ORCID Profile
0000-0002-0036-511X
Current Organisations
Bond University
,
Bond University Faculty of Health Sciences and Medicine
,
University of Western Australia
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2016
Publisher: S. Karger AG
Date: 2021
DOI: 10.1159/000514643
Abstract: b i Background: /i /b Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce. b i Objective: /i /b To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection. b i Methods: /i /b Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on i feasibility /i of intrapleural tPA/DNase delivery, its i efficacy /i and i safety /i were recorded. b i Results: /i /b Thirty-nine IPC-related pleural infections (predominantly i Staphylococcus aureus /i and gram-negative organisms) were treated in 38 patients 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3–6] atient) of tPA (2.5 mg–10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions none had systemic or significant pleural bleeding. b i Conclusion: /i /b Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.
Publisher: Wiley
Date: 05-12-2015
DOI: 10.1111/RESP.12441
Abstract: Flexi-rigid pleuroscopy is a useful tool in the work-up of pleural effusions, but pleural biopsy using flexible forceps can be difficult in some patients. This study evaluated the feasibility, safety and diagnostic value of using a flexible cryoprobe to obtain parietal pleural biopsies during pleuroscopy. This was a single-centre retrospective study. In patients undergoing diagnostic pleuroscopy, pleural biopsy using flexible forceps, followed by a flexible cryoprobe introduced through the pleuroscope, were performed. A pathologist independently reviewed all biopsies. Any complications, particularly bleeding, were recorded. All patients were followed up for ≥ 6 months (median 12 months (range 7-26)). Twenty-two patients (21 males median age 72 years 14 right-sided effusions) were included. All underwent flexible forceps biopsies (FFB) and cryoprobe biopsies (CB) of pleura. FFB and CB established a definitive diagnosis in 20/22 (90%). CB successfully obtained pleural tissue suitable for histopathological analysis in all patients. CB was larger than FFB (median, 25-75 IQR of 10, 7-15.8mm vs 4, 3-8mm), and had better preserved cellular architecture and tissue integrity. Crush artefacts were less common with CB (2/22) compared with FFB (21/22). No significant bleeding was reported. CB during flexi-rigid pleuroscopy is feasible, safe and effective. Its routine use during flexi-rigid pleuroscopy requires further evaluation.
Publisher: Elsevier BV
Date: 02-2022
Publisher: Wiley
Date: 12-2001
DOI: 10.1046/J.1440-1843.2001.00351.X
Abstract: We have recently demonstrated that transforming growth factor beta-2 (TGF-beta2) can produce effective pleurodesis. Whether this effect can be reproduced by the use of its downstream proteins is not known. This study compared the effectiveness of TGF-beta2 and fibronectin in inducing pleurodesis in rabbits. New Zealand white rabbits (1.5-2.0 kg) were given 1.7 microg of TGF-beta2 (n=5) or 2.0 mg of cellular fibronectin (n=4) intrapleurally via a chest tube. The induced pleural fluid was collected and analyzed. The rabbits were sacrificed after 14 days. The pleurodesis was graded macroscopically from 1 (none) to 8 (symphysis > 50%). All rabbits in the TGF-beta2 group developed effective pleurodesis while none in the fibronectin group had scores > 2 (pleurodesis scores 7.0 +/- 0.6 vs 1.3 +/- 0.3, P < 0.001). Rabbits that received TGF-beta2 produced large amounts of pleural fluid initially (< 4 days). Microscopically, the pleura of rabbits in the TGF-beta2 group showed prominent spindle cell proliferation and collagen deposition, but no significant inflammation or mesothelial proliferation. Pleural tissues of rabbits in the fibronectin group had occasional thin collagen deposits only. The intrapleural administration of 2.0 mg of fibronectin, a downstream product of TGF-beta, did not induce effective pleurodesis, as did the intrapleural administration of TGF-beta2. The present study suggests that the mechanism by which TGF-beta2 induces pleurodesis is not predominantly dependent on the production of fibronectin.
Publisher: Wiley
Date: 19-06-2014
DOI: 10.1111/RESP.12328
Abstract: The approach to management of malignant pleural effusions (MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms using the least invasive means and in the most cost-effective manner. There is now a realization that patient-reported outcome measures should be the primary goal of MPE treatment, and this now is the focus in most clinical trials. Efforts to minimize patient morbidity are complemented by development of less invasive treatments that have mostly replaced the more aggressive surgical approaches of the past. Therapeutic thoracentesis is simple, effective and generally safe, although its benefits may only be temporary. Pleurodesis is the conventional and for a long time the only definitive therapy available. However, the efficacy and safety of talc pleurodesis has been challenged. Indwelling pleural catheter (IPC) drainage is increasingly accepted worldwide and represents a new concept to improve symptoms without necessarily generating pleural symphysis. Recent studies support the effectiveness of IPC treatment and provide reassurance regarding its safety. An unprecedented number of clinical trials are now underway to improve various aspects of MPE care. However, choosing an optimal intervention for MPE in an in idual patient remains a challenge due to our limited understanding of the underlying pathophysiology of breathlessness in MPE and a lack of predictors of survival and pleurodesis outcome. This review provides an overview of common pleural interventional procedures used for MPE management, controversies and limitations of current practice, and areas of research most needed to improve practice in future.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 25-04-2011
DOI: 10.1111/J.1440-1843.2011.01964.X
Abstract: The incidence of pleural infection continues to rise worldwide. Identifying the causative organism(s) is important to guide antimicrobial therapy. The bacteriology of pleural infection is complex and has changed over time. Recent data suggest that the bacterial causes of empyema are significantly different between adult and paediatric patients, between community-acquired and nosocomial empyemas and can vary among geographical regions of the world. Since the introduction of pneumococcal vaccines, a change has been observed in the distribution of the serotypes of Streptococcus pneumoniae in empyema. These observations have implications on therapy and vaccine strategies. Clinicians need to be aware of the local bacteriology of empyema in order to guide antibiotic treatment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2003
DOI: 10.1097/00063198-200307000-00004
Abstract: The global incidence of asbestos-related lung diseases is expected to continue to rise. Although much attention is devoted to malignant diseases induced by asbestos, benign asbestos pleural diseases (pleural plaques, benign asbestos-related pleural effusion, diffuse pleural thickening, and rounded atelectasis) are common in clinical practice and often produce diagnostic difficulties. The authors describe the clinical features of benign asbestos-related pleural disease, before focusing on recent advances in radiology and on controversies surrounding the pathogenesis of asbestos-induced pleural injury. Advances in computed tomography have assisted the understanding and diagnosis of these diseases, and increasing evidence suggests radiologic appearances on computed tomography can predict impairment in pulmonary function tests. The pathogenesis of asbestos-induced pleural diseases has also been subject to extensive investigation. Asbestos fibers can provoke pleural inflammation from direct toxicity to mesothelial cells. Inhaled asbestos fibers can also elicit pleural injury indirectly via the release of growth factors and inflammatory cytokines from within the lung. Although progress has been made in the understanding of the mechanisms of asbestos pleural injury, many important questions remain unanswered. The role of genetic factors and possible environmental cofactors (eg, simian virus 40) in the pathogenesis of benign asbestos pleural diseases requires further research.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2009
Publisher: Elsevier BV
Date: 04-2003
Abstract: To compare the results of pleural fluid analysis for WBC counts and differential cell counts as follows: (1) counting performed manually vs that performed by an automated cell counter (2) cells collected in different types of specimen containers and (3) cell counts performed at 4 and 24 h postthoracentesis. Twenty-eight pleural fluid s les were each collected in five different containers (ie, ethylenediaminetetraacetic acid (EDTA)-treated glass, citrate-treated glass, heparinized glass, plain glass, and plain plastic tubes). The WBC counts and differential cell counts were obtained manually (on the EDTA tube) and with an automated counter on all tubes within 4 h of collection, and again after 24 h of refrigeration. There was a close correlation between the WBC counts obtained manually and those obtained with the automated counter from the pleural fluid s les collected in the EDTA tubes (r = 0.92). With the automated counter, the pleural fluid WBC counts were similar among the three tubes containing anticoagulants, but the counts obtained from the tubes without anticoagulants were significantly lower. The differential cell counts obtained manually and those obtained with the automated cell counter differed substantially. Although the percentage of lymphocytes was similar, the automated counter was inaccurate in differentiating neutrophils from large monocytes or mesothelial cells. The WBC counts obtained within 4 h of collection and 24 h after collection were virtually identical. The WBC counts obtained manually and with the automated counter from pleural fluid s les in EDTA tubes correlated very closely. The pleural fluid WBC count was lower if the pleural fluids had been collected in tubes without an anticoagulant. Automated WBC counts from pleural fluid specimens were inaccurate, possibly due to difficulty in separating neutrophils from monocyte/mesothelial cells. Refrigerated storage for up to 24 h had no significant effect on the total WBC count or on the WBC count differential regardless of the tube utilized.
Publisher: American Physiological Society
Date: 05-2018
DOI: 10.1152/AJPLUNG.00501.2017
Abstract: Recent studies have shed new light on the role of the fibrinolytic system in the pathogenesis of pleural organization, including the mechanisms by which the system regulates mesenchymal transition of mesothelial cells and how that process affects outcomes of pleural injury. The key contribution of plasminogen activator inhibitor-1 to the outcomes of pleural injury is now better understood as is its role in the regulation of intrapleural fibrinolytic therapy. In addition, the mechanisms by which fibrinolysins are processed after intrapleural administration have now been elucidated, informing new candidate diagnostics and therapeutics for pleural loculation and failed drainage. The emergence of new potential interventional targets offers the potential for the development of new and more effective therapeutic candidates.
Publisher: Wiley
Date: 03-05-2021
DOI: 10.1002/HSR2.262
Publisher: American Medical Association (AMA)
Date: 10-04-2018
Publisher: Wiley
Date: 16-01-2020
DOI: 10.1111/RESP.13765
Publisher: Elsevier BV
Date: 08-2001
Abstract: Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. We studied the ADA levels in a variety of nontuberculous lymphocytic effusions and analyzed the relationships between ADA and conventional hematologic and biochemical parameters. One hundred six lymphocytic pleural fluid s les (lymphocyte count > 50%) were analyzed. These included post-coronary artery bypass grafting (CABG) effusions (n = 45), malignant effusions (n = 27), miscellaneous exudative effusions (n = 10), and transudative effusions (n = 24). ADA levels were determined using the Giusti method. In 22 randomly selected cases, ADA was measured again on the same s le 6 weeks later. The ADA level reached the diagnostic cutoff for tuberculosis (40 U/L) in only three cases (2.8%): two lymphomas and one complicated parapneumonic effusion. There was no significant correlation between effusion ADA levels and the total leukocyte (r = 0.08), differential lymphocyte (r = 0.18) or monocyte (r = - 0.18) counts. ADA levels were significantly lower in the transudative effusions (7.2 +/- 3.5 U/L) than in post-CABG (16.6 +/- 7.2 U/L), malignant (15.3 +/- 11.2 U/L), and other exudative (15.4 +/- 13.1 U/L) effusions (p < 0.001). ADA measurements were consistent when assayed 6 weeks apart (r = 0.95 p < 0.00001 coefficient of variation, 14%). ADA levels in nontuberculous lymphocytic effusions seldom exceeded the diagnostic cutoff for TB. Effusion ADA levels cannot be predicted from total or differential leukocyte counts. Post-CABG pleural fluids had ADA levels similar to other nontuberculous lymphocytic effusions. ADA is stable in effusion fluids, and its measurement is reproducible.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2007
DOI: 10.1038/NATURE05887
Publisher: Wiley
Date: 07-2020
DOI: 10.1111/RESP.13881
Publisher: European Respiratory Society
Date: 28-09-2019
Publisher: American Society for Clinical Investigation
Date: 16-05-2019
Publisher: BENTHAM SCIENCE PUBLISHERS
Date: 02-2016
Publisher: Public Library of Science (PLoS)
Date: 21-05-2013
Publisher: Wiley
Date: 11-09-2015
Publisher: Hindawi Limited
Date: 09-06-2018
DOI: 10.1111/ECC.12722
Abstract: The purpose of this study was to investigate the feasibility and preliminary efficacy of a pragmatic distance-based intervention designed to increase physical activity (PA) participation in lung cancer survivors. Fourteen lung cancer survivors were recruited via invitation from the State Cancer Registry to join a 12-week PA intervention of print materials paired with brief telephone follow-up. Outcome measures of feasibility, PA participation and quality of life (QoL) were assessed at baseline, post-intervention and follow-up via telephone interview. Eligibility, recruitment and attrition rates were 16%, 58% and 29% respectively. No adverse events were reported however, pain scores worsened following the intervention (median change -3.6, IQR -8.0, 0.0). Average intervention adherence was 91% with low median ratings of participation burden (i.e., all items 1/7) and high trial evaluation (i.e., all items 7/7). Post-intervention, median change in self-reported moderate and vigorous PA was 84 min (IQR -22, 188), and several domains of QoL improved. However, for both of these outcomes, improvements were not maintained at follow-up. Our findings suggest that this pragmatic distance-based intervention was safe, had good adherence rates, and indicate potential for improving short-term PA and QoL in lung cancer survivors. Additional strategies are needed to improve other indicators of feasibility, particularly recruitment, retention and long-term maintenance of improvements. Australian New Zealand Clinical Trials Registration: ACTRN12612000085875.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.CHEST.2016.07.030
Abstract: The incidence of pleural infection has been rising in recent years. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) has significantly reduced the need for surgery, and its impact on clinical care is rising worldwide. Efforts are underway to optimize the delivery regimen and establish the short and longer term effects of this therapy. The complex interactions of bacterial infection within the pleura with inflammatory responses and clinical interventions (antibiotics and tPA/DNase or other fibrinolysins) require further studies to improve future treatment options. Intrapleural instillation of tPA potently induces pleural fluid formation, principally via a monocyte chemotactic protein (MCP)-1 dependent mechanism. Activation of transcriptional programs in pleural resident cells and infiltrating cells during pleural infection and malignancy results in the local secretion of a cocktail of proinflammatory signaling molecules (including MCP-1) within the pleural confines that contributes to effusion formation. Understanding the biology of these molecules and their interaction may provide novel targets for pleural fluid control.
Publisher: American Thoracic Society
Date: 07-2015
Publisher: European Respiratory Society (ERS)
Date: 08-2003
DOI: 10.1183/09031936.03.00086202
Abstract: Conventional pleurodesing agents often provoke acute pleural inflammation followed by fibrosis. The inflammation frequently causes pain and fever. Transforming growth factor (TGF)-beta is a pro-fibrotic but anti-inflammatory cytokine. Intrapleural TGF-beta2 administration produces effective pleurodesis in animals, but its effects on mesothelial cells are unknown. The authors hypothesised that, unlike conventional pleurodesing agents, TGF-beta2 can induce collagen synthesis without stimulating pleural inflammation. In the in vitro studies, TGF-beta2, talc and doxycycline were administered to rabbit mesothelial cells for 24 h. These agents were also injected intrapleurally in rabbits and the induced pleural fluids collected at 24 h. TGF-beta2 was as potent as talc and doxycycline in upregulating mesothelial cell collagen expression. Talc and doxycycline both induced significant increases in interleukin (IL)-8 production from mesothelial cells in vitro and in rabbit pleural fluids in vivo. TGF-beta2, however, did not stimulate mesothelial cell IL-8 release in vitro and induced a dose-dependent suppression of pleural fluid IL-8. Pleural fluid IL-8 levels correlated significantly with leukocyte and lactate dehydrogenase concentrations in the fluids. In summary, transforming growth factor-beta was a potent inducer of mesothelial cell collagen synthesis. Unlike talc and tetracycline, which provoked pleural inflammation, transforming growth factor-beta2 suppressed pleural inflammation in vivo. Transforming growth factor-beta2 can produce effective pleural fibrosis without necessitating acute pleural inflammation.
Publisher: American Chemical Society (ACS)
Date: 04-04-2023
Publisher: Cambridge University Press (CUP)
Date: 05-2016
Publisher: BMJ
Date: 06-08-2014
Publisher: Wiley
Date: 24-05-2017
DOI: 10.1111/RESP.13081
Publisher: BMJ
Date: 07-2016
Publisher: SAGE Publications
Date: 2018
Abstract: Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach in idual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, in idualized according the patient’s wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.
Publisher: American Thoracic Society
Date: 15-01-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Elsevier BV
Date: 02-2001
Publisher: American Thoracic Society
Date: 02-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2002
DOI: 10.1097/00063198-200207000-00009
Abstract: Pleural effusion is common in clinical practice. Increased vascular permeability and leakage play a principal role in the development of exudative pleural effusions. In vitro and in vivo evidence have solidly established vascular endothelial growth factor (VEGF), a potent inducer of vascular permeability, as a crucial mediator in pleural fluid formation. VEGF is present in high quantities in human effusions. In the pleural space, mesothelial cells, infiltrating inflammatory cells, and (in malignant pleuritis) cancer cells contribute to the VEGF accumulation in the pleural fluids. Pleural fluid VEGF is biologically active and may promote tumor growth and chemotaxis. Strategies to antagonize the VEGF activity at various target points of its signaling pathway have shown success in vitro and in animal models of malignant pleural or peritoneal effusions. Novel agents targeting VEGF activities are undergoing clinical trials. Regulation of VEGF activity and vascular permeability represent a rapidly expanding field of research, which is likely to provide further insight in the pathophysiology of pleural fluid formation.
Publisher: BMJ
Date: 08-2010
Publisher: European Respiratory Society (ERS)
Date: 03-08-2023
DOI: 10.1183/23120541.00209-2023
Abstract: Little is known about activity behaviours and quality-of-life (QoL) of patients with parapneumonic pleural effusions (PPE) after hospital discharge. This study is a secondary analysis of a randomized trial (dexamethasone versus placebo) for hospitalised patients with PPE. We: (i) described the patients’ activity behaviour patterns and QoL measured at discharge and at 30 days post-discharge and (ii) examined the association between activity behaviours and QoL scores. Activity behaviour (7-day accelerometry Actigraph GT3X+) and QoL (Medical Outcomes Study Short-Form 36) were assessed. Repeated measures analysis of covariance controlling for baseline values and a series of linear regression models were undertaken. Thirty-six out of 53 eligible participants completed accelerometry assessments. Despite modest increases in light physical activity (+7.5%) and some domains of QoL ( points) from discharge to 30 days post-discharge, patients had persistently high levels of sedentary behaviour ( % of waking wear time) and poor QoL (≤50 out of 100 points) irrespective of treatment group (p=0.135–0.903). Increasing moderate-to-vigorous physical activity was associated with higher scores on most QoL domains (p=0.006–0.037). Linear regression indicates that a clinically important difference of 5 points in physical composite QoL score can be achieved by reallocating 16.1 min·day −1 of sedentary time to moderate-to-vigorous physical activity. Patients with PPE had low levels of physical activity and QoL at discharge and 30-days post irrespective of treatment. Moderate-to-vigorous physical activity participation was associated with higher QoL scores. Increasing moderate-to-vigorous physical activity following discharge from the hospital may be associated with improvements in QoL.
