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
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
BACKGROUND Malignant pleural mesothelioma(MPM),a rare aggressive malignancy,is primarily caused by asbestos exposure.MPM typically affects older adults(median age,76 years),is uncommon in those under age 50 years and ...BACKGROUND Malignant pleural mesothelioma(MPM),a rare aggressive malignancy,is primarily caused by asbestos exposure.MPM typically affects older adults(median age,76 years),is uncommon in those under age 50 years and shows male predominance.Based on the American Society of Clinical Oncology guidelines,F-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT)is essential for initial MPM staging.Integrating quantitative FDG metabolic data with computed tomography(CT)anatomy optimizes biopsy accuracy and staging.CASE SUMMARY A 21-year-old female college student presented with fever(peak 38.4°C),cough,and white mucoid sputum after cold exposure.Initial evaluation revealed elevated C-reactive protein[C-reactive protein(CRP);65.52 mg/L]and Mycoplasma pneumoniae IgM.Despite resolution of fever following a 14-day moxifloxacin regimen,persistent cough prompted chest CT,which demonstrated left pleural mass-like thickenings.Levofloxacin therapy for 2 weeks failed to alleviate symptoms,accompanied by 2.5-kg weight loss over 1 month.Re-evaluation showed rising CRP(88.87 mg/L)with stable CT lesions,and negative T-cell spot test for tuberculosis and tumor markers.Contrast-enhanced CT revealed heterogeneously enhancing masses,while PET/CT detected two broad-based pleural lesions with intense FDG avidity.CT-guided biopsy confirmed epithelioid MPM.Thoracoscopy exposed diffuse fragile,hemorrhagic nodules implanting on diaphragmatic and parietal pleura,confirming metastatic MPM with partial resection performed.This presentation challenges conventional imaging paradigms of MPM,underscoring its diagnostic complexity.CONCLUSION MPM should still be considered an important differential diagnosis in young patients presenting with solitary pleural masses and no history of typical asbestos exposure.F-18 FDG PET/CT,while serving as an essential component of initial staging for MPM,has some inherent limitations.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
Background:The prognosis of stage IV non-small cell lung cancer(NSCLC)with pleural metastasis is poor,with a 5-year survival rate of only 2%to 4%for patients,with the median survival was 9.5-11.5 months.According to ...Background:The prognosis of stage IV non-small cell lung cancer(NSCLC)with pleural metastasis is poor,with a 5-year survival rate of only 2%to 4%for patients,with the median survival was 9.5-11.5 months.According to the“NCCN Lung Cancer Guidelines,”stage IV NSCLC lung cancer is a contraindication for surgery.It is recommended to adopt a standard treatment plan mainly based on chemotherapy or targeted therapy with EGFR-TKIs.However,Neoadjuvant therapy with alectinib for non-small cell lung cancer with pleural metastasis is rarely reported.Case presentation:A 41-year-old Asian male patient presented with a persistent cough for one month.A chest computed tomography(CT)scan conducted two years prior revealed that a nodular radiative anomalous concentrated shadow was observed in the inferior tongue segment of the upper lobe of the left lung,approximately 2.2×1.6×1.2 cm in size,with a SUVmax of about 5.5.Two small nodular shadows were seen beside the disease in the inferior lingual segment of the upper lobe of the left lung,with the larger one having a diameter of approximately 0.6 cm.Multiple lymph node metastases in the left hilum and mediastinum;Multiple metastases of the left pleura and a small amount of pleural effusion on the left side.The patient began to receive 2 courses of chemotherapy and targeted therapy(pemetrexed+carboplatin+crizotinib)and 1 course of chemotherapy and other targeted therapy(pemetrexed+carboplatin+alectinib).The result of re-examination of CT demonstrated that peripheral lung cancer in the lower lingual segment of the left upper lung is approximately 0.8×0.9 cm in size,slightly smaller than before.A thoracoscopic lobectomy was performed,and the pulmonary bulla was removed concurrently.Pathological examination confirmed non-small cell lung carcinoma(NSCLC)in the mass.Patient discharged on the 7th day after the operation and received 2 courses of chemotherapy(pemetrexed+carboplatin)and had been receiving alectinib targeted drug treatment all along for over 5 years.However,the patient stopped taking the medicine on his own for half a year.Though in the recent CT examination,the result demonstrated no recurrence and metastasis and the patient has been clinically cured.Unfortunately,the results of brain magnetic resonance imaging suggested that multiple brain metastases of lung cancer occurred,and the patient began taking the third-generation ALK-targeted drug lorlatinib.Conclusions:The patient with stage IV non-small cell lung cancer(NSCLC)presenting with pleural metastasis received neoadjuvant alectinib therapy and underwent thoracoscopic lobectomy,which resulted in significant therapeutic effects and fulfilled the criteria for clinical cure.This case highlights the potential for improved preventative strategies and treatment approaches in similar patients.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
