarily improved the patient’s symptoms.After the final cranioplasty,the contralateral SDE completely disappeared.The patient did not experience any new contralateral neurological dysfunction,and the Glasgow prognostic score was 11 points(E4V1M6).CONCLUSION For neurosurgeons,accurate assessment of the condition is necessary when treating patients with stubborn SDE after DC surgery,and timely cranioplasty can be performed to avoid multiple surgeries.This is a safe and effective surgical method for treating traumatic subdural effusion.
基金Anhui Provincial Natural Science Foundation of China(2108085ME176)the Natural Science Foundation of China(52276043)。
文摘Double-wall effusion cooling coupled with thermal barrier coating(TBC)is an important way of thermal protection for gas turbine vanes and blades of next-generation aero-engine,and formation of discrete crater holes by TBC spraying is an approved design.To protect both metal and TBC synchronously,a recommended geometry of crater is obtained through a fully automatic multi-objective optimization combined with conjugate heat transfer simulation in this work.The length and width of crater(i.e.,L/D and W/D)were applied as design variables,and the area-averaged overall effectiveness of the metal and TBC surfaces(i.e.,Φ_(av) and τ_(av))were selected as objective functions.The optimization procedure consists of automated geometry and mesh generation,conjugate heat transfer simulation validated by experimental data and Kriging surrogated model.The results showed that the Φ_(av) and τ_(av) are successfully increased respectively by 9.1%and 6.0%through optimization.Appropriate enlargement of the width and length of the crater can significantly improve the film coverage effect,since that the beneficial anti-CRVP is enhanced and the harmful CRVP is weakened.
基金supported by the National Natural Science Foundation of China(52275296)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘This study aims to investigate the impact of middle ear effusion(MEE)on sound transmission in the human ear and its potential diagnostic significance.Firstly,the material properties of specific structures were adjusted based on the existing human ear finite element(FE)model,and the accuracy of the model was validated using experimental data.Secondly,six FE models were developed to simulate varying degrees of MEE by systematically altering the material properties of the middle ear cavity(MEC)at different anatomical locations.Finally,the effects of these six FE models,representing varying degrees of MEE,on sound transmission characteristics and energy absorption(EA)rate in the human ear were systematically analyzed.When the degree of MEE is less than 50%of the MEC volume,its impact on the sound transmission characteristics of the human ear remains minimal,resulting in an estimated hearing loss of approximately 3 dB,with EA rate remaining close to normal levels.Once the effusion exceeds 50%of the MEC volume,a significant deterioration in acoustic transmission is observed,accompanied by a flattening of the EA curve and a drop in EA rates to below 20%.When the effusion completely fills the MEC,the maximum hearing loss reaches 46.47 dB,and the EA rate approaches zero across the entire frequency range.These findings provide theoretical insights into the biomechanical effects of MEE on human auditory transmission and offer a reference for clinical diagnosis and evaluation.
文摘BACKGROUND Otitis media with effusion(OME),glue ear,serous otitis media,or secretory otitis media is a common paediatric condition.Two widely used surgical interventions for OME are myringotomy alone and myringotomy with tympanostomy tube.While both procedures aim to improve hearing outcomes,the efficacy of these approaches has been a subject of ongoing research and debate.AIM To compare the efficacy of myringotomy alone and myringotomy with tympa-nostomy tube.METHODS In this comparative study,66 patients diagnosed as OME meeting the inclusion criteria were selected via ear,nose and throat department.They were divided into two groups randomly,each of 33 patients.In the first group(Group A)myrin-gotomy alone was performed while in the second group(Group B)myringotomy with tympanostomy tube placement was performed.We observed hearing outcome by pure tone audiogram(PTA)pre operatively.Patients were followed up and re-assessed in outdoor patient department at 4th week postoperatively again by PTA.RESULTS The mean age of the patients in Group A was 10.96±2.76 SD but the mean age of the patients in Group B was 10.22±2.73 SD(P=0.1056).In Group A,males were 63.6%and females were 36.3%.Also in Group B,males were 63.6%and females were 36.3%(P=1.0).In group A,post operative hearing gain using pure tone audiometry at one month was 20.45±3.78 SD while in group B,post operative hearing gain using pure tone audiometry at one month was 23.84±3.69 SD(P=0.00005).However,ear discharge was noted in 3.03%cases in group A and 15.15%cases in group B(P=0.035).By applying independent t-test,the P<0.05 indicated that there is a significant association between Group B and hearing improvement at 4th week.CONCLUSION Our study concluded that myringotomy with tympanostomy tube seems to have better hearing results than myringotomy alone in treatment of OME.