Publisher: Wiley
Date: 21-02-2015
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.LUNGCAN.2019.12.018
Abstract: Currently, there is no optimal salvage therapy for patients with malignant pleural mesothelioma (MPM) who relapse after treatment with first-line chemotherapy. In line with the strong preclinical rationale for targeting fibroblast growth factor receptor (FGFR) signalling in malignant mesothelioma, we conducted a phase II study assessing the efficacy of AZD4547, an oral tyrosine multi-kinase FGFR 1-3 inhibitor, as a second or third-line treatment. We conducted a single-center, open-label, single-arm phase II study of AZD4547 in eligible patients with confirmed, measurable MPM and radiological progression after first or second-line systemic chemotherapy. Patients received continuous, twice-daily oral AZD4547 on a 3-weekly cycle. The primary end point was 6-month progression free survival (PFS6). Response was assessed with CT scan every 6 weeks according to the modified RECIST criteria for mesothelioma (mRECIST) and toxicities were also assessed. The study used a Simon's two-stage design: 26 patients would be recruited to the first stage and more than 7 (27 %) of 26 patients were required to achieve PFS6 to continue to stage two, for a potential total cohort of 55 patients. 3 of 24 patients (12 %) were progression-free at 6 months. Hence, the study fulfilled stopping criteria regardless of further recruitment and warranted discontinuation. The most common toxicities (across all grades) were hyperphosphatemia, xerostomia, mucositis, retinopathy, dysgeusia, and fatigue. Maximum toxicities were grade 2 or below for all patients across all cycles. There was no association between tumour BAP1 protein loss and clinical outcomes. The FGFR 1-3 inhibitor AZD4547 did not demonstrate efficacy in patients with MPM who had progressed after first line treatment with platinum-based chemotherapy.
Publisher: Wiley
Date: 16-10-2018
DOI: 10.1111/JHN.12600
Abstract: Dietetics students are a widely researched group. As emerging dietitians, they can provide valuable insights to inform how dietetics education programmes may be enhanced to meet contemporary healthcare needs. This review aimed to systematically synthesise dietetics students' experiences of dietetics workforce preparation. MEDLINE, CINAHL, Embase, PsycINFO, ERIC, Informit and ProQuest Dissertations and Theses Global were searched to identify research published until June 2017. Studies investigating dietetics students' experiences of dietetics workforce preparation, and employing qualitative data collection and analysis methods were included. Data analysis was guided by thematic synthesis, where themes were constructed through an iterative and inductive process. Study quality was appraised using the RATS Qualitative Research Review Guidelines. From the 3301 records identified, five studies met the inclusion criteria and the views of 120 dietetics students from two countries over a 9-year period were synthesised. The overarching theme of 'navigating through the ups and downs' was underpinned by four main themes: enduring hurdles reconciling expectations transforming self and making and breaking connections. Quality appraisal results rated selection bias as being inadequate/inappropriate across all studies. Dietetics students undertake a transformational journey through dietetics education. They are inspired by seeing what is possible through meaningful encounters with practitioners in erse settings. However, they are challenged by competitive environments and perceived ideals that are embedded in the profession. Strategies that focus on exposing dietetics students to inspirational practitioners, increasing and celebrating ersity in academic lacement settings, and incentivising collaboration across dietetics education, could act as catalysts to enhance the experience of future dietetics students and the nutrition-related health of those they will serve.
Publisher: Oxford University Press (OUP)
Date: 10-2010
DOI: 10.1016/J.EJCTS.2010.01.057
Abstract: Medical thoracoscopy is recommended in the investigation of patients with exudative pleural effusions, especially when pleural fluid analysis is uninformative. The histological finding of 'nonspecific pleuritis/fibrosis' is common in thoracoscopic biopsies and presents a great uncertainty for clinicians and patients as the long-term outcome of these patients is unclear, and anxieties about undiagnosed malignancy persist. A retrospective case-note study of 142 patients who underwent medical thoracoscopy over a 58-month period in a tertiary referral centre with a high incidence of mesothelioma. Patients with 'nonspecific pleuritis/fibrosis' were followed up until death or for a mean (±SD) period of 21.3 (±12.0) months. A definitive histological diagnosis was achieved in 98 (69%) patients. A total of 44 (31%) patients had 'nonspecific pleuritis/fibrosis'. Five (12%) were subsequently diagnosed with malignant pleural disease after a mean interval of 9.8 (±4.6) months. All five patients had histologically confirmed mesothelioma. In 26 patients with 'nonspecific pleuritis/fibrosis', no cause for the pleural effusion was discovered. The false-negative rate of thoracoscopic biopsy for the detection of pleural malignancy was 5%, with a diagnostic sensitivity of 95% and negative predictive value of 90%. Pleural effusion recurrence was more frequently associated with a false-negative pleural biopsy result. However, there was no correlation with other patient characteristics or the thoracoscopist's prediction based on macroscopic appearances. Thoracoscopic pleural biopsy is valuable in the diagnosis of pleural malignancies. Patients with 'nonspecific pleuritis/fibrosis' require follow-up as a malignant diagnosis (especially mesothelioma) may eventually be established in approximately 12% of cases.
Publisher: Wiley
Date: 2006
Publisher: Wiley
Date: 15-06-2021
DOI: 10.1111/CYT.13015
Abstract: To assess the utility of BRCA1‐associated protein 1 (BAP1) immunohistochemistry (IHC) for the diagnosis of malignant pleural mesothelioma (MPM) in fluid s les with atypical cytology. Pleural fluid s les with an atypical mesothelial proliferation (diagnostic categories: ‘atypical’ and ‘suspicious’) received between January 2015 and March 2018 at a tertiary referral centre were identified. Results of routine IHC testing were recorded for each case. BAP1 by IHC was performed and a final diagnosis sought from subsequent pathology specimens, medical records, or consensus clinical diagnosis. Of 50 cases identified, 41 were reported as atypical and 9 as suspicious. Seven (14%) demonstrated loss of BAP1 staining, 40 retained BAP1 staining, 1 had heterogeneous staining, and 2 had insufficient cells for analysis. All seven cases with BAP1 loss were diagnosed with MPM on follow‐up. Of those with retained BAP1, 52.5% (21) were subsequently diagnosed with MPM, while 40% (16) had non‐MPM diagnoses after a median follow‐up of 24 months. Three cases were not further investigated based on patient and clinician decision. The case with heterogeneous staining was diagnosed as mesothelioma by clinical consensus. BAP1 IHC loss is highly specific for malignancy and has value as a rule‐in test. Even in a tertiary centre with clinical interest in the cytological diagnosis of MPM this investigation was able to increase diagnostic accuracy beyond routine IHC studies. Cytological criteria remain valuable, as retained BAP1 in an atypical or suspicious mesothelial proliferation cannot exclude malignancy.
Publisher: Informa UK Limited
Date: 03-11-2020
Publisher: Wiley
Date: 26-06-2012
DOI: 10.1111/J.1440-1843.2012.02175.X
Abstract: This review article summarizes the content of a series of interrelated workshop presentations from the Annual Scientific Meeting of the Asian Pacific Society of Respirology held in Shanghai in November, 2011. The article describes tips and strategies for writing research papers and research grant applications and includes discussion of: the role of pulmonologists in research the debates around the use of the journal impact factor tips for writing manuscripts and publishing research in high-impact journals how journals assess manuscripts and the most common reasons editors reject manuscripts how to write grant applications and what grant panels look for in successful proposals and how to undertake research in resource-limited countries.
Publisher: Wiley
Date: 27-05-2004
Publisher: Wiley
Date: 12-01-2016
Publisher: American Thoracic Society
Date: 09-2008
Publisher: European Respiratory Society
Date: 03-2020
Publisher: Elsevier BV
Date: 09-2020
Publisher: European Respiratory Society (ERS)
Date: 31-08-2010
Publisher: Springer Science and Business Media LLC
Date: 02-02-2017
Publisher: Wiley
Date: 17-10-2022
DOI: 10.1002/RCR2.1055
Abstract: Indwelling pleural catheter is an established management for malignant pleural effusions. Extending its use to patients with malignant ascites by insertion of a catheter intraperitoneally enables regular outpatient drainage and improves quality‐of‐life. However, indwelling pleural eritoneal catheter (IPC/IPeC) is associated with catheter‐related infections, traditionally managed with systemic antibiotics and occasionally requires catheter removal. Direct administration of antibiotics intra‐abdominally via peritoneal dialysis (PD) catheters is a well‐established, efficacious practice in PD‐related peritonitis and minimizes systemic adverse effects. We applied the same principles to a patient with peritoneal mesothelioma who developed peritonitis 3 weeks after insertion of IPeC. Intraperitoneal vancomycin was administered via, and compatible with, the IPeC. The patient tolerated the treatment without adverse effects and made a full recovery without requiring catheter removal.
Publisher: Elsevier BV
Date: 09-2014
Abstract: Indwelling pleural catheters (IPCs) are commonly used to manage malignant effusions. Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of IPC-related catheter tract metastases (CTMs) to date, to our knowledge. This is a single-center, retrospective review of IPCs inserted over a 44-month period. CTM was defined as a new, solid chest wall lesion over the IPC insertion site and/or the tunneled subcutaneous tract that was clinically compatible with a malignant tract metastasis. One hundred ten IPCs were placed in 107 patients (76.6% men 60% with mesothelioma). CTM developed in 11 cases (10%): nine with malignant pleural mesothelioma and two with metastatic adenocarcinoma. CTM often developed late (median, 280 days range, 56-693) post-IPC insertion. Seven cases had chest wall pain, and six received palliative radiotherapy to the CTM. Radiotherapy was well tolerated, with no major complications and causing no damage to the catheters. Longer interval after IPC insertion was the sole significant risk factor for development of CTM (OR, 2.495 95% CI, 1.247-4.993 P = .0098) in the multivariate analyses. IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas. The duration of interval after IPC insertion is the key risk factor identified for development of CTM. Symptoms are generally mild and respond well to radiotherapy, which can be administered safely without removal of the catheter.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2013
Publisher: American Physiological Society
Date: 04-2005
DOI: 10.1152/AJPLUNG.00173.2004
Abstract: Pleural inflammation underlies many pleural diseases, but its pathogenesis remains unclear. Proteinase-activated receptor-2 (PAR 2 ) is a novel seven-transmembrane receptor with immunoregulatory roles. We hypothesized that PAR 2 is present on mesothelial cells and can induce pleural inflammation. PAR 2 was detected by immunohistochemistry in all (19 parietal and 11 visceral) human pleural biopsies examined. In cultured murine mesothelial cells, a specific PAR 2 -activating peptide (SLIGRL-NH 2 ) at 10, 100, and 1,000 μM stimulated a 3-, 42-, and 1,330-fold increase of macrophage inflammatory protein (MIP)-2 release relative to medium control, respectively ( P 0.05 all) and a 2-, 32-, and 75-fold rise over the control peptide (LSIGRL-NH 2 , P 0.05 all). A similar pattern was seen for TNF-α release. Known physiological activators of PAR 2 , tryptase, trypsin, and coagulation factor Xa, also stimulated dose-dependent MIP-2 release from mesothelial cells in vitro. Dexamethasone inhibited the PAR 2 -mediated MIP-2 release in a dose-dependent manner. In vivo, pleural fluid MIP-2 levels in C57BL/6 mice injected intrapleurally with SLIGRL-NH 2 (10 mg/kg) were significantly higher than in mice injected with LSIGRL-NH 2 or PBS (2,710 ± 165 vs. 880 ± 357 vs. 88 ± 46 pg/ml, respectively P 0.001). Pleural fluid neutrophil counts were higher in SLIGRL-NH 2 group than in the LSIGRL-NH 2 and PBS groups (by 40- and 26-fold, respectively P 0.05). This study establishes that activation of mesothelial cell PAR 2 potently induces the release of inflammatory cytokines in vitro and neutrophil recruitment into the pleural cavity in vivo.
Publisher: European Respiratory Society
Date: 03-2020
Publisher: Elsevier BV
Date: 02-2003
Abstract: The objectives of this study are as follows: (1) to determine the incidence of complications from thoracentesis performed under ultrasound guidance by interventional radiologists in a tertiary referral teaching hospital (2) to evaluate the incidence of vasovagal events without the use of atropine prior to thoracentesis and (3) to evaluate patient or radiographic factors that may contribute to, or be predictive of, the development of re-expansion pulmonary edema after ultrasound-guided thoracentesis. Prospective descriptive study. Saint Thomas Hospital, a tertiary referral teaching hospital in Nashville, TN. All patients referred to interventional radiology for diagnostic and/or therapeutic ultrasound-guided thoracentesis between August 1997 and September 2000. A total of 941 thoracenteses in 605 patients were performed during the study period. The following complications were recorded: pain (n = 25 2.7%), pneumothorax (n = 24 2.5%), shortness of breath (n = 9 1.0%), cough (n = 8 0.8%), vasovagal reaction (n = 6 0.6%), bleeding (n = 2 0.2%), hematoma (n = 2 0.2%), and re-expansion pulmonary edema (n = 2 0.2%). Eight patients with pneumothorax received tube thoracostomies (0.8%). When > 1,100 mL of fluid were removed, the incidence of pneumothorax requiring tube thoracostomy and pain was increased (p 1,000 mL of pleural fluid were removed. The complication rate with thoracentesis performed by interventional radiologists under ultrasound guidance is lower than that reported for non-image-guided thoracentesis. Premedication with atropine is unnecessary given the low incidence of vasovagal reactions. Re-expansion pulmonary edema is uncommon even when > 1,000 mL of pleural fluid are removed, as long as the procedure is stopped when symptoms develop.
Publisher: Wiley
Date: 07-2009
DOI: 10.1111/J.1440-1843.2009.01484.X
Abstract: Respiratory illnesses are a huge and rising burden to health-care systems and societies worldwide. Research is crucial to tackle the enormous problem of chest diseases. However the vast number of research questions and available research approaches often creates confusion and risks dilution of resources by spreading them too diffusely. Clear research directions will help to use research funds efficiently to provide treatment advances that benefit patient care. This paper presents the visions of leading experts on future research directions, focusing on what should rather than what is going to be done. These opinions provide a guide for new investigators and a platform for intellectual debates through which coordinated research efforts can help progress towards respiratory health.
Publisher: European Respiratory Society
Date: 28-09-2019
Publisher: American Medical Association (AMA)
Date: 21-11-2017
Publisher: BMJ
Date: 08-2001
Abstract: Talc and tetracyclines induce pleurodesis by directly injuring the pleura. The injury results in intense inflammation which subsequently leads to fibrosis. Corticosteroids can inhibit talc pleurodesis by reducing the inflammatory process. We hypothesised that transforming growth factor beta2 (TGFbeta2), a fibrogenic cytokine with immunomodulatory functions, could induce effective pleurodesis without generating significant pleural inflammation and therefore remain effective despite co-administration of corticosteroids. Thirty rabbits were ided into two groups. Rabbits in the steroid group received weekly intramuscular injections of triamcinolone diacetate (0.8 mg/kg). Ten rabbits in each group were given 5.0 microg TGFbeta2 intrapleurally via a chest tube while the remaining five received 1.7 microg TGFbeta2. Pleurodesis was graded macroscopically after 14 days from 1 (none) to 8 (>50% symphysis). TGFbeta2 produced excellent pleurodesis at both 5.0 microg and 1.7 microg doses. The pleural effusions produced after the injection were low in all inflammatory markers. No significant differences were seen between the steroid group and controls in macroscopic pleurodesis scores (7.2 (1.3) v 7.1 (1.2)), levels of inflammatory markers in the pleural fluids (leucocyte 1107 (387)/mm(3) v 1376 (581)/mm(3) protein 3.1 (0.3) mg/dl v 2.9 (0.3) mg/dl, and LDH 478 (232) IU/l v 502 (123) IU/l), and the degree of microscopic pleural fibrosis and pleural inflammation. TGFbeta2 can induce effective pleurodesis and remains effective in the presence of high dose parenteral corticosteroids.
Publisher: Wiley
Date: 15-07-2019
Abstract: The present study aimed to systematically map and summarise existing research regarding dietetics workforce preparation and preparedness that has been conducted in Australia. The secondary aim was to then identify gaps in the literature to inform future priority areas in Australian dietetics education research. The databases MEDLINE, CINAHL, Embase, ERIC, Informit and PsycINFO were systematically searched from inception until July 2017 using key search terms to identify eligible studies. Extracted data were independently reviewed, and study quality was appraised by multiple researchers. Results were categorised by setting and primary focus/foci and then narratively summarised. Sixty-eight studies were included from 3779 records identified. Dietetics education research in Australia has spanned almost 30 years with more than half of studies (51% 35/68) published in the last five years. The greatest proportion of research was conducted in the university setting (43% 29/68), with students as participants (48% 43/90) and was focused on the medical nutrition therapy area of dietetics practice (43% 29/68). Published studies involving graduates (14% 13/90) conducted in the workplace (12% 8/68) and regarding emerging areas of dietetics practice (0% 0/90) are lacking. Employment outcomes of dietetics graduates across Australia were last published over 25 years ago. This review provides a map for dietetics educators and researchers in Australia to guide future research regarding the preparation and preparedness of dietitians. Advancing the Australian dietetics workforce of the future will require a strategic, coordinated and collaborative approach to address the research gaps identified in this review.
Publisher: American Thoracic Society
Date: 09-2009
Publisher: Radiological Society of North America (RSNA)
Date: 12-2003
Publisher: Elsevier
Date: 2021
Publisher: Wiley
Date: 26-09-2011
Publisher: Wiley
Date: 19-04-2022
DOI: 10.1111/RESP.14261
Abstract: Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) therapy is increasingly used in pleural infection. Bleeding risks and costs associated with tPA remain the clinical concerns. Our dose de‐escalation series aims to establish the lowest effective dosing regimen for tPA/DNase. This study assesses the intrapleural use of 2.5 mg tPA/5 mg DNase for pleural infection. Consecutive patients with pleural infection treated with a starting regime of 2.5 mg tPA/5 mg DNase were included from two centres in Australia and UK. Escalation of tPA dose was permitted if clinical response was inadequate. Sixty‐nine patients (mean age 61.0 years) received intrapleural 2.5 mg tPA/5 mg DNase. Most (88.4%) were treated successfully and discharged from hospital without surgery by 90 days. Patients received a median of 5 [interquartile range [IQR] = 3–6] doses of tPA/DNase. Total amount of tPA used per patient was 12.5 mg [median, IQR = 7.5–15.0]. Seventeen patients required dose escalation of tPA most ( n = 12) for attempted drainage of distant non‐communicating locule(s). Treatment success was corroborated by clearance of pleural opacities on radiographs (from median 27.0% [IQR = 17.1–44.5] to 11.0% [IQR = 6.4–23.3] of hemithorax, p 0.0001), increased pleural fluid drainage (1.98 L [median, IQR = 1.38–2.68] over 72 h following commencement of tPA/DNase) and reduction of serum C‐reactive protein level (by 45.0% [IQR = 39.3–77.0] from baseline at day 5, p 0.0001). Two patients required surgery. Six patients with significant comorbidities (e.g., advanced cancer) had ongoing infection when palliated and died. Two patients experienced self‐limiting pleural bleeding and received blood transfusion. A starting intrapleural regime of 2.5 mg tPA/5 mg DNase, with up‐titration if needed, can be effective and deserves further exploration.