BACKGROUND Kidney transplantation is the best option for patients with end-stage renal disease.However,the need for lifelong immunosuppression results in renal transplant recipients being susceptible to various infect...BACKGROUND Kidney transplantation is the best option for patients with end-stage renal disease.However,the need for lifelong immunosuppression results in renal transplant recipients being susceptible to various infections.Rhodococcus equi(R.equi)is a rare opportunistic pathogen in humans,and there are limited reports of infection with R.equi in post-renal transplant recipients and no uniform standard of treat-ment.This article reports on the diagnosis and treatment of a renal transplant recipient infected with R.equi 21 mo postoperatively and summarizes the charac-teristics of infection with R.equi after renal transplantation,along with a detailed review of the literature.Here,we present the case of a 25-year-old man who was infected with R.equi 21 mo after renal transplantation.Although the clinical features at the time of presentation were not specific,chest computed tomography(CT)showed a large volume of pus in the right thoracic cavity and right middle lung atelectasis,and fiberoptic bronchoscopy showed an endobronchial mass in the right middle and lower lobe orifices.Bacterial culture and metagenomic next-generation sequen-cing sequencing of the pus were suggestive of R.equi infection.The immunosup-pressive drugs were immediately suspended and intravenous vancomycin and azithromycin were administered,along with adequate drainage of the abscess.The endobronchial mass was then resected.After the patient’s clinical symptoms and chest CT presentation resolved,he was switched to intravenous ciprofloxacin and azithromycin,followed by oral ciprofloxacin and azithromycin.The patient was re-hospitalized 2 wk after discharge for recurrence of R.equi infection.He recovered after another round of adequate abscess drainage and intravenous ciprofloxacin and azithromycin.CONCLUSION Infection with R.equi in renal transplant recipients is rare and complex,and the clinical presentation lacks specificity.Elaborate antibiotic therapy is required,and adequate abscess drainage and surgical excision are necessary.Given the recurrent nature of R.equi,patients need to be followed-up closely.展开更多
BACKGROUND The bacterium Eikenella,classified as a gram-negative member of the phylum Proteobacteria,is distinguished by its rarity,corrosive nature,facultative anaerobic properties,and conditional pathogenicity.It re...BACKGROUND The bacterium Eikenella,classified as a gram-negative member of the phylum Proteobacteria,is distinguished by its rarity,corrosive nature,facultative anaerobic properties,and conditional pathogenicity.It represents the sole species within its genus-Eikenella corrodens(E.corrodens)-and can be found colonizing both human and animal oral and nasopharyngeal regions.Additionally,it occasionally inhabits the gastrointestinal or urogenital tracts.However,its slow growth rate can be attributed to its high nutritional requirements.However,there is an uneven distribution of construction and diagnostic capacity in China which poses undeniable challenges for the clinical examination and analysis of this case,especially in the basic hospitals.CASE SUMMARY Here we presented a case of empyema associated with E.corrodens infection in a 67-year-old male patient without any previous history of infectious diseases in our primary hospital in Dongguan district of China.The patient was admitted due to recurrent worsening cough,sputum production,and dyspnea for 3 d,which had persisted for over 20 years.Moreover,the patient experienced a onehour episode of unconsciousness.Upon admission,immediate comprehensive examinations were conducted on the patient which subsequently led to his admission to the intensive care unit.Meanwhile,the patient presented with drowsiness and profuse sweating along with bilateral conjunctival edema observed during initiation