The diagnostic significance of the detection of cytokeratin 19 mRNA by quantitative RT-PCR in benign and malignant pleural effusions

Objective: To evaluate the diagnostic significance of detecting cytokeratin 19 (CK19) mRNA by quantitative reverse transcription polymerase chain reaction (RT-PCR) in benign and malignant pleural effusions. Methods: CK19 mRNA was examined by quantitative RT-PCR and CK19 was detected by Enzyme-linked immunoadsorbent assay (ELISA) in 32 patients with malignant pleural effusions and 35 patients with benign pleural effusions. Results: On the threshold of 200 copies/μl, the positive rate of CK19 mRNA in patients with malignant pleural effusions was 62.5%. The positive rates of CK19 mRNA and CK19 in the malignant pleural effusions were significantly higher than those in the benign group (P<0.01). Furthermore, the positive rate of CK19 mRNA was higher than that of CK19 in the malignant group (P<0.05). Conclusion: Detection of CK19 mRNA can be a promising diagnostic marker in differential diagnosis of benign and malignant pleural effusions.

Metagenomic next-generation sequencing for pleural effusions induced by viral pleurisy:A case report

BACKGROUND Viral pleurisy is a viral infected disease with exudative pleural effusions.It is one of the causes for pleural effusions.Because of the difficult etiology diagnosis,clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion.Here,we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus.Viral infection was identified by metagenomic next-generation sequencing(mNGS).CASE SUMMARY A 40-year-old male with a history of dermatomyositis,rheumatoid arthritis,and secondary interstitial pneumonia was administered with long-term oral prednisone.He presented with fever and chest pain after exposure to cold,accompanied by generalized sore and weakness,night sweat,occasional cough,and few sputums.The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed.The pleural fluids were found to be yellow and slightly turbid after pleural catheterization.Thoracoscopy showed fibrous adhesion and auto-pleurodesis.Combining the results in pleural fluid analysis and mNGS,the patient was diagnosed as viral pleuritis.After receiving Aciclovir,the symptoms and signs of the patient were relieved.CONCLUSION Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination.mNGS is helpful for diagnosis.

Adenosine deaminase isoenzymes estimation - as a diagnostic tool for tuberculous pleural effusions

Objective:To assess the efficacy of ADA isoenzyme estimation over that of total ADA level in pleural fluid and serum as a more efficient diagnostic indicator in tuberculous pleural effusions in high prevalence country like India.Methods:The efficacy was analysed in total thirty four patients of pleural effusions.Total ADA was estimated by Guitsi and Galanti Calorimetric method and ADA isoenzymes with and without EHNA[Erythro-9-（2- hydroxy-3-nonyl） adenine]a potent ADA1 inhibitor using the same method.Results:The results demonstrated a statistically significant values of ADA2 in serum（P【0.001）,pleural fluid（P = 0.000） and significant value for the ratio of pleural fluid ADA2/serum ADA2（P【0.001） and pleural fluid ADA/ADA(2（P【0. 005）.The sensitivity and specificity values of pleural fluid ADA|2 is 81.8%and 91.6%（cut off value 60 IU/L for Tuberculous effusions）,serum ADA2 95.4%and 66%（cut off value 70 IU/L for tuberculous effusions）. ADA2 is an isoenzyme,which is significantly raised in tuberculous pleural effusions both in the serum and pleural fluid.Conclusion:Estimation of ADA isoenzymes is redundant as a diagnostic aid over total ADA estimation in view of the limited improvements both in specificity and sensitivity patterns and also in term of cost-benefit ratio.

Management of recurrent malignant pleural effusions with a tunneled indwelling pleural catheter

In this review, we report on the use of indwelling pleural catheters in the treatment of malignant pleural effusions. We describe the most commonly used catheter. Also, treatment with indwelling pleuralcatheters as compared to talc pleurodesis is reviewed. A comparison of efficacy, costs, effects on quality of life, and complications is made. Only one randomized controlled trial comparing the two is available up to date, but several are underway. We conclude that treatment for malignant pleural effusions with indwelling pleural catheters is a save, cost-effective, and patientfriendly method, with low complication rates.