Publisher: Massachusetts Medical Society
Date: 30-01-2020
Publisher: Wiley
Date: 19-09-2018
DOI: 10.1111/RESP.13171
Publisher: Georg Thieme Verlag KG
Date: 12-2010
Abstract: Drainage of the pleural space is not a modern concept, but the optimal size of chest drains to use remains debated. Conventional teaching advocates blunt dissection and large-bore tubes but in recent years, small-bore catheters have gained popularity. In the absence of high-quality randomized data, this review summarizes the available literature on the choice of chest drains. The objective data supporting the use of large-bore tubes is scarce in most pleural diseases. Increasing evidence shows that small-bore catheters induce less pain and are of comparable efficacy to large-bore tubes, including in the management of pleural infection, malignant effusion, and pneumothoraces. The onus now is on those who favor large tubes to produce clinical data to justify the more invasive approach.
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/IMJ.14642
Abstract: Patients suffering from malignant ascites usually require repeated large volume paracentesis (LVP) for symptomatic relief. This often requires hospital admission and has inherent risks. To report the first Australian experience of placing tunnelled indwelling peritoneal catheters (IPeC) for management of recurrent malignant ascites. A retrospective study was conducted of tunnelled IPeC use in patients with symptomatic malignant ascites in four hospitals in Western Australia (from 2010 to 2018). Procedure data, success rate and safety profile were collected from a database. Forty-eight patients (median age 65 years female 56%) underwent 51 peritoneal catheter insertion procedures that were performed mostly by pleural specialists. The majority of patients (96%) had prior LVP (median two drainages, interquartile range (IQR) 1-4) before IPeC insertion. The IPeC was inserted successfully under ultrasound guidance in all patients. The median length of hospital stay for IPeC insertion and initial ascites drainage was 2 days (IQR 2-3 days) and most patients (96%) did not require further paracentesis after IPeC placement. The majority (96%) of patients experienced relief from ascites symptoms after catheter insertion. Most IPeC-related adverse events were self-limiting, including pain (in 25% cases), transient hypotension after initial fluid drainage (10%), peritoneal fluid leakage (10%), bacterial peritonitis (8%), fluid loculation (2%) and catheter dislodgement (2%). Six (12%) patients had IPeC removed. All patients with bacterial peritonitis responded to antibiotics and one required catheter removal. Use of tunnelled IPeC improves symptoms and can minimise further invasive drainage procedures in patients with symptomatic malignant ascites. Placement of IPeC was associated with a low rate of adverse events, most of which could be managed conservatively.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 26-08-2021
DOI: 10.1002/RCR2.837
Abstract: Large primary spontaneous pneumothorax (PSP) has traditionally been managed with needle aspiration, chest tube drainage and, in refractory cases, thoracic surgery. A recent randomized trial, however, provided evidence that a conservative observational approach was safe and 85% of patients recovered without requiring pleural drainage interventions. A conservative approach provided similar re‐expansion rates at 8 weeks compared with chest tube drainage and offered the advantages of early hospital discharge, fewer days off work and avoidance of procedural risks. Nonetheless, clinicians are understandably anxious with conservative (non‐drainage) management for patients with very large pneumothorax. Here, we report a patient with a right‐sided PSP and total lung collapse that was managed successfully without intervention with minimal time in hospital or off work.
Publisher: Wiley
Date: 25-08-2016
DOI: 10.1111/RESP.12874
Abstract: Malignant pleural effusion (MPE) affects >90% of mesothelioma patients. Research on MPE has focused on its physical impact on breathlessness MPE is rich in growth mediators but its contribution to tumour biology has not been investigated. We aimed to examine the potential effects of MPE in promoting growth, migration and chemo-resistance of mesothelioma. Pleural fluid s les from 151 patients (56 mesothelioma, 60 metastatic pleural cancer and 35 benign) were used. Seven validated human mesothelioma cell lines and three primary cultured mesothelioma lines were employed. Pleural fluid from mesothelioma patients (diluted to 30%) consistently stimulated cell proliferation (trypan-blue cell viability assay) in five mesothelioma cell lines tested by (median) 2.23-fold over controls (all P < 0.0001). The fluid also induced cell migration by (median) 2.13-fold in six mesothelioma cell lines using scratch-wound assay. In a murine flank model of mesothelioma, tumour infused with daily instillations of pleural fluid grew significantly faster over saline controls (median 52.5 cm This 'proof-of-concept' study reveals potent biological capabilities of malignant pleural fluid in mesothelioma pathobiology.
Publisher: European Respiratory Society
Date: 03-2020
Publisher: Springer Science and Business Media LLC
Date: 18-03-2019
DOI: 10.1038/S41430-019-0418-9
Abstract: Malignant pleural mesothelioma (MPM) is an incurable cancer and optimizing daily physical activity and quality of life are key goals of patient management. Little is known about the prevalence of pre-sarcopenia and malnutrition in MPM or their associations with patient outcomes. This study aimed to determine the prevalence of pre-sarcopenia and malnutrition in MPM and investigate if activity levels and quality of life differed according to body composition and nutritional status. Patients with a diagnosis of MPM were recruited. Pre-sarcopenia was defined as low appendicular skeletal muscle mass (≤ 7.26 kg/m Sixty-one people participated (79% male, median age 69 [IQR 62-74] years and median BMI 25.8 [IQR 24.3-28.4] kg/m Participants with MPM had high rates of pre-sarcopenia and malnutrition. Pre-sarcopenia was associated with poorer activity levels, whilst malnutrition was associated with poorer quality of life. Interventions that aim to address reduced muscle mass and weight loss, should be tested in MPM to assess their impact on patient outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
Publisher: BMJ
Date: 04-2011
Abstract: Pleural infection is common, and has a >30% major morbidity and mortality-particularly when infection is caused by Gram-negative, Staphylococcus aureus or mixed aerobic pathogens. Standard pleural fluid culture is negative in ∼40% of cases. Culturing pleural fluid in blood culture bottles may increase microbial yield, and is cheap and easy to perform. To determine whether inoculating pleural fluid into blood culture bottles increases the culture positivity of pleural infection over standard laboratory culture, and to assess the optimum volume of inoculum to introduce. 62 patients with pleural infection were enrolled. Pairs of aerobic and anaerobic blood culture bottles were inoculated at the bedside with 2, 5 or 10 ml of pleural fluid, and two pleural fluid specimens were sent for standard culture. Pleural fluid from nine control patients was cultured to test for 'false-positive' results. The addition of blood culture bottle culture to standard culture increased the proportion of patients with identifiable pathogens by 20.8% (20/53 (37.7%) to 31/53 (58.5%) (difference 20.8%, 95% CI difference 8.9% to 20.8%, p<0.001)). The second standard culture did not similarly improve the culture positivity (19/49 (38.8%) to 22/49 (44.9%) (difference 6.1%, 95% CI difference -2.5% to 6.1%, p=0.08)). The culture inoculum volume did not influence bacterial isolation frequency. The control fluids were culture negative. Blood culture bottle culture of infected pleural fluid increases microbial yield when used in addition to standard culture. This technique should be part of routine care.
Publisher: Wiley
Date: 15-02-2021
DOI: 10.1111/RESP.14015
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.PEC.2022.02.017
Abstract: Practice guidelines emphasize the importance of investigating psychosocial distress in mesothelioma patients and family caregivers. We aimed to synthesize research on the psychosocial support needs of mesothelioma patients and their family caregivers. We conducted a systematic review with a narrative synthesis and quality assessment. The review process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, Scopus, PsychArticles, and PsycINFO were searched until December 2020 and 37 studies in English met inclusion criteria. Most (n = 24) included mesothelioma patients as a very small proportion of their cancer s les. A narrative synthesis was conducted on the 13 studies including only mesothelioma patients (n = 297) and/or caregivers (n = 82). Patients and caregivers want improvements in the diagnosis delivery and access to palliative care. Patients want emotional support, patient-centered treatment, improved information about illness progression and death, and to meet others with mesothelioma. Caregivers want one-on-one practical and emotional support. Study quality varied. Few studies focus on the psychosocial support needs relevant to mesothelioma. Mesothelioma patients and family caregivers highlight targeted psychosocial care as an unmet need. Efforts are required to design and test psychosocial interventions for this vulnerable and overlooked group. PROSPERO (registration number CRD42020167852).
Publisher: Elsevier
Date: 2008
Publisher: Informa UK Limited
Date: 08-03-2017
DOI: 10.1080/17476348.2017.1300532
Abstract: Management of symptomatic malignant pleural effusions is becoming more complex due to the range of treatment options, which include therapeutic thoracenteses, thoracoscopic talc pleurodesis, bedside pleurodesis with talc or other sclerosing agents via small-bore chest catheters, indwelling pleural catheters, surgery, or a combination of some of these procedures. Areas covered: Recent advances for the expanding range of treatment options in malignant pleural effusions are summarized, according to the best available evidence. Expert commentary: Selection of a treatment approach in malignant pleural effusions should take into account patient preferences and performance status, tumor type, predicted prognosis, presence of a non-expandable lung, and local experience or availability. The role of pleurodesis has decreased with the advent of indwelling pleural catheters, which provide a high degree of symptomatic relief on an outpatient basis and, therefore, are being positioned as a first choice therapy in many centers. Talc poudrage pleurodesis should probably be reserved for those situations in which pleural tumor invasion is discovered during diagnostic thoracoscopy. Ongoing randomized controlled trials will offer solid evidence on which of the available palliative approaches should be selected for each particular patient.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2015
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.JTHO.2022.04.008
Abstract: Pleural mesothelioma (PM) is an aggressive malignancy with no identified predictive biomarkers. We assessed whether tumor BAP1 status is a predictive biomarker for survival in patients receiving first-line combination platinum and pemetrexed therapy. PM cases (n = 114) from Aalborg, Denmark, were stained for BAP1 on tissue microarrays. Demographic, clinical, and survival data were extracted from registries and medical records. Surgical cases were excluded. BAP1 status was associated with overall survival (OS) by Cox regression and Kaplan-Meier methods. Results were validated in an independent cohort from Perth, Australia (n = 234). BAP1 loss was found in 62% and 60.3% of all Danish and Australian s les, respectively. BAP1 loss was an independent predictor of OS in multivariate analyses corrected for histological subtype, performance status, age, sex, and treatment (hazard ratio = 2.49, p < 0.001, and 1.48, p = 0.01, respectively). First-line platinum and pemetrexed-treated patients with BAP1 loss had significantly longer median survival than those with retained BAP1 in both the Danish (20.1 versus 7.3 mo, p < 0.001) and Australian cohorts (19.6 versus 11.1 mo, p < 0.01). Survival in patients with BAP1 retained and treated with platinum and pemetrexed was similar as in those with best supportive care. There was a higher OS in patients with best supportive care with BAP1 loss, but it was significant only in the Australian cohort (16.8 versus 8.3 mo, p < 0.01). BAP1 is a predictive biomarker for survival after first-line combination platinum and pemetrexed chemotherapy and a potential prognostic marker in PM. BAP1 in tumor is a promising clinical tool for treatment stratification.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.CCM.2006.01.004
Abstract: Malignant mesothelioma is increasing in incidence globally and has no known cure. Its unique clinical feature of local infiltration along tissue planes makes it a difficult neoplasm to manage. There have been few randomized controlled trials regarding treatment options, although these have increased in recent years, and results are eagerly awaited. This article summarizes important advances in the management of mesothelioma, especially diagnostic and therapeutic aspects.
Publisher: Elsevier BV
Date: 07-2021
Publisher: American Thoracic Society
Date: 2019
Publisher: American Thoracic Society
Date: 11-2014
Publisher: Wiley
Date: 07-08-2023
DOI: 10.1002/CAM4.6373
Abstract: Quantifying the benefits and harms of breast cancer screening accurately is important for planning and evaluating screening programs and for enabling women to make informed decisions about participation. However, few cohort studies have attempted to estimate benefit and harm simultaneously. We aimed to quantify the impact of mammographic screening on breast cancer mortality and overdiagnosis using a cohort of women invited to attend Australia's national screening program, BreastScreen. In a cohort of 41,330 women without prior breast cancer diagnosis, screening, or diagnostic procedures invited to attend BreastScreen Western Australia in 1994‐1995, we estimated the cumulative risk of breast cancer mortality and breast cancer incidence (invasive and ductal carcinoma in situ) from age 50 to 85 years for attenders and non‐attenders. Data were obtained by linking population‐based state and national health registries. Breast cancer mortality risks were estimated from a survival analysis that accounted for competing risk of death from other causes. Breast cancer risk for unscreened women was estimated by survival analysis, while accounting for competing causes of death. For screened women, breast cancer risk was the sum of risk of being diagnosed at first screen, estimated using logistic regression, and risk of diagnosis following a negative first screen estimated from a survival analysis. For every 1,000 women 50 years old at first invitation to attend BreastScreen, there were 20 (95% CI 12‐30) fewer breast cancer deaths and 25 (95% CI 15‐35) more breast cancers diagnosed for women who attended than for non‐attendees by age 85. Of the breast cancers diagnosed in screened women, 21% (95% CI 13%‐27%) could be attributed to screening. The estimated ratio of benefit to harm was consistent with, but slightly less favourable to screening than most other estimates from cohort studies. Women who participate in organised screening for breast cancer in Australia have substantially lower breast cancer mortality, while some screen‐detected cancers may be overdiagnosed.
Publisher: Wiley
Date: 26-05-2021
DOI: 10.1111/CEO.13940
Abstract: To describe ocular adverse events and retinal changes during fibroblast growth factor receptor (FGFR) inhibitor (AZD4547) anticancer therapy. This is a sub‐study examining ocular adverse effects from AZD4547 therapy (single‐centre, open‐label, single arm phase II clinical trial). Comprehensive ocular examinations were performed 3 weekly in 24 patients. Macular optical coherence tomography (OCT) scan (30 0 × 25 0 ) was obtained at each visit and OCT parameters [central 1 mm retinal thickness (CRT) and total macular volume in central 6 mm] extracted. OCT scans were sub ided into outer (ELM to RPE) and inner (ELM to ILM) layers to compare outer and inner retinal changes. In 24 patients, AZD4547 was associated with eyelash elongation ( n = 5, 21%) and punctate corneal erosion ( n = 2, 8%). One patient developed clinically significant posterior capsular opacification during the study. OCT data were available in 23 patients, retinal changes ranged from an asymptomatic increased visibility of the interdigitation zone (IDZ) ( n = 10, 43%) to multilobular subretinal fluid pockets ( n = 5, 22%), which was associated with mild visual acuity loss. In a subset of patients ( n = 9) with pre‐AZD4547 dosing OCT baseline, CRT increased by mean ( SD ) of 9 (4) μm in those with IDZ change only compared with 64 (38) μm in those with other retinal changes. Retinal changes tended to be bilateral, self‐limiting and improved over time without medical intervention. The ocular signs and symptoms did not result in dose cessation. Posteriorly, FGFR inhibition leads to outer retinal changes ranging from increased visibility of IDZ to distinct, multiple fluid pockets.
Publisher: BMJ
Date: 12-2000
DOI: 10.1136/THORAX.55.12.1058
Abstract: We have recently shown that transforming growth factor (TGF)beta(2) induces effective pleurodesis in rabbits. However, rabbits have a thin pleura while humans have a thick visceral pleura. The effect of intrapleural administration of TGF beta(2) in animals with a thick pleura and its associated systemic effects have not been investigated. This study was undertaken (1) to develop a new animal model for the study of pleurodesis using sheep which have a thick pleura resembling that of humans (2) to study the efficacy of TGF beta(2) as a pleurodesis agent in the sheep model and (3) to assess whether histological changes occur in extrapulmonary organs after intrapleural administration of TGF beta(2). Twelve sheep were ided into four groups and were given a single intrapleural injection of TGF beta(2) in a concentration of 1.0 microg/kg, 0.5 microg/kg, 0.25 microg/kg or 0.125 microg/kg to the right pleural cavity via a chest tube. The left pleural cavity served as the control. Any pleural fluid that accumulated after the intrapleural TGF beta(2) injection was collected and analysed. The degree of pleurodesis was graded from 1 (no adhesions) to 8 (complete symphysis >50% of chest wall) at day 14 when the sheep were killed. Biopsy specimens were taken from the lungs and extrapulmonary organs. All sheep that received > or = 0.25 microg/kg TGF beta(2) developed excellent pleurodesis (score = 8) while those that received 0.125 microg/kg had a median score of 6. The pleurodesis score did not exceed 2 in the control (left) side of any sheep. Sheep receiving > or = 0.50 microg/kg TGF beta(2) developed large exudative pleural effusions while those receiving a lower dose did not. The production of effusions neither hindered nor was necessary for inducing pleurodesis. There were no significant fibrotic changes in any of the extrapulmonary organs. Intrapleural injection of 0.25-1.0 microg/kg TGF beta(2) produces excellent pleurodesis in a new sheep model with no evidence of extrapulmonary fibrosis.
Publisher: Elsevier BV
Date: 10-1999
Abstract: Bilateral pneumothoraces can result from unilateral air leak after heart-lung transplantation. The recommended initial management of such patients is insertion of a unilateral chest tube. We report a patient who developed bilateral pneumothoraces after undergoing transbronchial biopsies 2 years after a heart-lung transplant. The unilateral chest tube failed to drain the contralateral pneumothorax and a tension pneumothorax developed. The advocated approach should be used with caution.
Publisher: American Thoracic Society
Date: 10-2018
Publisher: Oxford University Press (OUP)
Date: 05-2008
DOI: 10.1086/586716
Abstract: A resurgence of Haemophilus influenzae type b (Hib) disease occurred in the United Kingdom between 1999 and 2003 and was partially attributed to lower immunogenicity of combination vaccines. The reservoir for Hib that led to transmission in this period is unknown. We estimated the point prevalence of Hib carriage in school-aged children and adults, using oropharyngeal swabbing and selective media. We characterized the Hib isolates by multilocus sequence typing (MLST) and measured Hib antibody concentrations in adults by enzyme-linked immunosorbent assay. Point prevalence for Hib carriage in 855 children aged 6-16 years was 4.2% (95% confidence interval [CI], 2.5%-5.9%). Five clonal groups of Hib were identified by MLST, 86% from the lineage of sequence type 6. No Hib was isolated in 385 adults (upper limit of 95% CI, 0.95%). The geometric mean concentration of serum antibody to polyribosylribitol phosphate was 0.47 microg/mL (95% CI, 0.37-0.59 mirog/mL) in adults. Hib carriage is common in school-aged children, who are a significant reservoir for ongoing transmission of Hib to susceptible in iduals in the United Kingdom. Surveillance of transmission and immunity across all ages of the population is essential to monitor the evolution of Hib epidemiology.