of non-invasive ventilation,suggesting empyema.A significant amount of coffee-colored malodorous pleural fluid was drained during the procedure above and sent to the laboratory department for inspection.Finally,laboratory culture results confirmed the presence of E.corrodens infection in the pleural fluid sample.The patient received antimicrobial therapy until died on day 22 in the hospital.CONCLUSION In this report,we presented a case of empyema associated with E.corrodens infection.Multiple courses of morphological examination,viable culture analysis,and biochemical identification revealed its difficulties in detecting distinctive characteristics,as well as a detection model worth promoting.It’s just that there were still certain deficiencies in terms of morphological assessment,biochemical identification,and drug susceptibility testing.展开更多
Measles,caused by the measles virus(MeV),is a highly infectious pediatric viral disease and its recovery usually occurs within one week of the onset of the rash[1].However,some patients may develop complications,the m...Measles,caused by the measles virus(MeV),is a highly infectious pediatric viral disease and its recovery usually occurs within one week of the onset of the rash[1].However,some patients may develop complications,the most common of which is pneumonia,often detected at autopsy[2,3].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 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
Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure.The ban on asbestos has helped to lower the incidence,but in ...Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure.The ban on asbestos has helped to lower the incidence,but in developing countries like India,it is expected to rise.It has an extended latency period usually progressing over decades and presents with nonspecific symptoms.It has a median survival ranging between 10-22 months.The diagnosis of malignant pleural mesothelioma is challenging and is done using computed tomography(CT),magnetic resonance imaging,or positron emission tomography-CT,with the last two predicting the resectability of the tumor better than CT alone.A pleural biopsy along with an array of immunohistochemical markers,such as p16,BRCA1 associated protein 1,and claudin-4,are required for a definitive diagnosis.Several genetic alterations have prognostic significance as well.The current histological subtype identification is indispensable for decision making because of the new therapeutic avenues being explored.The combination of nivolumab and ipilimumab-based immunotherapy outperformed platinum and pemetrexed-based chemotherapy in terms of survival benefit and improved quality of life especially for non-epithelioid subtypes.However,the latter continues to be a robust treatment option for patients with the epithelioid subtype.Surgery is recommended for resectable cases with radiotherapy being indicated in neoadjuvant,adjuvant,and palliative settings along with systemic treatment.This review article provides an overview of epidemiology,etiology,clinical manifestations,diagnostic approaches(including immunohistochemical and genetic markers),staging,and multidisciplinary approaches to current treatment for malignant pleural mesothelioma using surgery,chemotherapy,immunotherapy,and radiotherapy.It also sheds light on some recent studies(EMPHACIS,CALGB30901,Checkmate-743,etc.)that have led to significant developments in recent years with clinically meaningful results.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
Pleural involvement of cryptococcal infection is uncommon and is more commonly observed in immunocompromised hosts than in immunocompetent ones.Pleural involvement in cryptococcal infections can manifest with or witho...Pleural involvement of cryptococcal infection is uncommon and is more commonly observed in immunocompromised hosts than in immunocompetent ones.Pleural involvement in cryptococcal infections can manifest with or without pleural effusion.The presence of Cryptococcus spp.in the effusion or pleura is required for the diagnosis of cryptococcal pleural infection,which is commonly determined by pleural biopsy,fluid culture,and/or detection of cryptococcal antigen in the pleura or pleural fluid.展开更多
Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this...Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.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
Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the ...Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the malignant pleural effusion by chemotherapy.Methods:Every time after elimination of pleural effusion,we injected DDP and Nocardia rubra cell wall skeleton at the same time into pleural cavity;or after we emplaced an improved central vena catheter into pleural cavity then took out closed-drainage or eliminated the pleural effusion every day,then injected 5-FU 0.5 qd intrapleural-space.After the malignant pleural effusion had being controlled,800μg Nocardia rubra cell wall skeleton was injected intrapleural-space. (We call it as"improved following-therapy").Results:Using the improved following-therapy,the control rate of malignant pleural effusion increased:CR+PR,79.07%>65.79%(P<0.05),and the incidence rate of the encapsulated pleural effusion that would impact on patient’s respiratory faction decreased.Conclusion:Giving chemotherapy after closed-drainage or immediately after taking out pleural effusion everyday,then giving biotherapy after pleural effusion had been controlled,the curative effect would be enhanced and the side-reaction would be reduced.展开更多
BACKGROUND Paragonimiasis is a parasitic disease that has multiple symptoms,with pulmonary types being common.According to our clinical practices,the pleural effusion of our patients is full of fibrous contents.Draina...BACKGROUND Paragonimiasis is a parasitic disease that has multiple symptoms,with pulmonary types being common.According to our clinical practices,the pleural effusion of our patients is full of fibrous contents.Drainage,praziquantel,and triclabendazole are recommended for the treatment,but when fibrous contents are contained in pleural effusion,surgical interventions are necessary.However,no related reports have been noted.Herein,we present a case of pulmonary paragonimiasis treated by thoracoscopy.CASE SUMMARY A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days.Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani,serological test showed eosinophilia,and moderate left pleural effusion and calcification were detected on computed tomography(CT).She was diagnosed with paragonimiasis,and praziquantel was prescribed.However,radiography showed an egg-sized nodule in the left pleural cavity during follow-up.She was then admitted to our hospital again.The serological results were normal except slight eosinophilia.CT scan displayed a cystic-like node in the lower left pleural cavity.The patient underwent a thoracoscopic mass resection.A mass with a size of 6 cm×4 cm×3 cm adhered to the pleura was resected.The pathological examination showed that the mass was composed of non-structured necrotic tissue,indicating a granuloma.The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass.CONCLUSION This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.展开更多
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.
基金Supported by the Tianjin Science and Technology Project,No.TJWJ2025RC008。
文摘BACKGROUND Malignant pleural mesothelioma(MPM),a rare aggressive malignancy,is primarily caused by asbestos exposure.MPM typically affects older adults(median age,76 years),is uncommon in those under age 50 years and shows male predominance.Based on the American Society of Clinical Oncology guidelines,F-18 fluorodeoxyglucose positron emission tomography/computed tomography(F-18 FDG PET/CT)is essential for initial MPM staging.Integrating quantitative FDG metabolic data with computed tomography(CT)anatomy optimizes biopsy accuracy and staging.CASE SUMMARY A 21-year-old female college student presented with fever(peak 38.4°C),cough,and white mucoid sputum after cold exposure.Initial evaluation revealed elevated C-reactive protein[C-reactive protein(CRP);65.52 mg/L]and Mycoplasma pneumoniae IgM.Despite resolution of fever following a 14-day moxifloxacin regimen,persistent cough prompted chest CT,which demonstrated left pleural mass-like thickenings.Levofloxacin therapy for 2 weeks failed to alleviate symptoms,accompanied by 2.5-kg weight loss over 1 month.Re-evaluation showed rising CRP(88.87 mg/L)with stable CT lesions,and negative T-cell spot test for tuberculosis and tumor markers.Contrast-enhanced CT revealed heterogeneously enhancing masses,while PET/CT detected two broad-based pleural lesions with intense FDG avidity.CT-guided biopsy confirmed epithelioid MPM.Thoracoscopy exposed diffuse fragile,hemorrhagic nodules implanting on diaphragmatic and parietal pleura,confirming metastatic MPM with partial resection performed.This presentation challenges conventional imaging paradigms of MPM,underscoring its diagnostic complexity.CONCLUSION MPM should still be considered an important differential diagnosis in young patients presenting with solitary pleural masses and no history of typical asbestos exposure.F-18 FDG PET/CT,while serving as an essential component of initial staging for MPM,has some inherent limitations.