TREATMENT OF PATIENTS WITH MALIGNANT PLEURAL EFFUSIONS DUE TO ADVANCED LUNG CANCER BY TRANSFER OF AUTOLOGOUS LAK CELLS COMBINED WITH rIL-2 OR rIL-2 ALONE

Experimental study both in vitro and in vivotogether with clinical trials showed that LAKcells have antitumor and antimetastatic effects(1-5)and that these effects are closely related tothe number of LAK cells transferred and the ad-ministration of rIL-2(1,6-8).Usually,autologousPBL’s are used as the source of LAK precursorsin the adoptive immunotherapy of cancer patients.But this not only puts an added burden on thecancer patient,it can cause serious side effectsas well(9).Although TIL’s may provide a solu-tion to this problem(10,11),their isolation fromsolid tumors is complex and consumes many rea-gents.We have reported that the isolation oflymphocytes from malignant ascites or from ma-lignant pleural effusions is not only simple

Persistence of Pleural Effusions and Empyemas after Pneumococcal Conjugate Vaccine Implementation in Uruguay

In Uruguay a post pneumococcal conjugate vaccine implementation surveillance of hospitalized children with pneumonia showed an increase of complicated pneumonias, while uncomplicated pneumonias decreased. Out of 151 pleural effusions, 62 were empyemas requiring drainage, the rest of cases were treated with antibiotics with a favorable outcome. Patient’s vaccinated status varied. Pneumococcal etiology was poorly documented. The few identified sero-types were 1 and 3, a fact that urges PCV13 use for their control.

Bilateral Pneumonia and Pleural Effusions Subsequent to Electronic Cigarette Use

Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manufactures as a safer alternative to tobacco cigarettes because of potentially reduced delivery of toxins. However, the scientific evidence and the long-term health effects of e-cigarettes are limited. We describe a case of a 43-year-old man who had been smoking electronic cigarettes excessively for three days and presented with acute dyspnea, increased work of breathing and tachycardia. Subsequent chest x-ray revealed bilateral pleural effusions. In addition, the patient had a new oxygen requirement and was thus admitted with a diagnosis of pneumonia and bilateral pleural effusions. The case and the potential harmful effects of electronic cigarettes are discussed herein.

Focus assessed transthoracic echocardiography (FATE) to diagnose pleural effusions causing haemodynamic compromise

The clinical assessment of patients with respiratory and circulatory problems can be complex, time consuming and have a high incidence of error. Bedside transthoracic ultrasound (US) is a useful adjunctive test in the evaluation of acutely unstable patients. This case series describes the use of the Focus Assessed Transthoracic Echocardiography (FATE) protocol to diagnose unsuspected pleural collections of fluid and how drainage significantly contributes to the haemodynamic improvement seen in these patients.

Diagnostic Utility of Indigenous Technique of Pleuroscopy in Undiagnosed Cases of Exudative Pleural Effusions

Background and Aims： Since our rural institution has liamted resources we always choose econoamcal options. Recently, indigenous technique of pleuroscopy is gaining popularity due to various advantages. We developed indigenous technique of medical thoracoscopy has been developed and done by using set of patented conduits and fiberoptic bronchoscope （FOB）.Therefore, we have used this technique for undiagnosed pleural effusions. Methods： An observational study was conducted in 79 undiagnosed cases of exudative pleural effusion from June 2016 to Jmmary 2017. Indigenous technique consists of use of fiber optic bronchoscope through various metallic conduits to be used in specified order for medical thoracoscopy. Procedure is done under conscious sedation and conduits are passed one after another in a specified order, through the chest stoma. The visualization of pleural cavity and various procedures were done with FOB （fiberoptic bronchoscope）. Results： Out of the 79 cases, the appearance of pleura showed, inflamed/reddened pleura in 16 （20.2%） cases, thin transparent adhesions in 18 （22.7%）, thin transparent loculations in 16 （20.2%） cases, thick loculations in 6 （7.6%） cases, hard pleural surface in 5 （6.3%）, large nodule/masses in 6 （7.6%）, small amlliary seedlings or sago grain appeoxmlce in 6 （7.6%）, scattered masses or nodules in 5 （6.3%） and, broncho-pleural fistula was observed in 1 （1.2%） case. Histopathological analysis showed chronic inflammation in 34.1% （27）, tubercular lesions in 24.05% （19） of patients. Primary aspergillosis and mesothelioma each has 1 case, and the rest 29.11% （23） were pleural metastasis. Thus, diagnostic yield of pleuroscopy pleural biopsy was 89.9% （71）. Conclusion： Indigenous technique appears to be an efficient and relatively safe procedure with good diagnostic yield in undiagnosed pleural effusions.