Publisher: Springer Science and Business Media LLC
Date: 17-01-2022
DOI: 10.1038/S41430-021-01062-6
Abstract: Skeletal muscle loss is common in advanced cancer and is associated with negative outcomes. In malignant pleural mesothelioma (MPM), no study has reported body composition changes or factors associated with these changes. This study aimed to describe changes in body composition over time and its relationship with activity levels, dietary intake and survival. The study was a secondary analysis of data collected from a longitudinal observational study of patients with MPM. Participants completed 3-month assessments for up to 18 months. Participants with two dual-energy x-ray absorptiometry (DXA) scans were included. Changes in appendicular skeletal muscle mass (ASM) and total fat mass were used to categorise participants into phenotypes. Activity levels were measured with an ActiGraph GT3X+ accelerometer and energy and protein intake was measured with a 3-day food record and 24-h recall. Eighteen participants were included (89% men, mean age 68.9 ± 7.1 years). Median time between DXA was 91 [IQR 84–118] days. Compared to participants with ASM maintenance ( n = 9), fewer participants with ASM loss ( n = 9) survived ≥12 months from follow-up ( p = 0.002). Participants with ASM loss increased sedentary time ( p = 0.028) and decreased light activity ( p = 0.028) and step count ( p = 0.008). Activity levels did not change in participants with ASM maintenance ( p 0.05). Energy and protein intake did not change in either group ( p 0.05). Muscle loss was associated with poorer survival and decreased activity levels. Interventions that improve physical activity or muscle mass could benefit patients with MPM.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2019
Publisher: SAGE Publications
Date: 2015
Abstract: Malignant pleural mesothelioma (MPM) is a rapidly fatal tumor of increasing worldwide incidence. Diagnosis of MPM may be difficult and is an area of academic and clinical interest. Diagnosis by effusion cytology is controversial, and the clinical utility of soluble biomarkers, particularly mesothelin, remains unexplored in the difficult to diagnose patient. We studied the diagnostic value of measuring mesothelin in patients with cytology-negative pleural effusion undergoing medical thoracoscopy. Patients were enrolled prospectively and underwent medical thoracoscopy. Biopsy s les were reviewed following standard care guidelines. Soluble mesothelin was quantitated by commercial enzyme-linked immunosorbent assay in effusion and serum s les collected at the time of thoracoscopy. Patients were followed up until death or for a median of 28 (interquartile range 18-43) months. Biopsy for thoracoscopy was definitive for malignancy in 17 of the 36 cases (16 MPM and 1 lung adenocarcinoma) and suspicious of malignancy in 6 cases. A final diagnosis of malignancy was made for 27 cases (24 MPM, 2 lung adenocarcinoma, and 1 primary pleural T-cell lymphoma). At thoracoscopy, soluble mesothelin was elevated in the effusion of 13 cases all of which were MPM. Serum mesothelin was elevated in 6 cases with MPM. One case with elevated mesothelin on whom thoracoscopic biopsy demonstrated a pleural plaque was diagnosed with metastatic MPM 9 months later. Elevated effusion mesothelin had a positive predictive value of 100% for a final diagnosis of MPM. Elevated mesothelin, in effusion or serum, should raise the index of suspicion of malignancy and warrants continued clinical follow-up.
Publisher: Hindawi Limited
Date: 31-07-2019
DOI: 10.1155/2019/8628612
Abstract: Malignant pleural mesothelioma (MPM) is an incurable cancer of the pleura that can be difficult to diagnose. Biomarkers for an easier and/or earlier diagnosis are needed. Approximately 90% of MPM patients develop a pleural effusion (PE). PEs are ideal sources of biomarkers as the fluid would almost always require drainage for diagnostic and/or therapeutic reasons. However, differentiating MPM PE from PE caused by other diseases can be challenging. MicroRNAs are popular biomarkers given their stable expression in tissue and fluid. MicroRNAs have been analysed in PE cytology s les for the diagnosis of MPM but have not been measured in frozen/fresh PE. We hypothesise that microRNAs expressed in PE are biomarkers for MPM. TaqMan OpenArray was used to analyse over 700 microRNAs in PE cells and supernatants from 26 MPMs and 21 other PE-causing diseases. In PE cells, combining miR-143, miR-210, and miR-200c could differentiate MPM with an area under the curve (AUC) of 0.92. The three-microRNA signature could also discriminate MPM from a further 40 adenocarcinomas with an AUC of 0.9887. These results suggest that the expression of miR-143, miR-210, and miR-200c in PE cells might provide a signature for diagnosing MPM.
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000496396
Abstract: b i Background: /i /b An important part of the investigation of pleural effusion is the identification of markers that help separate exudate from transudate. b i Objectives: /i /b The purposes of this study were to compare the accuracy of published and new sets of criteria to distinguish between exudative and transudative pleural effusions, and to determine whether serum biochemical analysis is necessary. b i Methods: /i /b An externally validated cohort study was performed. Pleural effusions were determined to be transudative or exudative on the basis of an assessment of the medical record by two clinicians blinded to biochemical results. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve were determined for each proposed combination of criteria. b i Results: /i /b Pleural fluid analysis was available for 311 thoracenteses in the main cohort and for 112 thoracenteses in the validation cohort. The best sensitivity (97% [95% CI 94–99]) and negative likelihood ratio (0.04 [95% CI 0.02–0.08]) for identifying exudative effusions were observed with criteria combining pleural fluid lactate dehydrogenase greater than 0.6 the upper limit of normal serum lactate dehydrogenase and pleural fluid cholesterol greater than 1.04 mmol/L (40 mg/dL). The overall diagnostic accuracy was similar to Light’s criteria. Findings were similar in the validation cohort. b i Conclusions: /i /b Our proposed criteria using simultaneously pleural fluid lactate dehydrogenase and pleural fluid cholesterol can identify an exudate with a sensitivity and an overall diagnostic accuracy similar to Light’s criteria. It avoids simultaneous blood s ling, thus reducing patient discomfort and potential costs.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Elsevier BV
Date: 08-2016
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.VACCINE.2006.04.021
Abstract: The differences in incidence rates of Haemophilus influenzae type b disease and the variation in Hib conjugate vaccine efficacy achieved among different ethnic groups suggest genetic influences on the immune response to Hib vaccine. The serum anti-PRP antibody concentration of 43 monozygotic (MZ) and 147 dizygotic (DZ) twin pairs in the Gambia was measured using a standardised Hib ELISA. Intrapair correlations for MZ and DZ twin pairs were compared and heritability in antibody responses to Hib conjugate vaccine was estimated to be 51% (95% CI: 32-66%), indicating a significant genetic contribution in the response. We conclude that genetic factors may be involved in the variation in immune response to Hib vaccine observed in different populations and may contribute to cases of vaccine failure.
Publisher: Elsevier BV
Date: 09-2015
Abstract: Indwelling pleural catheters (IPCs) are an effective option in the management of malignant pleural effusion. Up to 14% of patients with IPCs develop symptomatic pleural loculations causing ineffective fluid drainage and breathlessness. To our knowledge, this is the first study to describe intrapleural fibrinolytic therapy for IPC-related symptomatic loculations. All patients who received intrapleural fibrinolytic therapy for symptomatic loculations between January 1, 2002, and June 30, 2014, in four established IPC centers were retrospectively included. Patient outcomes, treatment effectiveness, and adverse events were recorded. Sixty-six patients (mean age, 64.7 ± 14.2 years 52% women) were included. Lung cancer (31.3%) and malignant pleural mesothelioma (20.3%) were the most common malignancies. Fibrinolytic instillation was performed in outpatient (61%) and inpatient settings. Tissue-plasminogen activator (n = 52), urokinase (n = 12), and streptokinase (n = 2) were used. The majority (69.7%) received only one fibrinolytic dose (range, one to six). Pleural fluid drainage increased in 93% of patients, and dyspnea improved in 83% following therapy. The median cumulative pleural fluid volume drained at 24 h posttreatment was 500 mL (interquartile range 300-1,034 mL). The area of opacity caused by pleural effusion on chest radiograph decreased from (mean, SD) 52% (14%) to 31% (21%) of the hemithorax (n = 13 P = .001). There were two cases of nonfatal pleural bleed (3%). Intrapleural fibrinolytic therapy can improve pleural fluid drainage and symptoms in selected patients with IPC and symptomatic loculation, but it carries a small risk of pleural bleeding. There is significant heterogeneity in its use currently, and further studies are needed to determine patient selection and optimal dosing regimen and to define its safety profile.
Publisher: Springer Science and Business Media LLC
Date: 02-02-2019
Publisher: Springer Science and Business Media LLC
Date: 03-03-2012
Publisher: Informa UK Limited
Date: 08-10-2015
DOI: 10.1586/17476348.2015.1098535
Abstract: Pleural effusions arise from a variety of systemic, inflammatory, infectious and malignant conditions. Their precise etiological diagnosis depends on a combination of medical history, physical examination, imaging tests and pertinent pleural fluid analyses including specific biomarkers (e.g., natriuretic peptides for heart failure, adenosine deaminase for tuberculosis, or mesothelin for mesothelioma). Invasive procedures, such as pleuroscopic biopsies, may be required for persistently symptomatic effusions which remain undiagnosed after the analysis of one or more pleural fluid s les. However, whenever parietal pleural nodularity or thickening exist, image-guided biopsies should first be attempted. This review addresses the current diagnostic approach to pleural effusions secondary to heart failure, pneumonia, cancer, tuberculosis and other less frequent conditions.
Publisher: American Medical Association (AMA)
Date: 22-12-2015
Abstract: For treatment of malignant pleural effusion, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because they may reduce pleurodesis efficacy. Smaller chest tubes may be less painful than larger tubes, but efficacy in pleurodesis has not been proven. To assess the effect of chest tube size and analgesia (NSAIDs vs opiates) on pain and clinical efficacy related to pleurodesis in patients with malignant pleural effusion. A 2×2 factorial phase 3 randomized clinical trial among 320 patients requiring pleurodesis in 16 UK hospitals from 2007 to 2013. Patients undergoing thoracoscopy (n = 206 clinical decision if biopsy was required) received a 24F chest tube and were randomized to receive opiates (n = 103) vs NSAIDs (n = 103), and those not undergoing thoracoscopy (n = 114) were randomized to 1 of 4 groups (24F chest tube and opioids [n = 28] 24F chest tube and NSAIDs [n = 29] 12F chest tube and opioids [n = 29] or 12F chest tube and NSAIDs [n = 28]). Pain while chest tube was in place (0- to 100-mm visual analog scale [VAS] 4 times/d superiority comparison) and pleurodesis efficacy at 3 months (failure defined as need for further pleural intervention noninferiority comparison margin, 15%). Pain scores in the opiate group (n = 150) vs the NSAID group (n = 144) were not significantly different (mean VAS score, 23.8 mm vs 22.1 mm adjusted difference, -1.5 mm 95% CI, -5.0 to 2.0 mm P = .40), but the NSAID group required more rescue analgesia (26.3% vs 38.1% rate ratio, 2.1 95% CI, 1.3-3.4 P = .003). Pleurodesis failure occurred in 30 patients (20%) in the opiate group and 33 (23%) in the NSAID group, meeting criteria for noninferiority (difference, -3% 1-sided 95% CI, -10% to ∞ P = .004 for noninferiority). Pain scores were lower among patients in the 12F chest tube group (n = 54) vs the 24F group (n = 56) (mean VAS score, 22.0 mm vs 26.8 mm adjusted difference, -6.0 mm 95% CI, -11.7 to -0.2 mm P = .04) and 12F chest tubes vs 24F chest tubes were associated with higher pleurodesis failure (30% vs 24%), failing to meet noninferiority criteria (difference, -6% 1-sided 95% CI, -20% to ∞ P = .14 for noninferiority). Complications during chest tube insertion occurred more commonly with 12F tubes (14% vs 24% odds ratio, 1.91 P = .20). Use of NSAIDs vs opiates resulted in no significant difference in pain scores but was associated with more rescue medication. NSAID use resulted in noninferior rates of pleurodesis efficacy at 3 months. Placement of 12F chest tubes vs 24F chest tubes was associated with a statistically significant but clinically modest reduction in pain but failed to meet noninferiority criteria for pleurodesis efficacy. isrctn.org Identifier: ISRCTN33288337.
Publisher: Elsevier BV
Date: 03-2007
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.MCNA.2010.01.003
Abstract: Chest pain from respiratory causes is a common complaint and may indicate the presence of a serious or even life-threatening pathologic condition. Most chest pains are the result of irritation or inflammation of the parietal pleura, as the visceral pleura is insensate, although pain may arise from direct malignant invasion or trauma to the chest wall. Rapid recognition with appropriate understanding of the anatomy and physiology of chest pain from respiratory causes is vital to ensure timely and appropriate therapy.
Publisher: Wiley
Date: 09-2009
Publisher: AME Publishing Company
Date: 04-2021
Publisher: American Thoracic Society
Date: 06-2023
Publisher: Elsevier BV
Date: 2022
Publisher: American Thoracic Society
Date: 15-02-2018
Publisher: Wiley
Date: 16-12-2020
DOI: 10.1111/RESP.13742
Publisher: BMJ
Date: 07-2008
Publisher: Wiley
Date: 29-11-2021
DOI: 10.1111/RESP.13982
Publisher: American Thoracic Society
Date: 15-08-2004
Publisher: American Thoracic Society
Date: 15-12-2002
Publisher: Wiley
Date: 07-2009
Publisher: Wiley
Date: 13-06-2018
Abstract: Dietetics educators represent a small but influential workforce group that has experienced significant change in recent years. The workforce development challenges faced by this group have been largely unexplored. The present study aimed to explore the experiences of, and challenges faced by, academic dietetics educators in preparing dietitians for the workforce. The approach taken in the present study was informed by qualitative description. Fifteen dietetics educators employed by 13 universities across Australia were purposively s led. In-depth, semi-structured interviews conducted via telephone (n = 12) or face-to-face (n = 3) were digitally recorded then transcribed verbatim. Data were managed with NVivo and inductively analysed using open coding. Codes were condensed into themes through an iterative process involving multiple researchers. The overarching theme of 'aiming for a moving target' was underpinned by the themes of: (i) striving for betterment (ii) bridging dissonance and (iii) distressing impossibilities. Interviewees described how they were driven to enhance the preparation of dietitians but acknowledged disparity between what graduates are being prepared for and what they need to be prepared for. Heightened expectations of others, professional constraints and a lack of collegiality among the profession were among the challenges that manifested in a sense of frustration, concern and isolation. Dietetics educators are motivated to shape and enhance the future profession. However, they face numerous challenges in their efforts to prepare graduates who are well-equipped for increasingly erse dietetics practice. Strong leadership, academic collaboration and greater engagement of the broader workforce are required for the benefit of the entire profession.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
Publisher: Wiley
Date: 19-03-2016
DOI: 10.1111/RESP.12777
Abstract: Indwelling pleural catheters (IPC), used for management of malignant pleural effusions, are often left in situ for a long duration. This study reports for the first time the histological findings of IPCs removed from patients with underlying pleural malignancy. Forty-one IPCs (in situ for median 126 days, interquartile range 43-226) that were removed over a 54-month period from a single centre were examined. Mesothelioma (n = 18) was the predominant underlying malignancy followed by breast, tubo-ovarian and lung carcinomas. The catheter tubing was fully intact macroscopically in all IPCs. There was no evidence of direct tumour invasion or cancer cell growth on the catheter surfaces in none of the 29 IPCs that were histologically examined. Malignant cells were seen within organizing fibrinous tissues in the lumen of 11 IPCs (27%). A foreign body giant cell reaction was present at the cuff site in all the 29 IPC in which the subcutaneous cuff was examined. Acute (n = 10) and/or chronic inflammatory changes were seen in the luminal contents in all 41 IPCs. Our study provides reassuring evidence that the IPC material does not support direct tumour growth or invasion even in the setting of high mesothelioma prevalence. See Editorial, page 787.
Publisher: Springer Science and Business Media LLC
Date: 24-10-2022
DOI: 10.1186/S12890-022-02196-4
Abstract: Major advances in management of common pleural diseases have taken place in the past decade. However, pleural diseases are often managed by physicians of erse training background and research on implementation of new knowledge is scanty. We aim to evaluate the practice pattern in pleural medicine among physicians in Hong Kong, for identification of possible gaps for clinical service improvement. The Hong Kong Thoracic Society undertook a cross-sectional questionnaire survey in 2019, targeting clinicians of various subspecialties in internal medicine and levels of experience (basic and higher trainees, specialists) from twelve regional hospitals of erse service scopes throughout Hong Kong. Respondents were selected by non-probability quota s ling. The questionnaire tool consisted of 46 questions covering diagnostic and therapeutic aspects of common pleural diseases. The responses were anonymous, and analysed independently using SPSS statistics software. The survey collected 129 responses, 47(36%) were from clinicians specialized in respiratory medicine. Majority of the respondents (98%) managed pleural diseases, including performing pleural procedures in their practice. Fifty-five percent of all the respondents had not received any formal training in transthoracic ultrasonography. A significant proportion of clinicians were unaware of pleuroscopy for investigation of exudative pleural effusion, indwelling pleural catheter for recurrent malignant pleural effusion, and combined intra-pleural Alteplase plus DNase for treatment of pleural infection (30%, 15% and 70% of non-respiratory clinicians respectively). Significant heterogeneity was found in the management of pleural infection, malignant pleural effusion and pneumothorax among respiratory versus non-respiratory clinicians. Contributing factors to the observed heterogeneity included lack of awareness or training, limited accessibility of drugs, devices, or dedicated service support. Significant heterogeneity in management of pleural diseases was observed among medical clinicians in Hong Kong. Continuous medical education and training provision for both specialists and non-specialists has to be strengthened to enhance the implementation of advances, improve quality and equity of healthcare provision in pleural medicine.