基金Supported by the National Natural Science Foundation of China(No.81600747)Foundation of Liaoning Province Education Administration(No.JYTMS20230089)Joint Project Planned by the Department of Science and Technology of Liaoning Province(No.2023JH2/101700129).
文摘Dear Editor,We reported the case of idiopathic uveal effusion syndrome(IUES)with increased intraocular pressure.IUES is a disease caused by an abnormal increase in serous exudation of the choriocapillaris in the eye for unknown reasons;it accumulates in the choroid and subretinal space,leading to choroidal and ciliary body detachment and nonrhegmatogenous retinal detachment[1].The diagnosis of IUES requires the exclusion of other causes of uveal effusion,such as choroidal tumors,uveitis,and surgical causes[2-3].
基金supported by the Beijing Municipal Science and Technology Project(Z191100006619079)the General Program of the National Natural Science Foundation of China(82072381).
文摘Background:The diagnosis of tuberculous pleurisy(TP)presents a significant challenge due to the low bacterial load in pleural effusion(PE)samples.Cell-free Mycobacterium tuberculosis DNA(cf-TB)in PE samples is considered an optimal biomarker for diagnosing TP.This study aimed to evaluate the applicability of cf-TB testing across diverse research sites with a relatively large sample size.Methods:Patients suspected of TP and presenting with clinical symptoms and radiological evidence of PE were consecutively enrolled by treating physicians from 11 research sites across 6 provinces in China between April 2020 and August 2022.Following centrifugation,sediments obtained from PE were used for Xpert MTB/RIF(Xpert)and mycobacterial culture,while the supernatants were subjected to cf-TB testing.This study employed a composite reference standard to definite TP,which was characterized by any positive result for Mycobacterium tuberculosis(MTB)through either PE culture,PE Xpert,or pleural biopsy.Results:A total of 1412 participants underwent screening,and 1344(95.2%)were subsequently enrolled in this study.Data from 1241(92.3%)participants were included,comprising 284 with definite TP,677 with clinically diagnosed TP,and 280 without TP.The sensitivity of cf-TB testing in definite TP was 73.6%(95%CI 68.2%-78.4%),significantly higher than both Xpert(40.8%,95%CI 35.3%-46.7%,P<0.001)and mycobacterial culture(54.2%,95%CI 48.4%-59.9%,P<0.001).When clinically diagnosed TP was incorporated into the composite reference standard for sensitivity analysis,cf-TB testing showed a sensitivity of 46.8%(450/961,95%CI 43.7%-50.0%),significantly higher than both Xpert(12.1%,116/961,95%CI 10.2%-14.3%,P<0.001)and mycobacterial culture(16.0%,154/961,95%CI 13.8%-18.5%,P<0.001).The specificities of cf-TB testing,Xpert,and mycobacterial culture were all 100.0%.Conclusions:The performance of cf-TB testing is significantly superior to that of Xpert and mycobacterial culture methods,indicating that it can be considered as the primary diagnostic approach for improving TP detection.Trial registration:The trial was registered on Chictr.org.cn(ChiCTR2000031680,https://www.chictr.org.cn/showproj.html?proj=49316).
文摘This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was formed by combining 28,309 samples from the ChestX-ray14,PadChest,and CheXpert databases,with 10,287,6022,and 12,000 samples representing Pleural Effusion,Pulmonary Edema,and Normal cases,respectively.Consequently,the preprocessing step involves applying the Contrast Limited Adaptive Histogram Equalization(CLAHE)method to boost the local contrast of the X-ray samples,then resizing the images to 380×380 dimensions,followed by using the data augmentation technique.The classification task employs a deep learning model based on the EfficientNet-V1-B4 architecture and is trained using the AdamW optimizer.The proposed multiclass system achieved an accuracy(ACC)of 98.3%,recall of 98.3%,precision of 98.7%,and F1-score of 98.7%.Moreover,the robustness of the model was revealed by the Receiver Operating Characteristic(ROC)analysis,which demonstrated an Area Under the Curve(AUC)of 1.00 for edema and normal cases and 0.99 for effusion.The experimental results demonstrate the superiority of the proposedmulti-class system,which has the potential to assist clinicians in timely and accurate diagnosis,leading to improved patient outcomes.Notably,ablation-CAM visualization at the last convolutional layer portrayed further enhanced diagnostic capabilities with heat maps on X-ray images,which will aid clinicians in interpreting and localizing abnormalities more effectively.