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.
基金Guangzhou Municipal Health Commission Project(Project No.:2023C-TS17)。
文摘Background:The prognosis of stage IV non-small cell lung cancer(NSCLC)with pleural metastasis is poor,with a 5-year survival rate of only 2%to 4%for patients,with the median survival was 9.5-11.5 months.According to the“NCCN Lung Cancer Guidelines,”stage IV NSCLC lung cancer is a contraindication for surgery.It is recommended to adopt a standard treatment plan mainly based on chemotherapy or targeted therapy with EGFR-TKIs.However,Neoadjuvant therapy with alectinib for non-small cell lung cancer with pleural metastasis is rarely reported.Case presentation:A 41-year-old Asian male patient presented with a persistent cough for one month.A chest computed tomography(CT)scan conducted two years prior revealed that a nodular radiative anomalous concentrated shadow was observed in the inferior tongue segment of the upper lobe of the left lung,approximately 2.2×1.6×1.2 cm in size,with a SUVmax of about 5.5.Two small nodular shadows were seen beside the disease in the inferior lingual segment of the upper lobe of the left lung,with the larger one having a diameter of approximately 0.6 cm.Multiple lymph node metastases in the left hilum and mediastinum;Multiple metastases of the left pleura and a small amount of pleural effusion on the left side.The patient began to receive 2 courses of chemotherapy and targeted therapy(pemetrexed+carboplatin+crizotinib)and 1 course of chemotherapy and other targeted therapy(pemetrexed+carboplatin+alectinib).The result of re-examination of CT demonstrated that peripheral lung cancer in the lower lingual segment of the left upper lung is approximately 0.8×0.9 cm in size,slightly smaller than before.A thoracoscopic lobectomy was performed,and the pulmonary bulla was removed concurrently.Pathological examination confirmed non-small cell lung carcinoma(NSCLC)in the mass.Patient discharged on the 7th day after the operation and received 2 courses of chemotherapy(pemetrexed+carboplatin)and had been receiving alectinib targeted drug treatment all along for over 5 years.However,the patient stopped taking the medicine on his own for half a year.Though in the recent CT examination,the result demonstrated no recurrence and metastasis and the patient has been clinically cured.Unfortunately,the results of brain magnetic resonance imaging suggested that multiple brain metastases of lung cancer occurred,and the patient began taking the third-generation ALK-targeted drug lorlatinib.Conclusions:The patient with stage IV non-small cell lung cancer(NSCLC)presenting with pleural metastasis received neoadjuvant alectinib therapy and underwent thoracoscopic lobectomy,which resulted in significant therapeutic effects and fulfilled the criteria for clinical cure.This case highlights the potential for improved preventative strategies and treatment approaches in similar patients.
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).
基金Supported by Science and Technology Project of Guizhou Province,No.ZK[2023]380.