Publisher: Elsevier
Date: 2012
Publisher: Elsevier BV
Date: 10-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-09-2020
Publisher: BMJ
Date: 27-02-2007
Publisher: BMJ
Date: 24-02-2014
Publisher: Springer Science and Business Media LLC
Date: 27-06-2022
DOI: 10.1186/S13063-022-06405-7
Abstract: Malignant pleural effusions (MPEs) are common. MPE causes significant breathlessness and impairs quality of life. Indwelling pleural catheters (IPC) allow ambulatory drainage and reduce hospital days and re-intervention rates when compared to standard talc slurry pleurodesis. Daily drainage accelerates pleurodesis, and talc instillation via the IPC has been proven feasible and safe. Surgical pleurodesis via video-assisted thoracoscopic surgery (VATS) is considered a one-off intervention for MPE and is often recommended to patients who are fit for surgery. The AMPLE-3 trial is the first randomised trial to compare IPC (±talc pleurodesis) and VATS pleurodesis in those who are fit for surgery. A multi-centre, open-labelled randomised trial of patients with symptomatic MPE, expected survival of ≥ 6 months and good performance status randomised 1:1 to either IPC or VATS pleurodesis. Participant randomisation will be minimised for (i) cancer type (mesothelioma vs non-mesothelioma) (ii) previous pleurodesis (vs not) and (iii) trapped lung, if known ( vs not). Primary outcome is the need for further ipsilateral pleural interventions over 12 months or until death, if sooner. Secondary outcomes include days in hospital, quality of life (QoL) measures, physical activity levels, safety profile, health economics, adverse events, and survival. The trial will recruit 158 participants who will be followed up for 12 months. Sir Charles Gairdner and Osborne Park Health Care Group (HREC) has approved the study (reference: RGS356). Results will be published in peer-reviewed journals and presented at scientific meetings. Both IPC and VATS are commonly used procedures for MPE. The AMPLE-3 trial will provide data to help define the merits and shortcomings of these procedures and inform future clinical care algorithms. Australia New Zealand Clinical Trial Registry ACTRN12618001013257 . Registered on 18 June 2018. Protocol version: Version 3.00/4.02.19
Publisher: American Thoracic Society
Date: 08-2017
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.CHEST.2016.01.001
Abstract: Malignant pleural effusion (MPE) is common. Existing literature on pleural fluid compositions is restricted to cross-sectional s ling with little information on longitudinal changes of fluid biochemistry and cytokines with disease progression. Indwelling pleural catheters provide the unique opportunity for repeated s ling and longitudinal evaluation of MPE, which may provide insight into tumor pathobiology. We collected 638 MPE s les from 103 patients managed with indwelling pleural catheters over 95 days (median, range 0-735 days) and analyzed them for protein, pH, lactate dehydrogenase, and glucose levels. Peripheral blood was quantified for hematocrit, platelets, leukocytes, protein, and albumin. Cytokine levels (monocyte chemotactic protein [MCP]-1 vascular endothelial growth factor interleukin-6, -8, and -10 tumor necrosis factor-α and interferon-gamma) were determined in 298 s les from 35 patients with mesothelioma. Longitudinal changes of all parameters were analyzed using a linear mixed model. Significant decreases were observed over time in pleural fluid protein by 8 g/L per 100 days (SE, 1.32 P < .0001) and pH (0.04/100 days SE, 0.02 P = .0203), accompanied by a nonsignificant rise in lactate dehydrogenase. The ratio of pleural fluid to serum protein decreased by 0.06/100 days (SE, 0.02 P = .04). MPEs from mesothelioma (n = 63) had lower pleural fluid glucose (P = .0104) at baseline and a faster rate of decline in glucose (P = .0423) when compared with non-mesothelioma effusions (n = 38). A progressive rise in mesothelioma pleural fluid concentration of [log] MCP-1 ([log] 0.37 pg/mL per 100 days SE, 0.13 P = .0046), but not of other cytokines, was observed. MPE fluids become less exudative and more acidic over the disease course. The rise in MCP-1 levels suggests a pathobiological role in MPE.
Publisher: Wiley
Date: 10-02-2022
DOI: 10.1002/CNCY.22548
Abstract: The concept of mesothelioma in situ has been revisited and is a new World Health Organization diagnostic entity. The definition centers on ancillary techniques used in pleural mesothelioma (PM) assessment. At the authors' institution, most PM diagnoses are made on cytologic specimens. Effusion s les obtained before definitive PM diagnosis were interrogated using BRCA1 ‐ associated protein 1 gene ( BAP1 ), cyclin‐dependent kinase inhibitor 2A gene ( CDKN2A ) and cytologic evaluation to assess whether early or possible in situ disease could be characterized. All cases of PM diagnosed between January 2008 and December 2019 were identified at a tertiary referral center. Patients who had a pleural fluid s le collected 24 months before the diagnosis were selected, numbering 8 in total. The cytomorphology of each s le was reviewed and, retrospectively, BAP1 immunohistochemistry (IHC) and CDKN2A fluorescence in situ hybridization (FISH) were performed on initial and diagnostic s les. The initial s les were deemed benign in 5 cases and atypical mesothelial proliferations in 3 cases. A spectrum of apparently normal to atypical cytomorphologic changes was identified. BAP1 loss was present in 6 of 8 initial cases, whereas CDKN2A homozygous deletion was identified in 1 of 7 initial cases. Either abnormality was identified in 7 of 8 initial s les. Detectable abnormalities of BAP1 IHC and CDKN2A FISH were present in pleural fluid specimens before the development of cytomorphologic features diagnostic of PM. This is the largest series to date describing cytology s les early in the course of PM development, thereby highlighting a possible cytological equivalent for mesothelioma in situ.
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Wiley
Date: 13-02-2019
DOI: 10.1002/RCR2.408
Publisher: Wiley
Date: 31-08-2020
DOI: 10.1002/RCR2.646
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Elsevier BV
Date: 04-2007
Abstract: Pleural tuberculosis (TB) should be considered in any patient with a lymphocytic pleural effusion. The diagnostic approach is under debate. Knowledge of pleural TB epidemiology would be beneficial. To help clarify pleural TB epidemiology, we analyzed US national TB surveillance data for 1993 to 2003. We compared pleural TB to pulmonary TB (where each was reported as the major site of TB disease, and no additional sites of disease were reported). Applicable statistical tests were performed p < 0.05 was considered to be significant. From 1993 through 2003, 7,549 cases of pleural TB and 156,779 cases of pulmonary TB were reported (in 2003: pleural TB, 536 cases pulmonary TB, 10,551 cases). The annual proportion of pleural TB was relatively stable (median rate, 3.6% range, 3.3 to 4.0%) compared to that for pulmonary TB, which steadily decreased (average annual decrease, 0.9% p /= 65 years old (30.4% vs 23.3%, respectively p < 0.01), and it occurred significantly less often among children < 15 years old (1.8% vs 6.1%, respectively p < 0.01) and persons 45 to 64 years old (22.9% vs 27.9%, respectively p < 0.01). Pleural TB patients (63.4%) were born slightly more often in the United States than were pulmonary TB patients (60.9% p < 0.01). Drug-resistance patterns of pleural TB broadly reflected those of pulmonary TB. However, isolates from pleural TB patients were less often resistant to at least isoniazid (6.0% vs 7.8%, respectively p < 0.01) and to at least one first-line TB drug (9.9% vs 11.9%, respectively p < 0.01) compared with pulmonary TB patients. Knowledge of pleural TB demographic, clinical, and drug-resistance patterns may assist clinicians in making diagnostic and therapeutic decisions.
Publisher: Elsevier BV
Date: 04-2012
Abstract: Multiple medical disorders can lead to the development of pleural effusions. Most effusions are given a single diagnosis in clinical practice. However, the cause of the effusion can change during the disease course, and concomitant yet distinct causes are often underrecognized. We highlight this point by reporting a complex case of recurrent pleural effusions with different predominant causes during the disease course. Five causes for the pleural effusion were diagnosed, namely malignant pleural effusion, empyema, chylothorax, transudative pleural effusion secondary to hypoalbuminemia, and esophagopleural fistula. This case serves as a reminder to clinicians that recurrent pleural effusion, even within the same pleural space, can arise from different causes and, whenever clinically appropriate, reinvestigation of the pleural effusion may be needed.
Publisher: Elsevier BV
Date: 04-2007
Abstract: Indwelling pleural catheters are increasingly being used for ambulatory treatment of malignant pleural effusion, particularly for patients unsuitable for pleurodesis. These catheters are often left in situ for the rest of the patient's life. Tumor metastasis along the tract between pleura and skin surface is a potential complication in patients with chronic indwelling pleural catheters that has seldom been reported. We describe four cases of catheter-tract metastasis that developed between 3 weeks and 9 months after catheter insertion. Catheter-tract metastasis occurred in two patients with mesothelioma despite prophylactic irradiation at time of insertion, and in two patients with metastatic adenocarcinoma. All cases were successfully treated using external-beam radiotherapy without necessitating catheter removal. A retrospective audit in our center showed that catheter-tract metastasis occurred in 6.7% of 45 patients treated with indwelling pleural catheters for malignant pleural effusions. Both clinicians and patients should be aware of this potential complication.
Publisher: American Thoracic Society
Date: 15-07-2022
Publisher: European Respiratory Society (ERS)
Date: 06-2011
DOI: 10.1183/09031936.00007410
Abstract: Sputum smears and culture conversion are frequently used to evaluate treatment response in pulmonary tuberculosis patients. Limited data are available on the evaluation of the correlation between under-treatment sputum smear results and culture conversion. This prospective study included sputum culture-proven pulmonary tuberculosis patients at six hospitals in Taiwan. At least two sets of sputum were collected at the completion of 8 weeks of TB treatment. The sensitivities and specificities of 2-month sputum smears were estimated based on culture conversion status. A total of 371 patients were enrolled for analysis. Factors associated with culture conversion included having a smear positive before treatment, presence of a cavity on radiography, rif icin resistance and usage of the DOTS (directly observed therapy, short course) strategy. The sensitivities of 2-month sputum smears for culture conversion among all patients, initially smear-positive patients and initially smear-negative patients were 64.3, 71.4 and 38%, respectively, and the specificities were 81.6, 69.9 and 92.8%, respectively. In patients who were 2-month sputum smear-positive, the 2-month culture conversion rate was 80% if the patients were under DOTS and without cavitary lesions in radiograms. The predictive value of 2-month sputum smears in culture conversion was limited and highly influenced by clinical factors in pulmonary tuberculosis patients.
Publisher: European Respiratory Society (ERS)
Date: 29-03-2010
DOI: 10.1183/09031936.00106609
Abstract: Phosphoinositide 3-kinases (PI3Ks) contribute to the pathogenesis of asthma by regulating the activation of inflammatory mediators, inflammatory cell recruitment and immune cell function. Recent findings have indicated that PI3Ks also regulate the expression of interleukin (IL)-17, which has been recognised as an important cytokine involved in airway inflammation. In the present study, we investigated a role of PI3Kδ in the regulation of IL-17 expression in allergic airway disease using a murine model of asthma. After ovalbumin inhalation, administration of a selective p110δ inhibitor, IC87114, significantly attenuated airway infiltration of total cells, lymphocytes, neutrophils and eosinophils, as well as airway hyperresponsiveness, and attenuated the increase in IL-17 protein and mRNA expression. Moreover, IC87114 reduced levels of IL-4, -5 and -13, expression of keratinocyte chemoattractant protein and mRNA, and nuclear factor (NF)-κB activity. In addition, a NF-κB inhibitor, BAY 11-7085 substantially reduced the increase in IL-17 protein levels. Our results also showed that inhibition of IL-17 activity with an anti-IL-17 antibody remarkably reduced airway inflammation and hyperresponsiveness. These findings suggest that inhibition of the p110δ signalling pathway suppresses IL-17 expression through regulation of NF-κB activity and, thus, has therapeutic potential in asthma.
Publisher: Wiley
Date: 06-04-2020
DOI: 10.1111/RESP.13812
Publisher: Springer Science and Business Media LLC
Date: 30-05-2022
DOI: 10.1186/S13073-022-01060-8
Abstract: Malignant pleural mesothelioma (MPM) has a poor overall survival with few treatment options. Whole genome sequencing (WGS) combined with the immune features of MPM offers the prospect of identifying changes that could inform future clinical trials. We analysed somatic mutations from 229 MPM s les, including previously published data and 58 s les that had undergone WGS within this study. This was combined with RNA-seq analysis to characterize the tumour immune environment. The comprehensive genome analysis identified 12 driver genes, including new candidate genes. Whole genome doubling was a frequent event that correlated with shorter survival. Mutational signature analysis revealed SBS5/40 were dominant in 93% of s les, and defects in homologous recombination repair were infrequent in our cohort. The tumour immune environment contained high M2 macrophage infiltrate linked with MMP2 , MMP14 , TGFB1 and CCL2 expression, representing an immune suppressive environment. The expression of TGFB1 was associated with overall survival. A small subset of s les (less than 10%) had a higher proportion of CD8 T cells and a high cytolytic score, suggesting a ‘hot’ immune environment independent of the somatic mutations. We propose accounting for genomic and immune microenvironment status may influence therapeutic planning in the future.
Publisher: BMJ
Date: 03-2003
DOI: 10.1136/OEM.60.3.201
Abstract: Exercise impairment is common in subjects with asbestosis. Arterial oxygen desaturation during exercise is an important contributor to exercise limitation. The International Labour Office (ILO) classification of plain chest radiographs correlates with resting pulmonary function, but its value in predicting abnormal ventilatory responses to exercise, including desaturation, has not been explored. To determine in subjects with asbestosis (1) if radiographic profusion scores and the extent of small irregular shadows on plain chest radiographs correlate with resting lung function and abnormal ventilatory responses to exercise and (2) if radiographic scores add value to resting lung function tests in predicting abnormal ventilatory responses to exercise. Thirty eight male subjects with asbestosis were included. Plain chest radiographs were read according to the ILO classification independently by three observers. All subjects underwent assessment of lung function and an incremental exercise test. Profusion scores and number of affected zones correlated significantly with the percentage predicted values of single breath diffusing capacity (DLCO), forced vital capacity (FVC), and total lung capacity (TLC). Arterial oxygen desaturation occurred in 29% of the subjects. The severity of desaturation correlated significantly with profusion and the number of affected zones. The combined use of number of affected zones, FEV(1)/FVC ratio and DLCO predicted desaturation during exercise with an explained variance of 41%. VO(2)max was significantly related only to DLCO but was not predicted by the ILO score. Arterial oxygen desaturation correlated with the profusion and extent of parenchymal abnormality on chest radiographs. The addition of morphological indices to physiological measurements is valuable for predicting oxygen desaturation during exercise but not for VO(2)max. Refinement of the radiographic scoring system and the addition of more sophisticated imaging techniques may further improve the predictive power.
Publisher: American Association for Cancer Research (AACR)
Date: 07-2015
DOI: 10.1158/1541-7786.MCR-14-0442
Abstract: Malignant pleural mesothelioma (MPM) is often fatal, and studies have revealed that aberrant miRNAs contribute to MPM development and aggressiveness. Here, a screen of miRNAs identified reduced levels of miR-223 in MPM patient specimens. Interestingly, miR-223 targets Stathmin (STMN1), a microtubule regulator that has been associated with MPM. However, whether miR-223 regulates STMN1 in MPM and the functions of miR-223 and STMN1 in this disease are yet to be determined. STMN1 is also regulated by c-Jun N-terminal kinase (JNK) signaling, but whether this occurs in MPM and whether miR-223 plays a role are unknown. The relationship between STMN1, miR-223, and JNK was assessed using MPM cell lines, cells from pleural effusions, and MPM tissue. Evidence indicates that miR-223 is decreased in all MPM tissue compared with normal/healthy tissue. Conversely, STMN1 expression was higher in MPM cell lines when compared with primary mesothelial cell controls. Following overexpression of miR-223 in MPM cell lines, STMN1 levels were reduced, cell motility was inhibited, and tubulin acetylation induced. Knockdown of STMN1 using siRNAs led to inhibition of MPM cell proliferation and motility. Finally, miR-223 levels increased while STMN1 was reduced following the re-expression of the JNK isoforms in JNK-null murine embryonic fibroblasts, and STMN1 was reduced in MPM cell lines following the activation of JNK signaling. Implications: miR-223 regulates STMN1 in MPM, and both are in turn regulated by the JNK signaling pathway. As such, miR-223 and STMN1 play an important role in regulating MPM cell motility and may be therapeutic targets. Mol Cancer Res 13(7) 1106–18. ©2015 AACR.
Publisher: Wiley
Date: 22-11-2017
DOI: 10.1111/RESP.12951
Abstract: Exudative pleural effusions affect over 1500 patients per million population each year. The pathobiology of pleural exudate formation remains unclear. Our recent study revealed monocyte chemotactic protein-1 (MCP-1) as a key driver of fibrinolytic-induced exudate effusion while another study found a role for MCP-1 in malignant effusion formation. In the present study, we further evaluated the role of MCP-1 in the development of pleural effusion in a mouse model of acute pleural inflammation. λ-Carrageenan (CAR) was injected into the pleural cavity of CD1 mice and pleural effusion volume measured up to 16 h post-injection. Pleural effusion and serum protein and MCP-1 concentrations were measured and differential cell counts performed in fluids. Mice were also treated with either intraperitoneal (i) anti-MCP-1 antibody or isotype control or (ii) an MCP-1 receptor (CCR2) antagonist or vehicle control 12 h prior to and at the time of CAR injection. Intrapleural CAR induced significant pleural fluid accumulation (300.0 ± 49.9 μL) in mice after 4 h. Pleural fluid MCP-1 concentrations were significantly higher than corresponding serum MCP-1 (144 603 ± 23 204 pg/mL vs 3703 ± 801 pg/mL, P < 0.0001). A significant decrease in pleural fluid formation was seen both with anti-MCP-1 antibody (median (interquartile range, IQR): 36 (0-168) μL vs controls 290 (70-436) μL P = 0.02) or CCR2 antagonist (153 (30-222) μL vs controls 240 (151-331) μL, P = 0.0049). Blockade of MCP-1 activity significantly reduced inflammatory pleural effusion formation in a CAR model. Together with recent successes in MCP-1 blockade in other effusion formation models, our data strongly support clinical evaluation of MCP-1 antagonists as a novel approach to pleural fluid management.
Publisher: Public Library of Science (PLoS)
Date: 26-04-2021
DOI: 10.1371/JOURNAL.PONE.0250628
Abstract: Predicting survival of patients with malignant pleural effusions (MPEs) is notoriously difficult. A robust prognostic marker can guide clinical decision making. The neutrophil-to-lymphocyte ratio (NLR) in blood has been shown to predict survival in many cancers. Pleural fluid bathes the malignant pleural tissues, thus the NLR of the pleural fluid may reflect more closely the local tumour environment. The objective of this study was to explore the prognostic significance of pleural effusion NLR for MPE. We analysed matched effusion and blood from 117 patients with malignant and 24 with benign pleural effusions. Those who had received recent chemotherapy or had a pleurodesis were excluded. Neutrophil and lymphocyte counts in effusions were performed by manual review of cytospin cell preparations by trained observers. Clinical data were extracted from a state-wide hospital database. We found significantly fewer neutrophils (expressed as percentage of total leukocyte count) in pleural fluid than in corresponding blood (9% vs 73% p .001). The NLR was an order of magnitude lower in pleural fluid than in corresponding blood: median [IQR] = 0.20 [0.04–1.18] vs 4.9 [3.0–8.3], p .001. Correlation between blood and pleural fluid NLR in MPE patients was moderate (r s = 0.321, p .001). In univariate analysis, NLR ( .745)) in malignant pleural fluid was predictive of poorer survival (HR = 1.698 [1.0054–2.736] p = 0.030), and remained significant after adjustment for age, sex, presence of a chest drain, cancer type, concurrent infection and subsequent treatment with chemotherapy (HR = 1.786 [1.089–2.928] p = 0.022). Patients with pleural fluid NLR 0.745 had a significantly shorter median survival of 130 (95% CI 0–282) days compared to 312 (95% CI 195–428) days for pleural NLR 0.745, p = 0.026. The NLR in blood was also predictive of poorer survival in MPE patients (HR = 1.959 [1.019–3.096] p .001). The proportion of neutrophils in pleural fluid was predictive of prognosis more strongly than lymphocytes. This study provides evidence that NLR in malignant effusions can predict survival, and therefore may provide prognostic information for this cohort. This prognostic association in the fluid is driven by the presence of neutrophils.