文摘BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.
文摘BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.
文摘Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.
文摘Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.
文摘Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria involved in effusion fluid infections in paediatrics in order to improve the choice of probabilistic antibiotics therapy. Methods: A cross-sectional, descriptive study was used in children aged 0 to 15 years from 2017 to 2020 at the Charles De Gaulle Pediatric University Hospital Center (CHUP-CDG) in Ouagadougou. Classical bacteriology methods such as macroscopy, Gram staining, identification galleries and antibiotics susceptibility testing were used. Results: Of 231 samples, 64 bacteria were isolated. The most common bacterial strains of pleural fluid were Staphylococcus aureus (25%) and 40% for Enterobacteriaceae. Of the peritoneal fluid, 77% were Enterobacteriaceae with 57% Escherichia coli;and from joint fluid, 33% were S. aureus and 22% for P. aeruginosa. The overall susceptibility profile showed 29% extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), 10% methicillin-resistant S. aureus (MRSA), and 8% carbapenemases. Conclusion: Bacteriological profile is characterized by ESBL-producing Enterobacteriaceae and MRSA. The most active antibiotics were macrolides, aminoglycosides, and cefoxitin (methicillin) for Gram-positive cocci, carbapenems, and aminoglycosides for Gram-negative bacilli. Then, the monitoring of antibiotics resistance must be permanent.
文摘Background: Malignant pleural effusion (MPE) is the most common complication of advanced NSCLC. Infusion chemotherapy is currently one of the most common intracavitary treatments for MPE. Unfortunately, there is no definitive consensus on which intracavitary infusion drug has the best effect on the treatment. The use of de-platinum-based thoracic perfusion therapy can offer several advantages, such as reducing drug toxicity and contributing to an improvement in patients’ physical condition. Therefore, this study was to investigate the clinical efficacy and safety of de-platinum-based pleural perfusion bevacizumab combined with Brucea Javanica Oil Emulsion Injection (BJOEI) in the treatment of malignant pleural effusion in advanced lung adenocarcinoma. Methods: A total of 60 patients diagnosed with lung adenocarcinoma and malignant pleural effusion were selected from Binzhou People’s Hospital, Shandong Provincial Cancer Hospital, and Binzhou Central Hospital between June 2022 and May 2024, with 30 cases treated in each group. The study was divided into two groups: the treatment group received bevacizumab injection perfusion in combination with intravenous infusion of Brucea Javanica Oil Emulsion Injection (BJOEI), while the control group received bevacizumab injection combined with cisplatin perfusion. To analyze the data and evaluate their efficacy and adverse reactions, such as disease control rate (DCR), overall response rate (ORR), Karnofsky Performance Status (KPS), vascular endothelial growth factor (VEGF), and so forth. Results: Following the treatment, the quality of life scores in both groups exhibited an increase compared to pre-treatment levels. Moreover, the enhancement observed in the treatment group was deemed statistically significant (P = 0.007). Following treatment, The expression of VEGF in the pleural effusion of both groups of patients was significantly decreased, and the disparity within the same group was found to be statistically significant (P P χ2 = 0.317, P = 0.573;χ2 = 0.218, P = 0.640). A stratified analysis of factors influencing the ORR revealed that the ORR in both groups exhibited statistical significance when the previous KPS score was below 70 (χ2 = 5.850, P = 0.016). The main adverse reactions in both groups included nausea, vomiting, gastrointestinal reactions, fatigue, and hematological toxicity. Among them, there was a statistically significant difference in the occurrence of gastrointestinal reactions and fatigue between the two groups (χ2 = 8.148, P = 0.004;χ2 = 6.696, P = 0.010). Conclusion: Bevacizumab, when combined with Brucea Javanica Oil Emulsion Injection (BJOEI), demonstrates noteworthy efficacy in treating malignant pleural effusion. This combination therapy reduces VEGF expression, in which the reduction supports the efficacy of thoracic perfusion and is associated with minimal adverse reactions, contributing to an improvement in patients’ physical condition and overall clinical tolerability, especially for the poor physique, especially in the elderly and KPS score is less than 70. Therefore, it can be considered a recommended approach for managing malignant pleural effusion, offering significant clinical value.
基金This project was supported by a grant from the Science and Technology Foundation of Hubei Province (2003AA301C10)
文摘In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.
