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 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 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 Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pedia...BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pediatric CCAP,and compare their etiology,clinical profile,and outcome in the post-pneumococcal vaccination era.METHODS This prospective observational study was conducted over a 2-year period.All details(demographics,clinical,management,and outcomes)were recorded.Continuous data were presented either as mean and SD,or as median and interquartile range.Categorical data were presented as frequencies and percentages(%).Data were analyzed by using the IBM SPSS Statistics for Windows,version 21(IBM Corp.,Armonk,NY,United States).RESULTS Of the 80 cases included(71%aged 4-8 years),the distribution was as follows:PPE(42%),empyema(39%),and NP(19%).Bacterial etiology was identified in 28%(empyema 63%,P=0.012).Staphylococcus aureus(45%)was most common followed by Escherichia coli(E.coli)(22.7%),and Streptococcus pneumoniae(13.6%).Patients with empyema,compared to PPE and NP,were less likely to receive prior antibiotics(32%vs 56%and 58%,respectively,P=0.03).Duration(days,mean±SD)of hospitalization was longer in children with NP compared to empyema and PPE(17.7±9.8,16.1±7.5,and 13.6±4.2,respectively).All children recovered with the medical management except 2 children requiring decortication.CONCLUSION Staphylococcus aureus and E.coli are the most common bacterial etiology in the post-pneumococcal vaccination era.Empyema might be related to a delay in antibiotics administration.NP is the most severe pediatric CCAP with prolonged hospitalization.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 Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-o...BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.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 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
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
Fusobacterium is a genus of obligate anaerobic gram-negative bacilli that usually colonize the oropharynx,gastrointestinal tract,upper respiratory tract,and vaginal mucosa of humans as a part of the normal flora.[1,2]...Fusobacterium is a genus of obligate anaerobic gram-negative bacilli that usually colonize the oropharynx,gastrointestinal tract,upper respiratory tract,and vaginal mucosa of humans as a part of the normal flora.[1,2]Infections may occur once host defense mechanisms are altered and mucosal barriers are disrupted.[3]The clinical spectrum is wide and includes pharyngitis,sinusitis,abscess formation,puerperal infections,bacteremia,and septic shock.Within this genus,two species are most commonly isolated:Fusobacterium nucleatum and Fusobacterium necrophorum(F.necrophorum).F.necrophorum is usually associated with Lemierre’s syndrome,[4,5]a type of septic thrombophlebitis of the internal jugular vein.展开更多
BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endosc...BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak,infection,stent migration and bleeding.Here,we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS,which we suspected to be caused by an abnormal biliary-vascular fistula.CASE SUMMARY A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUSHGS for relieving jaundice.The patient reported abdominal pain and chest tightness after the operation,with difficulty in urinating.X-ray suggested rightsided pleural effusion and dark green pleural effusion was drained out.However,the patient also developed dark green urine,which appeared everyday afternoon and disappeared automatically after intravenous treatment.The previous pleural effusion disappeared after one week,but later the patient showed an increase of ascites,and the lesions were compartmentalized and encapsulated internally.CONCLUSION Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.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
Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogen...Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.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
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 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 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BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pediatric CCAP,and compare their etiology,clinical profile,and outcome in the post-pneumococcal vaccination era.METHODS This prospective observational study was conducted over a 2-year period.All details(demographics,clinical,management,and outcomes)were recorded.Continuous data were presented either as mean and SD,or as median and interquartile range.Categorical data were presented as frequencies and percentages(%).Data were analyzed by using the IBM SPSS Statistics for Windows,version 21(IBM Corp.,Armonk,NY,United States).RESULTS Of the 80 cases included(71%aged 4-8 years),the distribution was as follows:PPE(42%),empyema(39%),and NP(19%).Bacterial etiology was identified in 28%(empyema 63%,P=0.012).Staphylococcus aureus(45%)was most common followed by Escherichia coli(E.coli)(22.7%),and Streptococcus pneumoniae(13.6%).Patients with empyema,compared to PPE and NP,were less likely to receive prior antibiotics(32%vs 56%and 58%,respectively,P=0.03).Duration(days,mean±SD)of hospitalization was longer in children with NP compared to empyema and PPE(17.7±9.8,16.1±7.5,and 13.6±4.2,respectively).All children recovered with the medical management except 2 children requiring decortication.CONCLUSION Staphylococcus aureus and E.coli are the most common bacterial etiology in the post-pneumococcal vaccination era.Empyema might be related to a delay in antibiotics administration.NP is the most severe pediatric CCAP with prolonged hospitalization.
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 Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.
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].
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.
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.
文摘Fusobacterium is a genus of obligate anaerobic gram-negative bacilli that usually colonize the oropharynx,gastrointestinal tract,upper respiratory tract,and vaginal mucosa of humans as a part of the normal flora.[1,2]Infections may occur once host defense mechanisms are altered and mucosal barriers are disrupted.[3]The clinical spectrum is wide and includes pharyngitis,sinusitis,abscess formation,puerperal infections,bacteremia,and septic shock.Within this genus,two species are most commonly isolated:Fusobacterium nucleatum and Fusobacterium necrophorum(F.necrophorum).F.necrophorum is usually associated with Lemierre’s syndrome,[4,5]a type of septic thrombophlebitis of the internal jugular vein.
基金Supported by the National Key Research and Development Program,No.2023YFC2307001the National Natural Science Foundation of China,No.82170570,No.82270698,and No.82470679.
文摘BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak,infection,stent migration and bleeding.Here,we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS,which we suspected to be caused by an abnormal biliary-vascular fistula.CASE SUMMARY A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUSHGS for relieving jaundice.The patient reported abdominal pain and chest tightness after the operation,with difficulty in urinating.X-ray suggested rightsided pleural effusion and dark green pleural effusion was drained out.However,the patient also developed dark green urine,which appeared everyday afternoon and disappeared automatically after intravenous treatment.The previous pleural effusion disappeared after one week,but later the patient showed an increase of ascites,and the lesions were compartmentalized and encapsulated internally.CONCLUSION Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.
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Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.
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).