Publisher: Wiley
Date: 27-09-2010
DOI: 10.1111/J.1440-1843.2010.01832.X
Abstract: The past decade has seen a dramatic rise in clinical and research interests in pleural disease in parallel with rising incidences of pleural cancers and infection worldwide. Development of specialist pleural services can streamline patient diagnosis and therapy, reduce health-care resource consumption, improve procedural training and safety and facilitate clinical research. Pleural ultrasound, pleuroscopy, indwelling pleural catheter services and pleural procedural education programmes for junior staff are important elements of most specialist pleural units. An integrated service including radiology, pathology, oncology and thoracic surgery input is pivotal to success. Establishing funding support and referral sources are the common initial hurdles. This article provides an overview of the need for specialist pleural disease units, the essential elements required and the likely challenges encountered in setting a service up.
Publisher: Elsevier BV
Date: 11-2012
Abstract: Malignant pleural mesothelioma (MPM) is an incurable cancer with a rising incidence. MPM is often perceived as a locally invasive cancer, and the exact cause of death is poorly understood.This two-center study describes the anatomic features of patients with MPM at postmortem. The Western Australia Mesothelioma Registry (Australia) and Coroner’s Office reports from the Avon region (England) were interrogated for the postmortem records of confirmed mesothelioma cases. Postmortem records of 318 patients with pleural mesothelioma (169 from Western Australia and 149 from Avon) were identified. Most patients (91.5%) were men (mean age, 68.4 ± 11.5 years), and MPM was right-sided in 55.3%. Extrapleural dissemination of tumor was found in 87.7% of cases and lymph node involvement in 53.3%. Tumor dissemination in extra thoracicsites was common (55.4% of patients), and almost all organs were involved, including liver(31.9%), spleen (10.8%), thyroid (6.9%), and the brain (3.0%). Pulmonary emboli were found in 6% of cases and considered as directly contributing to death in 13 patients (4.1%). The precise cause of death could only be determined in 63 (19.8%) cases even after postmortem. The BMI was significantly lower in cases that had no identifiable anatomic cause of death at postmortem(18.8 ± 4.3 vs 21.0 ± 4.7, P = .034). In this largest, to our knowledge, postmortem series on MPM, extrathoracic dissemination of mesothelioma was common and often under recognized. No anatomic cause of death was identified in the majority of patients even at autopsy, raising the possibility of physiologic and metabolic causes of death.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2020
DOI: 10.1007/S10459-019-09904-6
Abstract: Effective health workforce preparation is critical to the health of those who stand to benefit from its services. Emerging dietitians can provide important insights on an evolving workforce that is well-placed to advance future global health. This study aimed to explore a national s le of dietetics graduates' experiences of, and challenges faced in, dietetics workforce preparation and preparedness in Australia. An interpretive description methodology guided this study whereby researchers interpreted the meanings that participants attributed to their experiences. Twenty dietitians (graduated within the last 2 years) were purposively s led from across Australia and detailed insights were obtained through semi-structured interviews. A multi-analyst approach employing thematic and template analysis, enabled five themes to be identified across the data set. These included: (1) being held back (2) chasing the prize (3) valuing real learning (4) easing the transition and (5) encountering influencers. While graduates appreciated their preparation, they were not empowered or equipped to embrace opportunities in erse and emerging areas of dietetics practice. Graduates were challenged by the competitive landscape of securing obvious job opportunities and by a lack of support in transitioning into the workforce. Practice exposures and encounters with influential dietitians were highly valued. Research on role-emerging dietetics placements along with enhanced support mechanisms for novice dietitians is urgently required to ensure appropriate alignment between future dietetics preparation and practice. Obtaining insights into health professional graduates' experiences of their education can be used to ensure that emerging health workforces are relevant and responsive to future market needs.
Publisher: Informa UK Limited
Date: 09-11-2018
DOI: 10.1080/17476348.2018.1398085
Abstract: Optimal management of malignant pleural effusion (MPE) is important in the care of patients with advanced cancer. Surgical (especially video-assisted thoracoscopic surgery (VATS)) and non-surgical strategies are available. Clinicians should be aware of the evidence supporting the use of different modalities to guide treatment choice. Areas covered: This review covers published evidence of the advantages and disadvantages of VATS and non-surgical alternatives for MPE management. Expert commentary: Randomized clinical trials (RCTs) are needed to define the roles and benefits of VATS as existing literature is often flawed by selection bias. Three RCTs have failed to show benefits of VATS talc poudrage over bedside talc pleurodesis. VATS-pleurectomy offered no survival advantage in a RCT of mesothelioma patients. Modification of VATS techniques has reduced the invasiveness and associated risks. Future trials should compare VATS with contemporary, non-surgical approaches (especially combined Indwelling Pleural Catheter (IPC) and chemical pleurodesis therapy). In idualized management for different subgroups of MPE patients should be a long-term research goal. Studies are needed on better patient selection, and adjunct non-invasive, supportive (e.g. nutrition and exercise) therapies.
Publisher: Georg Thieme Verlag KG
Date: 02-12-2014
Abstract: Malignant pleural effusion (MPE) can complicate most malignancies and is a common clinical problem presenting to respiratory and cancer care physicians. Despite its frequent occurrence, current knowledge of MPE remains limited and controversy surrounds almost every aspect in its diagnosis and management. A lack of robust data has led to significant practice variations worldwide, inefficiencies in healthcare provision, and threats to patient safety. Recent studies have highlighted evolving concepts in MPE care that challenge traditional beliefs. Advancing laboratory techniques have improved the diagnostic yield from pleural fluid cytology, minimizing the need for invasive tissue biopsies, even in many cases of mesothelioma. Imaging-guided biopsy is comparable to thoracoscopy in suitable patients, if cytological examination was noncontributory. Cumulating evidence for the benefits of indwelling pleural catheters (IPCs) has led some centers to adopt this approach as first-line definitive management for MPE over conventional talc pleurodesis. The optimal technique of talc pleurodesis is still debated despite its use for many decades. Strategies combining pleurodesis and IPC are being studied. MPE consists of a heterogenous group of diseases and careful phenotyping of malignant effusion patients can provide important clinical information that will advance the field and allow better stratification of patients and planning of therapy accordingly. This review addresses the controversies in MPE diagnosis and management and exposes the deficits in knowledge of MPE that should be the focus of future research.
Publisher: Kare Publishing
Date: 07-07-2015
Publisher: BMJ
Date: 18-07-2014
Publisher: The American Association of Immunologists
Date: 15-11-2004
DOI: 10.4049/JIMMUNOL.173.10.6418
Abstract: Human NK cells may be ided into a CD56dim subset and a CD56bright subset. In peripheral blood, CD56dim NK cells dominate, whereas in lymph nodes, CD56bright NK cells are more common. In this study we show that CD56bright NK cells accumulate within inflammatory lesions in a wide variety of clinical diseases affecting several different anatomical sites. We demonstrate that when activated by the monokines IL-12, IL-15, and IL-18, these NK cells promote TNF-α production by CD14+ monocytes in a manner that is dependent on cell:cell contact. Conversely, CD14+ monocytes synergize with monokines to promote IFN-γ production by these NK cells. Again, this interaction is dependent on cell:cell contact. The experiments show that CD56bright NK cells accumulate in inflammatory lesions and, in the appropriate cytokine environment, can engage with CD14+ monocytes in a reciprocal activatory fashion, thereby lifying the inflammatory response. Such a positive feedback loop is likely to be important in the pathogenesis of chronic inflammatory conditions such as rheumatoid arthritis.
Publisher: Wiley
Date: 15-01-2023
DOI: 10.1111/RESP.14451
Abstract: Device‐assessed activity behaviours are a novel measure for comparing intervention outcomes in patients with malignant pleural effusion (MPE). Australasian Malignant PLeural Effusion (AMPLE)‐2 was a multi‐centre clinical trial where participants with MPE treated with an indwelling pleural catheter were randomized to daily (DD) or symptom‐guided (SGD) drainage for 60‐days. Our aim was to describe activity behaviour patterns in MPE patients, explore the impact of drainage regimen on activity behaviours and examine associations between activity behaviours and quality of life (QoL). Following randomization to DD or SGD, participants enrolled at the lead site (Perth) completed accelerometry assessment. This was repeated monthly for 5‐months. Activity behaviour outcomes were calculated as percent of daily waking‐wear time and compared between groups (Mann–Whitney U test Median [IQR]). Correlations between activity behaviour outcomes and QoL were examined. Forty‐one (91%) participants provided ≥1 valid accelerometry assessment (DD n = 20, SGD n = 21). Participants spent a large proportion of waking hours sedentary (72%–74% across timepoints), and very little time in moderate‐to‐vigorous physical activity ( % across timepoints). Compared to SGD group, DD group had a more favourable sedentary‐to‐light ratio in the week following randomization (2.4 [2.0–3.4] vs. 3.2 [2.4–6.1] p = 0.047) and at 60‐days (2.0 [1.9–2.9] vs. 2.9 [2.8–6.0] p = 0.016). Sedentary‐to‐light ratio was correlated with multiple QoL domains at multiple timepoints. Patients with MPE are largely sedentary. Preliminary results suggest that even modest differences in activity behaviours favouring the DD group could be meaningful for this clinical population. Accelerometry reflects QoL and is a useful outcome measure in MPE populations.
Publisher: AME Publishing Company
Date: 2019
Publisher: Elsevier BV
Date: 04-2012
Abstract: Indwelling pleural catheters (IPCs) are increasingly used in the management of malignant pleural effusions. IPCs are designed to be secured in situ indefinitely however, in selected patients, IPCs can be removed when drainage ceases. This case series reports complications of removal of IPCs that resulted in fractured catheters or necessitated deliberate severing of the catheters. From the combined data of two pleural centers, 61 of 170 IPCs inserted (35.9%) were removed. In six cases (9.8%), the removals were complicated, leading to fracture or iatrogenic severing of the IPC. Although four patients had catheter fragments retained within the pleural space, none developed any complications (eg, pain or infection) (median follow-up, 459 days range, 113-1,119 days), despite two patients undergoing subsequent chemotherapy. Clinicians should be aware that IPC removal can be problematic, but retained fragments are safe, and aggressive retrieval is unnecessary.
Publisher: Elsevier BV
Date: 09-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Wiley
Date: 23-02-2018
DOI: 10.1002/RCR2.306
Publisher: Wiley
Date: 17-10-2020
DOI: 10.1111/RESP.13718
Publisher: Elsevier BV
Date: 10-2008
Publisher: Wiley
Date: 04-05-2014
DOI: 10.1002/RCR2.58
Publisher: Bentham Science Publishers Ltd.
Date: 02-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Springer Science and Business Media LLC
Date: 02-2018
Publisher: Wiley
Date: 06-06-2007
DOI: 10.1111/J.1440-1843.2007.01100.X
Abstract: The experimental model of pleurodesis in rabbits has been useful in understanding the pathophysiology of the pleural inflammatory injury induced by several sclerosing agents. However, restrictions on the use of rabbits in laboratory investigation are making this model less accessible. The aim of this study was to present a new experimental model of pleurodesis in mice using talc or silver nitrate. Four groups of 10 C57BL/6 mice received talc 2 or 4 mg/g in 0.5 mL saline, or 0.025% or 0.05% silver nitrate in 0.5 mL H(2)O. After 28 days the animals were sacrificed, and the pleural cavity was opened and evaluated for evidence of macroscopic pleural adhesions and haemothorax (scores 0-4), atelectasis (scores 0-2), and microscopic pleural and alveolar inflammation and fibrosis (scores 0-4). Statistical analysis used ANOVA. Silver nitrate 0.05% produced a more effective pleurodesis in mice than did 0.025% silver nitrate or talc 4 mg/g, with significant higher scores for pleural adhesions, microscopic pleural inflammation and fibrosis. Haemothorax, atelectasis, and microscopic alveolar inflammation and fibrosis were negligible in both groups. Both talc 4 mg/g and 0.05% silver nitrate produced an efficient pleurodesis in this experimental model in mice. This new model may overcome the restrictions on the use of large- and medium-sized animals in laboratory investigation and may open new fields of investigation with knockout mice.
Publisher: Elsevier BV
Date: 03-2001
Abstract: More than 85% of patients develop pleural effusions after coronary artery bypass grafting (CABG). Although the majority resolve spontaneously, post-CABG effusions can persist. The cause of these persistent effusions is unknown, and the histology of the pleural changes has seldom been reported. To describe the patient characteristics and pathologic condition of the pleural tissues in patients with persistent post-CABG effusions. Eight patients with persistent post-CABG effusions who underwent thoracoscopy or thoracotomy over a 2-year period by one thoracic surgeon. These eight patients were selected as having undergone CABG > 2 months before their thoracic surgery and had no other identifiable causes of effusion. The median time from CABG to pleural surgery was 132 days (range, 74 to 2,258 days). The median left ventricular ejection fraction was 57% (range, 15 to 70%). All patients were dyspneic and had large (> or = 25% of the hemithorax) effusions on chest radiograph. All effusions persisted after two or more thoracenteses. Pleural effusion was left sided in three patients and bilateral in five patients. Pleural fluid was characterized by lymphocytosis (82 to 99%). Four of the eight patients had a visceral peel and trapped lung requiring decortication. Seven of the eight biopsy specimens showed pleural thickening characterized by dense fibrous tissues with associated mononuclear cell infiltration, while the eighth biopsy specimen showed only clotted blood. The degree of inflammation and fibrosis correlated with the interval between CABG and pleural surgery. Early post-CABG patients displayed more inflammation, with abundant lymphocytes in nodular configuration deep in the fibrous tissues away from the surface. Abundant keratin-positive, spindle-shaped cells were present in the fibrous tissues. Late cases showed predominantly mature fibrosis. Persistent post-CABG effusion can occur. Pleural fluids and pleural tissue in early-stage lesions were characterized by lymphocytosis. With time, the inflammatory changes were replaced by fibrosis that resulted in dyspnea and, at times, trapped lungs requiring surgical intervention.
Publisher: American Thoracic Society
Date: 06-2017
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.THORSURG.2012.10.004
Abstract: Benign pleural effusions are twice as common as malignant effusions and have erse causes and manifestations, which often makes them a diagnostic challenge. Differentiating effusions as a transudate or exudate is the first, and often helpful, step in directing investigations for diagnosis and management. Congestive heart failure and hepatic hydrothorax are the commonest causes for a transudative effusion. Commonly exudative effusions are caused by infections or may be secondary to pulmonary embolism, drugs, collagen vascular diseases, or may follow cardiac surgery. This article gives an overview of the causes and management of common benign pleural effusions.
Publisher: Wiley
Date: 06-09-2018
DOI: 10.1111/RESP.13395
Abstract: Pleural infection is a clinical challenge its microbiology can be complex. Epidemiological and outcome data of pleural infection in adult Australians are lacking. We describe the bacteriology and clinical outcomes of Australian adults with culture-positive pleural infection (CPPI) over a 6-year period. Cases with CPPI were identified through Western Australian public hospitals electronic record. Culture isolates, admission dates, vital status, co-morbidities, radiology, blood and pleural fluid tests were extracted. In total, 601 cases (71.4% males median age: 63 years (IQR: 50-74) median hospital stay 13 days) involving 894 bacterial isolates were identified. Hospital-acquired (HA)-CPPI was defined in 398 (66.2%) cases, community-acquired (CA)-CPPI in 164 (27.3%) cases and the remaining classified as oesophageal rupture/leak. Co-morbidities, most frequently cancer, were common (65.2%). Radiological evidence of pneumonia was present in only 43.8% of CA-CPPI and 27.3% of HA-CPPI. Of the 153 different bacterial strains cultured, Streptococcus species (32.9%) especially viridans streptococci group were most common in CA-CPPI, whereas HA-CPPI was most often associated with Staphylococcus aureus (11.6%) and Gram-negative (31.9%) infections. Mortality was high during hospitalization (CA-CPPI 13.4% vs HA-CPPI 16.6% P = 0.417) and at 1 year (CA-CPPI 32.4% vs HA-CPPI 45.5% P = 0.006). This is the first large multicentre epidemiological study of pleural infection in Australian adults and includes the largest cohort of HA-CPPI published to date. CPPI is caused by a erse range of organisms which vary between CA and HA sources. CPPI is a poor prognostic indicator both in the short term and in the subsequent 12 months.
Publisher: Radiological Society of North America (RSNA)
Date: 2007
DOI: 10.1148/RADIOL.2421051167
Abstract: To retrospectively correlate the extent of in idual diseases seen at thin-section computed tomography (CT) with pulmonary function in an initial group of patients with asbestos-related parenchymal disease (asbestosis) and to test these findings in a subsequent group of patients whose CT scans were retrospectively identified. This retrospective study had Institutional Review Board approval informed consent was not required. The study included 133 in iduals who had been exposed to asbestos. In the initial study group (81 patients 79 men, two women median age, 67 years), two observers used a CT scoring system to quantify the extent of pulmonary fibrosis, diffuse pleural thickening, small-airways disease, and emphysema. Multivariate equations were formulated by using independent CT variables to predict changes in total lung capacity (TLC) and carbon monoxide diffusing capacity (Dlco). The validity of these equations was then tested in a subsequent group of patients (52 patients all men median age, 60 years). At thin-section CT, the extent of asbestos-induced pleuropulmonary disease and emphysema correlated significantly with physiologic impairment (P<.001). Combined CT variables predicted 58% and 57% of the variability in TLC and Dlco, respectively, despite considerable variation in the proportion of coexisting pathologic conditions. When predictive equations with CT variables derived from the initial study group were applied to the subsequent study group, predicted TLC (rho=0.75, P<.001) and Dlco (rho=0.64, P<.001) correlated strongly with measured values. The proposed CT system provides a semiquantitative method for assessing the relative contribution of asbestos-induced pleuropulmonary disease and smoking-related emphysema to functional impairment.