Ultrasound Value in the Management of Parapneumonic Pleural Effusions in a Limited-Resource Setting: A Case Report

Pleural effusion is a common complication of acute lung infection, with rising morbidity and mortality. If poorly treated, parapneumonic effusion evolves to the fibrino-purulent stage wherein antibiotic therapy alone becomes inadequate. Chest CT is the gold standard diagnostic imaging tool, however, in a resource-limited context, it may not be performed. Chest ultrasound can therefore be an alternative for drainage and intermittent follow-up of complicated parapneumonic pleural effusions. We report the case of a 4-year-old child who presented with cough, breathing difficulties and fever for over two weeks and in whom an initial chest X-ray revealed a left hemithorax white-out with an air-fluid level. Chest ultrasound revealed a left pleuropulmonary massive fluid collection with an encysted empyema. It also allowed ultrasound-guided pleural effusion drainage of a fibrino-purulent liquid which tested positive for Kocuria kristinae, a bacterium sensitive to gentamycin, vancomycin, norfloxacin and clindamycin. The next follow-up ultrasound checks showed improvement and the control chest X-ray performed one month later demonstrated pulmonary functional recovery. This case highlights the importance of ultrasound in the management and follow-up of this chest pathology in resource-limited settings.

DIAGNOSTIC VALUE OF DENSITY GRADIENT CENTRIFU-GATION FOR EXFOLIATIVE TUMOR CELLS IN MALIG-NANT PLEURAL EFFUSIONS

Objective To find out a specific method for diagnosis of malignant pleural effusions (MPEs)with higher sensitivity and practicality. Methods The diagnosis of MPEs were made using density gradient cen-trifugation(DGC) , smear cytologic examination( SCE) and pleural needle biopsy (PNB). Comparisons between these results and those of benign pleural effusions were also made. Results The positive rates of DGC,SCE and PNB for diagnosing MPEs were 94. 3% ,62. 9% and 44. 6% , respectively, and the positive rate of SCE combined with PNB for diagnosing MPEs was 73. 2%. The positive rate of the exfoliative tumor cells ( ETCs ) by DGC was much higher than that of SCE or/and PNB with no false-positive. Conclusion The ETCs isolated by DGC from the MPEs is quite specific for the diagnosis of malignant tumors with higher sensitivity and practicality in clinico-patho-logical practice.

Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions： a comparative study

Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronchoscope, which is difficult to manipulate within the pleural cavity. The semi-rigid thoracoscope combines the best features of the flexible and rigid instruments. Since the practice with this instrument is limited in China, the diagnostic utility of semi-rigid thoracoscopy （namely medical thoracoscopy） under local anesthesia for undiagnosed exudative pleural effusions was evaluated . Methods In 50 patients with undiagnosed pleural effusions who were studied retrospectively, 23 received routine examinations between July 2004 and June 2005 and the rest 27 patients underwent medical thoracoscopy during July 2005 and June 2006. Routine examinations of the pleural effusions involved biochemistry and cytology, sputum cytology, and thoracentesis. The difference in diagnostic sensitivity, costs related to pleural fluid examination and complications were compared directly between the two groups. Results Medical thoracoscopy revealed tuberculous pleurisy in 6 patients, adenocarcinoma in 7, squamous-cell carcinoma in 2, metastatic carcinoma in 3, mesothelioma in 2, non-Hodgkin＇s lymphoma in 1, and others in 4. Only 2 patients could not get definite diagnoses. Diagnostic efficiency of medical thoracoscopy was 93% （25/27）. Only 21% patients were diagnosed after routine examinations, including parapneumonic effusion in 2 patients, lung cancer in 2 and undetermined metastatic malignancy in 1. Twelve patients with tuberculous pleurisy were suspected by routine examination. Costs related to pleural effusion testing showed no difference between the two groups （P=0.114）. Twenty-three patients in the routine examination group underwent 97 times of thoracentesis. Two pleural infection patients and 2 pneumothorax patients were identified and received antibiotic treatment and drainage. Medical thoracoscopy could be well tolerated by all the patients. The semi-rigid thoracoscope could be easily controlled by chest physicians. The most common complication was transient chest pain （20 of 27 patients） from the indwelling chest tube, which would be managed with conventional analgesics. One case of subcutaneous emphysema and 2 cases of postoperative fever were self-limiting. No severe complications occurred. Conclusions Medical thoracoscopy is a simple, safe, and cost-effective tool, with a high positive rate. Physicians should extend its access to proper patients if the facilities for medical thoracoscopy are available.

Diagnostic and therapeutic value of thoracoscopy for pleural effusions： experience from 628 consecutive cases in China

Pleural effusions, the excessive accumulations of fluid in pleural space, are frequently associated with a variety of clinical diseases, such as cancer, tuberculosis, pneumonia, etc. This means that both malignant and benign diseases can cause pleural effusions. Therefore, it is essential for clinicians to determine the etiology prior to the treatment of patients with pleural effusions.