文摘BACKGROUND Kidney transplantation is the best option for patients with end-stage renal disease.However,the need for lifelong immunosuppression results in renal transplant recipients being susceptible to various infections.Rhodococcus equi(R.equi)is a rare opportunistic pathogen in humans,and there are limited reports of infection with R.equi in post-renal transplant recipients and no uniform standard of treat-ment.This article reports on the diagnosis and treatment of a renal transplant recipient infected with R.equi 21 mo postoperatively and summarizes the charac-teristics of infection with R.equi after renal transplantation,along with a detailed review of the literature.Here,we present the case of a 25-year-old man who was infected with R.equi 21 mo after renal transplantation.Although the clinical features at the time of presentation were not specific,chest computed tomography(CT)showed a large volume of pus in the right thoracic cavity and right middle lung atelectasis,and fiberoptic bronchoscopy showed an endobronchial mass in the right middle and lower lobe orifices.Bacterial culture and metagenomic next-generation sequen-cing sequencing of the pus were suggestive of R.equi infection.The immunosup-pressive drugs were immediately suspended and intravenous vancomycin and azithromycin were administered,along with adequate drainage of the abscess.The endobronchial mass was then resected.After the patient’s clinical symptoms and chest CT presentation resolved,he was switched to intravenous ciprofloxacin and azithromycin,followed by oral ciprofloxacin and azithromycin.The patient was re-hospitalized 2 wk after discharge for recurrence of R.equi infection.He recovered after another round of adequate abscess drainage and intravenous ciprofloxacin and azithromycin.CONCLUSION Infection with R.equi in renal transplant recipients is rare and complex,and the clinical presentation lacks specificity.Elaborate antibiotic therapy is required,and adequate abscess drainage and surgical excision are necessary.Given the recurrent nature of R.equi,patients need to be followed-up closely.
基金Supported by the National Science Foundation of China(NSFC),No.81703846Dongguan Science and Technology of Social Development Program,No.20231800940062,No.20231800937142,No.20231800904242,No.20231800904232+1 种基金Doctoral Research Foundation of Binhaiwan Central Hospital in Dongguan,No.BS2023001First Batch of Young Medical Professionals award by the 2018 Tianjin Health Commission.
文摘BACKGROUND The bacterium Eikenella,classified as a gram-negative member of the phylum Proteobacteria,is distinguished by its rarity,corrosive nature,facultative anaerobic properties,and conditional pathogenicity.It represents the sole species within its genus-Eikenella corrodens(E.corrodens)-and can be found colonizing both human and animal oral and nasopharyngeal regions.Additionally,it occasionally inhabits the gastrointestinal or urogenital tracts.However,its slow growth rate can be attributed to its high nutritional requirements.However,there is an uneven distribution of construction and diagnostic capacity in China which poses undeniable challenges for the clinical examination and analysis of this case,especially in the basic hospitals.CASE SUMMARY Here we presented a case of empyema associated with E.corrodens infection in a 67-year-old male patient without any previous history of infectious diseases in our primary hospital in Dongguan district of China.The patient was admitted due to recurrent worsening cough,sputum production,and dyspnea for 3 d,which had persisted for over 20 years.Moreover,the patient experienced a onehour episode of unconsciousness.Upon admission,immediate comprehensive examinations were conducted on the patient which subsequently led to his admission to the intensive care unit.Meanwhile,the patient presented with drowsiness and profuse sweating along with bilateral conjunctival edema observed during initiation of non-invasive ventilation,suggesting empyema.A significant amount of coffee-colored malodorous pleural fluid was drained during the procedure above and sent to the laboratory department for inspection.Finally,laboratory culture results confirmed the presence of E.corrodens infection in the pleural fluid sample.The patient received antimicrobial therapy until died on day 22 in the hospital.CONCLUSION In this report,we presented a case of empyema associated with E.corrodens infection.Multiple courses of morphological examination,viable culture analysis,and biochemical identification revealed its difficulties in detecting distinctive characteristics,as well as a detection model worth promoting.It’s just that there were still certain deficiencies in terms of morphological assessment,biochemical identification,and drug susceptibility testing.
文摘Measles,caused by the measles virus(MeV),is a highly infectious pediatric viral disease and its recovery usually occurs within one week of the onset of the rash[1].However,some patients may develop complications,the most common of which is pneumonia,often detected at autopsy[2,3].