Publisher: Wiley
Date: 31-07-2002
DOI: 10.1046/J.1440-1843.2002.00397.X
Abstract: Transforming growth factor (TGF)-beta2 can produce effective pleurodesis in animals, but its efficacy has not been compared with commonly used pleurodesing agents in sheep, which have a thick pleura resembling that of humans. The acute physiological effects and the level of systemic TGF-beta absorption after its intrapleural administration have not been studied. The aims of the present study were to compare: (i) the effectiveness of TGF-beta2, talc and bleomycin in producing pleurodesis in sheep (ii) the acute side-effects and systemic TGF-beta levels following the intrapleural administration of these agents and (iii) histological changes after intrapleural injections of these agents. Twelve sheep were ided into three groups and were given a single intrapleural dose of TGF-beta2 (0.25 microg/kg), talc slurry (5 g) or bleomycin (60 IU) via a chest tube. Saline or buffer was injected into the contralateral side, which served as the control. Arterial blood gases and respiratory and heart rates were monitored for the first 24 h. Plasma levels of TGF-beta1 and TGF-beta2 were measured. Pleurodesis was graded macroscopically from 1 (none) to 8 (symphysis > 50% of hemithorax) at day 14. At day 14, the pleurodesis score of the TGF-beta2 group (7.7+/-0.6) was similar to that of the talc (7.0+/-1.7) group and significantly higher than that of the bleomycin group (3.3+/-2.3 P < 0.05). No significant differences were seen in arterial blood gas analysis, vital signs and plasma TGF-beta1 and TGF-beta2 concentrations among the three groups. Transforming growth factor-beta2 was as effective as talc and more so than bleomycin in inducing pleurodesis in sheep. Intrapleural administration of TGF-beta2 appeared safe. No acute changes in gaseous exchange or macroscopic abnormalities were seen following intrapleural TGF-beta2. Importantly, there was no evidence of an increase in systemic TGF-beta levels following its intrapleural administration.
Publisher: European Respiratory Society (ERS)
Date: 31-08-2016
DOI: 10.1183/16000617.0026-2016
Abstract: The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines. The causes of benign pleural effusions are broad, heterogenous and patients may benefit from in idualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations. Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting.
Publisher: Wiley
Date: 11-09-2023
DOI: 10.1111/RESP.14595
Publisher: Southern Medical Association
Date: 12-2000
Publisher: Public Library of Science (PLoS)
Date: 30-11-2017
Publisher: Public Library of Science (PLoS)
Date: 05-03-2015
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.CHEST.2018.02.038
Abstract: Detection of pleural abnormalities on CT scan is critical in diagnosis of pleural disease. CT scan detects minute parenchymal lung nodules, but often fails to detect similar-sized pleural nodularity. This is likely because the density of the visceral arietal pleura and pleural fluid is similar. We hypothesize that an air-pleural interface enhances detection of pleural abnormalities. We describe six patients with pleural abnormalities that were not (or barely) detected on initial CT scan. However, pneumothorax (either ex vacuo or from a genuine air leak) after pleural fluid drainage permitted the visualization of small pleural abnormalities on CT scan, which would be amenable to imaging-guided biopsies. This case series provides proof-of-principle evidence that the sensitivity of CT scan detection of pleural abnormalities is dependent on adjacent tissue density and can be enhanced by intrapleural air. Future studies of the potential for artificial pneumothorax to improve the diagnosis of pleural disease are warranted.
Publisher: Public Library of Science (PLoS)
Date: 30-07-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-10-2019
Publisher: Wiley
Date: 19-01-2017
DOI: 10.1111/RESP.12977
Abstract: The ability to perform bedside thoracic ultrasound is increasingly recognized as an essential skill for thoracic clinicians, extending the clinical examination and aiding diagnostic and therapeutic procedures. Thoracic ultrasound reduces complications and increases success rates when used prior to thoracentesis or intercostal chest tube insertion. It is increasingly difficult to defend performing these procedures without real or near-real time image guidance. To assist thoracic physicians and others achieve and demonstrate thoracic ultrasound competence, the Interventional Pulmonology Special Interest Group (IP-SIG) of the Thoracic Society of Australia and New Zealand (TSANZ) has developed a new pathway with four components: (i) completion of an approved thoracic ultrasound theory and hands-on teaching course. (ii) A log of at least 40 relevant scans. (iii) Two formative assessments (following 5-10 scans and again after 20 scans) using the Ultrasound-Guided Thoracentesis Skills and Tasks Assessment Tool (UG-STAT). (iv) A barrier assessment (UG-STAT, pass score of 90%) by an accredited assessor not directly involved in the candidate's training. Upon completion of these requirements a candidate may apply to the TSANZ for recognition of competence. This pathway is intended to provide a regional standard for thoracic ultrasound training.
Publisher: Oxford University PressOxford
Date: 03-2019
DOI: 10.1093/MED/9780198746690.003.0440
Abstract: Benign tumours are rare in the pleural cavity, with solitary fibrous tumour of the pleura the most frequent of these rarities. Malignant pleural tumours are common and can arise from the pleura (most commonly mesothelioma) or as metastases from extrapleural malignancies (especially lung and breast cancer). They typically present with breathlessness, chest pain, and a pleural effusion. Diagnosis requires histocytological confirmation of malignant cells from pleural fluid and/or pleural biopsies. Most cases are due to asbestos exposure, characteristically after a latent period of more than 20 years, with risk related to the duration and intensity of asbestos exposure and the fibre type (worst with needle-like hiboles). Most tumours that have spread to the pleura are incurable.
Publisher: BMJ
Date: 07-01-2013
DOI: 10.1136/THORAXJNL-2012-203043
Abstract: Few data exist on the pleurodesis outcome in patients with malignant pleural mesothelioma (MPM). A retrospective review of the Western Australian Mesothelioma Registry over 5 years revealed 390 evaluable patients. Only a subset of patients (42.3%) underwent pleurodesis, surgically (n=78) or by bedside instillation of sclerosants (n=87). Surgical pleurodesis showed no advantages over bedside pleurodesis in efficacy (32% vs 31% failures requiring further drainage, p=0.98), patient survival (p=0.52) or total time spent in hospital from procedure till death (p=0.36). No clinical, biochemical or radiographic parameters tested adequately predict pleurodesis outcome.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2006
Publisher: European Respiratory Society (ERS)
Date: 26-01-2023
DOI: 10.1183/23120541.00534-2022
Abstract: The clinical impact of phenotyping empyema is poorly described. This study was designed to evaluate clinical characteristics and outcomes based on the two readily available parameters, pleural fluid culture status and macroscopic fluid appearance. A retrospective study was conducted on patients with empyema hospitalised between 2013 and 2020. Empyema was classified into culture-positive empyema (CPE) or culture-negative empyema (CNE) and pus-appearing empyema (PAE) or non-pus-appearing empyema (non-PAE) based on the pleural fluid culture status and macroscopic fluid appearance, respectively. Altogether, 212 patients had confirmed empyema (CPE: n=188, CNE: n=24 PAE: n=118, non-PAE: n=94). The cohort was predominantly male (n=163, 76.9%) with a mean age of 65.0±13.6 years. Most patients (n=180, 84.9%) had at least one comorbidity. Patients with CPE had higher rates of in-hospital mortality (19.1% versus 0.0%, p=0.017) and 90-day mortality (18.6% versus 0.0%, p=0.017) and more extrapulmonary sources of infection (29.8% versus 8.3%, p=0.026) when compared with patients with CNE. No significant difference in mortality rate was found between PAE and non-PAE during the in-hospital stay and at 30 days and 90 days. Patients with PAE had less extrapulmonary sources of infection (20.3% versus 36.2%, p=0.010) and more anaerobic infection (40.9% versus 24.5%, p=0.017) than those with non-PAE. The median RAPID (renal, age, purulence, infection source, and dietary factors) scores were higher in the CPE and non-PAE groups. After adjusting for covariates, culture positivity was not independently associated with mortality on multivariable analysis. Empyema is a heterogeneous disease with different clinical characteristics. Phenotyping empyema into different subclasses based on pleural fluid microbiological results and macroscopic fluid appearance provides insight into the underlying bacteriology, source of infection and subsequent clinical outcomes.
Publisher: Oxford University PressOxford
Date: 03-2019
DOI: 10.1093/MED/9780198746690.003.0441
Abstract: Mediastinal masses are most conveniently categorized by their anatomical site in the anterior, middle, or posterior mediastinum. Most present as a radiographic abnormality alone, or in association with symptoms arising from compression of other mediastinal structures. Systemic symptoms such as fever or weight loss are more likely with malignant tumours such as lymphomas or thymomas. Detailed knowledge of normal mediastinal anatomy is a prerequisite to the interpretation of both normal and abnormal chest radiographs. Lymph nodes are present in all three compartments thereby knowledge of their anatomical relationships, together with sites of drainage, is important when interpreting radiographic mediastinal enlargement. The most important group of visceral nodes lie in the middle mediastinum and are predominantly subcarinal and paratracheal. Bronchopulmonary and hilar nodes are numerous but not visible radiographically unless pathologically enlarged.
Publisher: Public Library of Science (PLoS)
Date: 05-05-2023
DOI: 10.1371/JOURNAL.PONE.0274364
Abstract: Mesothelioma is characterised by its aggressive invasive behaviour, affecting the surrounding tissues of the pleura or peritoneum. We compared an invasive pleural model with a non-invasive subcutaneous model of mesothelioma and performed transcriptomic analyses on the tumour s les. Invasive pleural tumours were characterised by a transcriptomic signature enriched for genes associated with MEF2C and MYOCD signaling, muscle differentiation and myogenesis. Further analysis using the CMap and LINCS databases identified geldanamycin as a potential antagonist of this signature, so we evaluated its potential in vitro and in vivo . Nanomolar concentrations of geldanamycin significantly reduced cell growth, invasion, and migration in vitro . However, administration of geldanamycin in vivo did not result in significant anti-cancer activity. Our findings show that myogenesis and muscle differentiation pathways are upregulated in pleural mesothelioma which may be related to the invasive behaviour. However, geldanamycin as a single agent does not appear to be a viable treatment for mesothelioma.
Publisher: American Thoracic Society
Date: 2002
DOI: 10.1164/AJRCCM.165.1.2104006
Abstract: Vascular endothelial growth factor (VEGF) increases vascular permeability and is important in pleural effusion formation. In studies using transforming growth factor beta (TGF-beta) to produce pleurodesis, we observed that although TGF-beta was more effective than talc or doxycycline, it induced transient production of large pleural effusions. We hypothesized that TGF-beta stimulates VEGF production in pleural tissues in vivo, and by mesothelial cells in vitro. New Zealand White rabbits (n = 33) were given TGF-beta(2) (1.7 or 5.0 microg), talc (400 mg/kg), doxycycline (10 mg/kg), or buffer intrapleurally. Pleural fluid was collected at 24 h. Intrapleural injection of TGF-beta(2) induced a dose-dependent increase in VEGF production. The pleural fluid VEGF level was 2-fold higher in rabbits given 5.0 microg of TGF-beta(2) than in those given 1.7 microg of TGF-beta(2) and 3-fold higher than in those given buffer. VEGF levels were higher after the injection of TGF-beta(2) than after administration of talc or doxycycline. The pleural fluid VEGF correlated significantly with the volume of pleural effusions (r = 0.79, p < 0.00001). In vitro, TGF-beta(2) stimulated a dose-dependent increase in VEGF production from murine pleural mesothelial cells. At 4 and 24 h, TGF-beta(2), but not talc or doxycycline, induced a significant increase in VEGF, when compared with controls. The mesothelial cell VEGF production was significantly reduced by anti-TGF-beta antibody in the TGF-beta(2), talc, and control (buffer and medium) groups. In conclusion, mesothelial cells are an important source of VEGF. TGF-beta increases the VEGF production by mesothelial cells in vivo and in vitro.
Publisher: European Respiratory Society (ERS)
Date: 12-11-2021
Publisher: Wiley
Date: 06-06-2007
DOI: 10.1111/J.1440-1843.2007.01098.X
Abstract: The study was designed to better characterize pleural fluid absorption in rabbits with the following two objectives: to determine the relative absorption of saline versus high-protein solutions, and to identify the relative rates of absorption of dextran molecules of varying sizes. Twenty New Zealand white rabbits received a 12-mL intrapleural injection of saline solution and a 10% protein solution on opposite sides, each solution containing dextran molecules with varying MWs. At sacrifice at 1, 4, 8, 18 and 24 h, the volume of pleural fluid and the concentrations of the dextran molecules were determined. Saline was absorbed faster than the high-protein fluid (P < 0.001). Dextran concentrations in the saline were significantly higher than those in the protein solution at all times after injection (P = 0.005 P < 0.001, respectively). The higher-MW dextrans were cleared more slowly than the lower-MW dextrans in a continuously graded manner. Saline was absorbed faster than a solution with a high protein content. There was a continuous spectrum in the rate of absorption of the dextran molecules, with the larger molecules being absorbed more slowly.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JCHROMB.2018.02.027
Abstract: Piperacillin, in combination with tazobactam is a common first-line antibiotic used for the treatment of pleural infection, however its pleural pharmacokinetics and penetration has not previously been reported. The objective of this work was to develop and validate a rapid and sensitive liquid chromatography with tandem mass spectrometry (LC-MS/MS) assay for quantification of piperacillin (PIP) and tazobactam (TAZ). PIP and TAZ were extracted from both human plasma and pleural fluid s les by protein precipitation in methanol containing the internal standards (IS) piperacillin-d
Publisher: Public Library of Science (PLoS)
Date: 12-12-2012
Publisher: Massachusetts Medical Society
Date: 11-08-2011
Publisher: Wiley
Date: 12-2017
DOI: 10.1002/RCR2.205
Publisher: Cambridge University Press (CUP)
Date: 21-01-2021
DOI: 10.1017/S1368980021000197
Abstract: To examine associations between diet and risk of developing gastro-oesophageal reflux disease (GERD). Prospective cohort with a median follow-up of 15·8 years. Baseline diet was measured using a FFQ. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least 2 years after baseline. Sex-specific logistic regressions were performed to estimate OR for GERD associated with diet quality scores and intakes of nutrients, food groups and in idual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined. Melbourne, Australia. A cohort of 20 926 participants (62 % women) aged 40–59 years at recruitment between 1990 and 1994. For men, total fat intake was associated with increased risk of GERD (OR 1·05 per 5 g/d 95 % CI 1·01, 1·09 P = 0·016), whereas total carbohydrate (OR 0·89 per 30 g/d 95 % CI 0·82, 0·98 P = 0·010) and starch intakes (OR 0·84 per 30 g/d 95 % CI 0·75, 0·94 P = 0·005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores. Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.
Publisher: Elsevier BV
Date: 10-2018
Publisher: Wiley
Date: 07-06-2022
DOI: 10.1111/RESP.14307
Abstract: The pathophysiology of breathlessness in pleural effusion is unclear. In the PLEASE‐1 study, abnormal ipsilateral hemidiaphragm shape and movement, assessed qualitatively, were independently associated with breathlessness relief after pleural drainage. Effects of pleural effusion on contralateral hemidiaphragm function are unknown. PLEASE‐2, a prospective exploratory pilot study, assessed the effects of unilateral effusion and drainage on both hemidiaphragms using advanced quantitative bedside ultrasonography. In iduals with symptomatic unilateral pleural effusion undergoing therapeutic drainage were included. Measurements pre‐ and post‐drainage included severity of breathlessness (visual analogue scale) and ultrasound measurements of diaphragm excursion and thickness, in addition to shape and movement. Diaphragm measurements were compared to published reference values. Twenty participants were recruited (mean age 68.9 [SD 12.8] years, 12 females). During tidal breathing, contralateral hemidiaphragm excursion exceeded ipsilateral excursion and reference values (all p ≤ 0.001). Contralateral excursion was greatest in participants with abnormal ipsilateral hemidiaphragm movement and was inversely correlated with ipsilateral tidal excursion ( r = −0.676, p = 0.001). Following drainage (mean volume 2121 [SD = 1206] ml), abnormal shape ( n = 12) and paradoxical movement ( n = 9) of the ipsilateral hemidiaphragm resolved in all participants, and tidal excursion of the contralateral hemidiaphragm normalized. Relief of breathlessness post‐drainage correlated with improvement in ipsilateral hemidiaphragm excursion ( r = 0.556, p = 0.031). This pilot study suggests, for the first time, that unilateral pleural effusion not only impairs ipsilateral hemidiaphragm function but also causes compensatory hyperactivity of the contralateral hemidiaphragm, which resolves post‐drainage. These findings provide a basis for detailed studies of diaphragmatic function and ventilatory drive in patients with symptomatic pleural effusion.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.LUNGCAN.2015.07.015
Abstract: Malignant pleural mesothelioma (MPM) is a chemotherapy resistant tumor with a poor prognosis. Hypoxia is increasingly recognized as an important factor in tumor aggressiveness and cellular resistance to chemotherapy and radiation treatment. This prospective pilot study was performed with [F-18] fluoromisonidazole (FMISO) PET-CT to characterize hypoxia in patients with MPM. Twenty prospectively recruited patients with histologically or cytologically confirmed MPM not currently receiving systemic or local treatment underwent both FMISO and fluorodeoxyglucose (FDG) PET-CT scans within 2 weeks. FMISO and FDG PET-CT scans were independently analyzed visually and semi-quantitatively using SUVmax and tumor to background ratio (TBR) in order to assess tumor hypoxia and metabolic activity. Lesion by lesion analysis was performed in sites of measurable pleural masses. Visual analysis demonstrated tumor FMISO activity in 17 of 20 patients, and tumor FDG activity in 19 of 20 patients. Focal areas of bulky tumor were most likely to demonstrate hypoxia. In 19 patients suitable for semi-quantitative analysis the median FDG SUVmax was 6.4 (range 1.9-19.1), median FMISO SUVmax was 2.5 (range 1.4-3.7) and median FMISO TBR was 1.8 (1.1-2.5). There was a positive correlation between intensity of metabolic activity and hypoxia (r=0.72, p=0.001). Lesion by lesion analysis demonstrated a positive correlation between tumor thickness and FMISO activity (r=0.77, p<0.001). This pilot study confirms that MPM is a tumor with significant areas of hypoxia, particularly in dominant tumor masses. The relationship of tumor hypoxia to effectiveness of chemotherapy and/or radiation therapy warrants prospective assessment.
Publisher: Oxford University Press (OUP)
Date: 21-11-2019
DOI: 10.1136/POSTGRADMEDJ-2018-135893
Abstract: Sir William Osler’s great work and achievements are extensively documented. Less well known is his prolonged battle with postinfluenza pneumonia, lung abscess and pleural infection that eventually led to his demise. At the age of 70, he was a victim of the global Spanish influenza epidemic, and subsequently developed pneumonia. In the era before antibiotics, he received supportive care and opium for symptom control. The infection extended to the pleura and he required repeated thoracentesis which failed to halt his deterioration. He proceeded to open surgical drainage involving rib resection. Unfortunately, he died shortly after the operation from massive pleuropulmonary haemorrhage. In this article, we review the events leading up to Osler’s death and contrast his care 100 years ago with contemporary state-of-the-art management in pleural infection.