Expression of soluble Toll-like receptors in pleural effusions

Background The Toll-like receptors （TLRs） represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the presence of soluble TLRs in pleural effusions, and the diagnostic values of TLRs for pleural effusion with various etiologies.Methods Pleural effusion and serum samples were collected from 102 patients （36 with malignant pleural effusion, 36with tuberculous pleural effusion, 18 with bacterial pleural effusion, and 12 with transudative pleural effusion）.The concentrations of TLR1 to TLR10 were determined in effusion and serum samples by enzyme linked immunosorbent assay.Four classical parameters （protein, lactate dehydrogenase, glucose and C-reactive protein （CRP）） in the pleural fluid were also assessed.Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid TLRs and biochemical parameters for differentiating bacterial pleural effusion.Results The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups, respectively.Analysis of receiver operating characteristic curves revealed that the area under the curves of TLR1, TLR3, TLR4, TLR7 and TLR9 were 0.831, 0.843,0.842, 0.883 and 0.786, respectively, suggesting that these TLRs play a role in the diagnosis of bacterial pleural effusion.Also, the diagnostic value of TLRs for bacterial pleural effusions was much better than that of biochemical parameters （protein, lactate dehydrogenase, glucose and CRP）.Conclusions The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 appeared to be increased in bacterial pleural effusion compared to non-bacterial pleural effusions.Determination of these pleural TLRs may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.

The negative enrichment by immunomagnetic beads for tumor cells from malignant pleural effusions

Objective To establish a method (negative enrichment by immunomagnetic beads) for detection of tumor cells in pleural effusions and to evaluate the sensitivity and specificity of the method for clinical application. Methods Five,10,20,50 and 100 A549(lung adenocarcinoma) cells were labeled

Pulmonary Edema and Pleural Effusion Detection Using Efficient Net-V1-B4 Architecture and AdamW Optimizer from Chest X-Rays Images

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.

Pleural effusion,ascites,colon ulcers and hematochezia:What we can learn from the diagnostic process of a patient with plasma cell myeloma:A case report

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.

Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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.

Detection of hTERT mRNA,CEA,CA19-9 in Pleural Effusion and Its Clinical Significance

OBJECTIVE To explore the clinical significance of the human telomerase reverse transcriptase(hTERT)mRNA,CEA and CA19-9 in differential diagnosis of benign and malignant pleural effusions. METHODS Concentrations of CEA and CA19-9 in pleural effusions were assayed using automated chemiluminescence,and expression of hTERT mRNA was detected by RT-PCR. RESULTS The positive rates of hTERT mRNA,CEA and CA19-9 expression in the group with malignant effusions were significantly higher compared to the group with benign effusion (P<0.05).The sensitivity(%),specificity(%)and diagnostic accordance rates(%)of the 3 tumor markers were as follows:i) hTERT mRNA:81.8/90.5/86.1;ii)CEA:52.3/92.9/72.1;iii)CA19-9: 34.1/90.5/61.6.The positive rates of hTERT mRNA+CEA(%) expression in the pleural effusions were 97.7. CONCLUSION All of these tumor markers can be helpful for differential diagnosis of pleural effusions.hTERT mRNA had more clinical value in differentiation of the pleural efffusions. CA19-9 is unfit to be as an optimal index.The combined assay of hTERT mRNA and CEA in pleural effusions can further raise the positive detection rate of the tumor markers and can be helpful in producing a diagnosis.

Evaluation of serum and pleural levels of endostatin and vascular epithelial growth factor in lung cancer patients with pleural effusion

Objective:To evaluate the diagnostic value of endostatin(ES),vascular endothelial growth factor (VEGF) and careinoembryonie antigen(CEA) in both serum and pleural effusion of lung cancer patients.Methods:Levels of ES,VEGF and CEA in 52 malignant pleural effusion due to lung cancer and 50 patients with non-malignant disease were measured by using sandwich enzymelinked immunosorbent assay and microparticle enzyme immunoassay.Results:The ES.VEGF and CEA levels in pleural effusion and serum,and their ratio(F/S) were higher in lung cancer group than that in benign group,and the differences were statistically significant(P【0.05).The diagnostic efficiency of ES+VEGF for lung cancer was superior to either single detection.The diagnostic efficiency of ES+VEGK+CEA was superior to either ES+VEGF or ES+CEA.Conclusions: The results suggest that ES,VEGF and CEA might be useful in the differentiation between benign and malignant pleural effusion due to lung cancer.In comparison with either single determination of concentration in serum or pleural fluid,the couiljined detection of two or three markers is of important clinical significance in the diagnosis of lung cancer.