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 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Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure.The ban on asbestos has helped to lower the incidence,but in developing countries like India,it is expected to rise.It has an extended latency period usually progressing over decades and presents with nonspecific symptoms.It has a median survival ranging between 10-22 months.The diagnosis of malignant pleural mesothelioma is challenging and is done using computed tomography(CT),magnetic resonance imaging,or positron emission tomography-CT,with the last two predicting the resectability of the tumor better than CT alone.A pleural biopsy along with an array of immunohistochemical markers,such as p16,BRCA1 associated protein 1,and claudin-4,are required for a definitive diagnosis.Several genetic alterations have prognostic significance as well.The current histological subtype identification is indispensable for decision making because of the new therapeutic avenues being explored.The combination of nivolumab and ipilimumab-based immunotherapy outperformed platinum and pemetrexed-based chemotherapy in terms of survival benefit and improved quality of life especially for non-epithelioid subtypes.However,the latter continues to be a robust treatment option for patients with the epithelioid subtype.Surgery is recommended for resectable cases with radiotherapy being indicated in neoadjuvant,adjuvant,and palliative settings along with systemic treatment.This review article provides an overview of epidemiology,etiology,clinical manifestations,diagnostic approaches(including immunohistochemical and genetic markers),staging,and multidisciplinary approaches to current treatment for malignant pleural mesothelioma using surgery,chemotherapy,immunotherapy,and radiotherapy.It also sheds light on some recent studies(EMPHACIS,CALGB30901,Checkmate-743,etc.)that have led to significant developments in recent years with clinically meaningful results.
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.
文摘Pleural involvement of cryptococcal infection is uncommon and is more commonly observed in immunocompromised hosts than in immunocompetent ones.Pleural involvement in cryptococcal infections can manifest with or without pleural effusion.The presence of Cryptococcus spp.in the effusion or pleura is required for the diagnosis of cryptococcal pleural infection,which is commonly determined by pleural biopsy,fluid culture,and/or detection of cryptococcal antigen in the pleura or pleural fluid.
文摘Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.
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.
文摘Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the malignant pleural effusion by chemotherapy.Methods:Every time after elimination of pleural effusion,we injected DDP and Nocardia rubra cell wall skeleton at the same time into pleural cavity;or after we emplaced an improved central vena catheter into pleural cavity then took out closed-drainage or eliminated the pleural effusion every day,then injected 5-FU 0.5 qd intrapleural-space.After the malignant pleural effusion had being controlled,800μg Nocardia rubra cell wall skeleton was injected intrapleural-space. (We call it as"improved following-therapy").Results:Using the improved following-therapy,the control rate of malignant pleural effusion increased:CR+PR,79.07%>65.79%(P<0.05),and the incidence rate of the encapsulated pleural effusion that would impact on patient’s respiratory faction decreased.Conclusion:Giving chemotherapy after closed-drainage or immediately after taking out pleural effusion everyday,then giving biotherapy after pleural effusion had been controlled,the curative effect would be enhanced and the side-reaction would be reduced.
文摘BACKGROUND Paragonimiasis is a parasitic disease that has multiple symptoms,with pulmonary types being common.According to our clinical practices,the pleural effusion of our patients is full of fibrous contents.Drainage,praziquantel,and triclabendazole are recommended for the treatment,but when fibrous contents are contained in pleural effusion,surgical interventions are necessary.However,no related reports have been noted.Herein,we present a case of pulmonary paragonimiasis treated by thoracoscopy.CASE SUMMARY A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days.Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani,serological test showed eosinophilia,and moderate left pleural effusion and calcification were detected on computed tomography(CT).She was diagnosed with paragonimiasis,and praziquantel was prescribed.However,radiography showed an egg-sized nodule in the left pleural cavity during follow-up.She was then admitted to our hospital again.The serological results were normal except slight eosinophilia.CT scan displayed a cystic-like node in the lower left pleural cavity.The patient underwent a thoracoscopic mass resection.A mass with a size of 6 cm×4 cm×3 cm adhered to the pleura was resected.The pathological examination showed that the mass was composed of non-structured necrotic tissue,indicating a granuloma.The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass.CONCLUSION This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.