Publisher: Wiley
Date: 21-01-2019
DOI: 10.1111/JHN.12620
Abstract: Dietetics practice educators are instrumental in the development of future dietitians. The present study aimed to explore dietetics practice educators' experiences of, and challenges faced in, dietetics workforce preparation. This study was guided by interpretive description methodology. Purposive and maximum variation s ling were used to recruit 18 dietetics practice educators from a variety of practice areas and locations across Australia. In-depth, semi-structured interviews were digitally recorded then transcribed verbatim and inductive coding of data was managed with nvivo (QSR International Pty Ltd, Doncaster, VIC, Australia). Multiple researchers analysed the data to develop preliminary themes using template analysis before final themes were identified. Three main themes were developed: nurturing others seeing the flaws and soldiering on. Practice educators take great satisfaction in witnessing students develop and are focused on cultivating future practitioners with authentic learning activities. However, they are impacted by perceived shortcomings of the systems in which they operate and consider that broadening the scope of dietetics placements to better align with contemporary practice could benefit graduates and the profession. Despite these challenges, practice educators are pragmatic in getting on with their roles and recognise the advantages gained from student placements. Despite facing numerous challenges, practice educators derive benefits from their role in workforce preparation. Evidence is required on how students can demonstrate competence in contemporary areas of practice and on how to enable the scope of student placements to be broadened. Such strategies could support practice educators to overcome challenges and help ensure the dietetics profession of tomorrow is relevant and responsive.
Publisher: Elsevier BV
Date: 06-2016
Publisher: Wiley
Date: 19-12-2007
Publisher: Wiley
Date: 10-10-2014
DOI: 10.1002/RCR2.80
Publisher: Walter de Gruyter GmbH
Date: 07-2011
DOI: 10.1515/BC.2011.062
Abstract: Pleural inflammation underlies the formation of most exudative pleural effusions and the plasma kallikrein-kinin system (KKS) is known to contribute. Mesothelial cells are the predominant cell type in the pleural cavity, but their potential role in plasma KKS activation and BK production has not been studied. Bradykinin concentrations were higher in pleural fluids than the corresponding serum s les in patients with a variety of diseases. Bradykinin concentrations did not correlate with disease diagnosis, but were elevated in exudative effusions. It was demonstrated, using a range of primary and transformed mesothelial and mesothelioma cell lines, that cells assembled high molecular weight kininogen and plasma prekallikrein to liberate bradykinin, a process inhibited by novobiocin, a heat shock protein 90 (HSP90) inhibitor, cysteine, bradykinin and protamine sulphate. Of the common plasma prekallikrein activators, mesothelial cells expressed HSP90, but not prolylcarboxypeptidase or Factor XII. Calcium mobilisation was induced in some mesothelium-derived cell lines by bradykinin. Des-Arg 9 -bradykinin was inactive, indicating that mesothelial cells are responsive to bradykinin, mediated via the bradykinin receptor subtype 2. In summary, pleural mesothelial cells support the assembly and activation of the plasma KKS by a mechanism dependent on HSP90, and may contribute to KKS-mediated inflammation in pleural disease.
Publisher: Wiley
Date: 12-1999
DOI: 10.1111/J.1445-5994.1999.TB00777.X
Abstract: Differentiation between malignant and benign pleural effusions is often difficult. Serum level of Cyfra 21-1, a marker of cytokeratin 19 fragments, has been used in the diagnosis and monitoring of epithelial tumours, especially bronchogenic carcinomas. This study is designed to establish the usefulness of effusion Cyfra 21-1 level in differentiating malignant from benign effusions. Forty-eight malignant effusion aspirates (proven by cytology or pleural biopsy) and 34 benign s les were compared. Cyfra 21-1 concentration was measured by a solid phase sandwich radioimmunoassay (Centocur, USA). Cyfra 21-1 level was significantly higher in malignant effusions (geometric mean 123.6 ng/mL, 95% confidence interval [CI] 76.6-199.4) than in benign ones (geometric mean 14.3 ng/mL, 95% CI 8.5-23.9), p<0.00005. By Receiver Operating Characteristics curve analysis, the sensitivity is 77% for a specificity of 79% if the cut-off is set at 32 ng/mL. No significant difference was observed (p=0.1) in Cyfra 21-1 concentration between adenocarcinoma and mesothelioma effusions. Cyfra 21-1 level was not influenced by the effusion protein concentration (r=0.29), or by renal function as measured by serum creatinine (r=0.1). There was no significant difference between Cyfra 21-1 levels in benign exudate and transudate effusions, p=0.28. Cyfra 21-1 is a useful adjunct in the workup of effusions but should not replace conventional investigations as there is considerable overlap in levels between benign and malignant groups. It is unable to differentiate between subgroups of malignancies.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.LUNGCAN.2018.03.009
Abstract: Malignant mesothelioma (MM) is an asbestos related tumour affecting cells of serosal cavities. More than 70% of MM patients develop pleural effusions which contain tumour cells, representing a readily accessible source of malignant cells for genetic analysis. Although common somatic mutations and losses have been identified in solid MM tumours, the characterization of tumour cells within pleural effusions could provide novel insights but is little studied. DNA and RNA were extracted from cells from short term cultures of 27 human MM pleural effusion s les. Whole exome and transcriptome sequencing was performed using the Ion Torrent platform. Somatic mutations were identified using VarScan2 and SomaticSniper. Copy number alterations were identified using ExomeCNV in R. Significant copy number alterations were identified across all s les using GISTIC2.0. The association between tumour intrinsic properties and survival was analyzed using the Cox proportional hazards regression model. We identified BAP1, CDKN2A and NF2 alterations in the cells from MM pleural effusions at a higher frequency than what is typically seen in MM tumours from surgical series. The median mutation rate was 1.09 mutations/Mb. TRAF7 and LATS2 alterations were also identified at a high frequency (66% and 59% respectively). Novel regions of interest were identified, including alterations in FGFR3, and the regions 19p13.3, 8p23.1 and 1p36.32. Short term cultures of tumour cells from MM pleural effusions offer an accessible alternative to surgical tumour biopsies in the study of MM genomics and reveal novel mutations of interest. Pleural effusion tumour cells provide an opportunity for the monitoring of tumour dynamics, treatment response and the clonal evolution of MM tumours.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
Publisher: Elsevier BV
Date: 08-2002
Abstract: The mechanisms responsible for the accumulation of eosinophils in pleural fluid are not fully understood. The purpose of this study was to evaluate the relationship between eosinophil accumulation and the levels of interleukin (IL)-5, IL-3, and granulocyte/macrophage colony-simulating factor (GM-CSF) in pleural effusions. We evaluated 30 patients with eosinophilic pleural effusions (eosinophil count > 10% nucleated cells in pleural fluid) and 10 patients with noneosinophilic pleural effusions. The patients with eosinophilic pleural effusions included 22 patients with post-coronary artery bypass graft surgery pleural effusions and 8 patients with eosinophilic pleural effusions caused by other causes. IL-5, IL-3, and GM-CSF in all pleural fluids were measured using enzyme-linked immunosorbent assay kits. The mean level of IL-5 in eosinophilic pleural effusions (283.1 +/- 341.6 pg/mL) was significantly (p < 0.025) higher than that in the noneosinophilic effusions (28.2 +/- 19.0 pg/mL). The absolute eosinophil count and percentage correlated significantly with the level of IL-5 in all patients (r = 0.55, p < 0.001, and r = 0.54, p 0.05). GM-CSF and IL-3 levels were below the detectable range in all pleural fluids. There is a significant relationship between the levels of IL-5 in pleural fluid and the total number and percentage of eosinophils in the pleural fluid. IL-5 seems to be related to the eosinophil accumulation associated with blood or air in the pleural space and other eosinophilic pleural effusions.
Publisher: American Association for Cancer Research (AACR)
Date: 02-06-2022
DOI: 10.1158/1055-9965.EPI-22-0234
Abstract: Mechanisms for how Helicobacter pylori infection affects risk of gastroesophageal reflux disease (GERD) and Barrett's esophagus are incompletely understood and might differ by sex. In a case–control study nested in the Melbourne Collaborative Cohort Study with 425 GERD cases and 169 Barrett's esophagus cases (identified at 2007–2010 follow-up), we estimated sex-specific odds ratios for participants who were H. pylori seronegative versus seropositive at baseline (1990–1994). To explore possible mechanisms, we (i) compared patterns of H. pylori-induced gastritis by sex using serum pepsinogen-I and gastrin-17 data and (ii) quantified the effect of H. pylori seronegativity on Barrett's esophagus mediated by GERD using causal mediation analysis. For men, H. pylori seronegativity was associated with 1.69-fold [95% confidence interval (CI), 1.03–2.75] and 2.28-fold (95% CI, 1.27–4.12) higher odds of GERD and Barrett's esophagus, respectively. No association was observed for women. H. pylori-induced atrophic antral gastritis was more common in men (68%) than in women (56% P = 0.015). For men, 5 of the 15 per 1,000 excess Barrett's esophagus risk from being seronegative were mediated by GERD. Men, but not women, who were H. pylori seronegative had increased risks of GERD and Barrett's esophagus. A possible explanation might be sex differences in patterns of H. pylori-induced atrophic antral gastritis, which could lead to less erosive reflux for men. Evidence of GERD mediating the effect of H. pylori on Barrett's esophagus risk among men supports this proposed mechanism. The findings highlight the importance of investigating sex differences in the effect of H. pylori on risk of GERD and Barrett's esophagus in future studies.
Publisher: Wiley
Date: 14-08-2014
DOI: 10.1111/RESP.12351
Abstract: Mesothelioma is an incurable cancer with a rising global incidence. Intrapleural delivery of a commercially available compound made up of proteins produced by Staphylococcus aureus has been used clinically to induce pleurodesis. We investigate if this bacterial compound has anti-tumoural activities against pleural malignancies, in addition to its pleurodesing effect. The effects of the treatment on mesothelioma cells were evaluated in vitro and further tested in two validated murine models. This S. aureus bio-product mixture effectively kills mesothelioma cells and induces the release of interleukin (IL)-8, monocyte chemotactic protein (MCP)-1 and vascular endothelial growth factor from primary human mesothelial cells but not malignant pleural mesothelioma cells in vitro. Intratumoural delivery of the treatment in BALB/c mice induced tumour necrosis and local activation of T cells. Tumour growth was significantly inhibited in the treatment group during and after the treatment period (size of tumour 58.8 ± 10.3 mm(2) vs 118.3 ± 6.7 mm(2) from saline controls at day 23, n = 9-12 per group), P < 0.001. Tumour growth resumed on cessation of treatment, confirming the inhibition was treatment related. Treatment benefits were further validated in an orthotopic peritoneal model of mesothelioma and the compound significantly reduced the mesothelioma load (P < 0.05 vs saline controls). Mice in the treatment group had a significant increase in the percentage of activated CD4(+) and CD8(+) T cells in tumour-draining lymph nodes. No histological side-effects were observed with the treatment. This proof-of-principle study demonstrates promising antitumoural activity of a commercially available compound of S. aureus bio-products against mesothelioma.
Publisher: Elsevier BV
Date: 12-2003
Abstract: Pleurodesis is important in the management of malignant pleural effusions, but no consensus exists on the optimal agent or methods of pleurodesis. How pleurodesis is practiced worldwide has not been studied. To identify variations in the clinical practice of pleurodesis in major English-speaking countries, and to quantify the experience of pulmonologists on the effectiveness and adverse effects of different pleurodesis agents worldwide. Eight hundred fifty-nine pulmonologists practicing in the United States, United Kingdom, Canada, Australia, and New Zealand participated in a Web-based survey. The respondents collectively perform > 8,300 pleurodesis annually. Talc was the preferred agent by most respondents (slurry, 56% poudrage, 12%), followed by tetracycline derivatives (26%), and bleomycin (7%). Differences were seen in pleurodesis practice patterns among practitioners among and within the surveyed countries. Physicians' overall satisfaction with the available pleurodesis agents was modest (5.0 out of 8), and the reported success rate averaged only 66%. Talc (both poudrage and slurry) was perceived as significantly more effective, but was associated with significantly more pain, nausea, and fever (p < 0.05). Respiratory failure occurred more commonly with talc poudrage than with other agents (p < 0.05), and had been observed by 70% and 54% of physicians who used talc poudrage and slurry, respectively. Significant variations exist in how pleurodesis is performed worldwide. Pleurodesis agents currently available are perceived as suboptimal. Talc poudrage and slurry were perceived to be more effective, but were associated with more complications, including respiratory failure.
Publisher: Wiley
Date: 26-10-2020
DOI: 10.1002/RCR2.675
Publisher: Elsevier BV
Date: 06-2015
Abstract: The clinical course of patients with malignant pleural effusions (MPEs) varies. The decision to undertake "definitive therapy" (pleurodesis, indwelling pleural catheter [IPC], or both) for MPEs is decided on a case-by-case basis. Identifying factors that predict definitive therapy may help guide early initiation of treatment. The aim of the study was to identify clinical, laboratory, and radiologic predictors associated with clinicians' prescription of definitive therapy for patients with MPE. A multicenter, observational study was conducted over 55 months involving tertiary centers in Perth, Western Australia, Australia, and Lleida, Spain. Demographic, clinical, radiologic, biochemical, and histologic data and the treatments received were recorded. Logistic regression was performed to determine the variables useful for predicting definitive therapy. Data of 540 patients (365 from Perth and 184 from Lleida) were analyzed 537 fulfilled the criteria of an MPE. Definitive therapy was used in 288 patients (53.6%): 199 received a pleurodesis and 89 an IPC. Univariate analysis of the combined cohort revealed that definitive therapy was more likely if the effusion has low pH, either as a continuous variable (OR, 30.30 P < .01) or with a pH cutoff of 50% of hemithorax) (OR, 2.75 P < .01) or was associated with mesothelioma (OR, 1.83 P < .01). Following multivariate analysis, low pleural pH (OR, 37.04 P < .01), large effusions (OR, 3.31 P < .01), and increasing age (OR 1.02, P = .01) were associated with the use of definitive therapy. Patients with MPE with an effusion of low pleural fluid pH and large size on radiographs at first presentation are more likely to be treated with pleurodesis and/or IPC.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2008
Publisher: BMJ Publishing Group Ltd and British Thoracic Society
Date: 12-2018
Publisher: Wiley
Date: 09-2008
DOI: 10.1111/J.1440-1843.2008.01345.X
Abstract: It has been suggested that pulmonary embolism (PE) is an under-recognized cause of pleural effusion. This study aimed to (i) establish the incidence and clinical relevance of pleural effusion in patients with pulmonary emboli and (ii) determine if there is a relationship between development of pleural effusions and the location of emboli and number of pulmonary arteries involved. A retrospective analysis of all CT pulmonary angiograms (CTPA) performed over 12 months on adult patients with clinically suspected PE in a hospital which used CTPA as first-line imaging investigation for PE. Of 285 CTPA, 60 patients (21%) had evidence of pulmonary emboli (38 had both central and peripheral clots and 22 peripheral emboli only). Emboli were bilateral in 39 cases and unilateral in 21 cases. Pleural effusion was present in almost one half (n = 29, 48%) of the patients with pulmonary emboli. Patients with pulmonary emboli were more likely to have a pleural effusion (OR 2.2 (95% CI: 1.1-4.7), P < 0.05) than patients without PE however, the effusions were generally very small. Most (86%) of the effusions were present on the same side as the emboli. The location of emboli and number of arteries involved did not predict the presence of pleural effusions. Pleural effusion is common in patients with pulmonary emboli demonstrated on CTPA. These effusions are small and seldom alter clinical management. Clinicians should therefore have a high threshold of suspicion in attributing large or contralateral pleural effusions to embolic diseases without excluding alternative diagnoses.
Publisher: American Thoracic Society
Date: 07-2008
Publisher: Wiley
Date: 18-04-2023
DOI: 10.1002/RCR2.1146
Abstract: Persistent air‐leaks can be difficult to localize in radiology. Bronchoscopic management of air‐leaks requires identification of the leak's location to allow suitable targeted treatment. One‐way endobronchial valves have become a suitable option for persistent air‐leaks. In this report, a combination scintigraphy and one‐way endobronchial valve treatment successfully resolved a persistent air‐leak.
Publisher: Wiley
Date: 05-05-2023
DOI: 10.1002/RCR2.1156
Abstract: We presented the case of an adult patient with hyper‐IgE syndrome (HIES) who was admitted acutely with a large hydropneumothorax from lung consolidation, a bronchopleural fistula and pleural infection. He has had recurrent pulmonary and skin infections since childhood and longstanding pneumatoceles. He was treated with systemic antibiotics and chest tube drainage. Administration of two doses of low‐dose intrapleural therapy (1 mg tissue plasminogen activator and 5 mg deoxyribonuclease) allowed complete evacuation of his residual loculated pleural fluid, aided resolution of his infection without provoking a significant air leak and avoided the need for surgery.
Publisher: Elsevier BV
Date: 10-2018
Publisher: Springer New York
Date: 07-11-2013
Publisher: Informa UK Limited
Date: 03-10-2022
DOI: 10.1080/17476348.2022.2147508
Abstract: Pleural infection causes significant morbidity and mortality. An important aspect in the treatment of pleural infection is the pharmacokinetics of antibiotics, an area often neglected. Pathophysiology of pleural infection and the importance of antibiotic therapy in the treatment of pleural infection are discussed. After reviewing all available literature on pharmacokinetics of antibiotics for pleural infection, the scarcity of data and knowledge gaps are highlighted. This review aims to heighten awareness of the limited pharmacokinetic data of commonly used antibiotics for pleural infection. It serves to remind clinicians that choice of antibiotics for pleural infection should be based not only on bacterial sensitivity but also adequate delivery of antibiotics to the infected pleural cavity. Antibiotic pharmacokinetics may vary with agents used, pleural thickness and in idual characteristics. Consideration must be given to insufficient pleural delivery of systemic antibiotics in patients lacking clinical improvement. Pleural infection research has disproportionately focused on fluid drainage. Optimizing delivery of effective antibiotic therapy to the pleural cavity must be regarded a key priority to progress clinical care. Large comprehensive cohort studies on pharmacokinetic variability are the essential next step. The possibility of intrapleural administration is also an area that warrants additional research.
Publisher: Wiley
Date: 23-09-2014
DOI: 10.1002/RCR2.78
Publisher: Wiley
Date: 24-04-2020
DOI: 10.1111/JGS.16458
Publisher: Elsevier BV
Date: 2003
Abstract: Successful ectopic gene therapy requires the transfection of the cells at the ectopic site, with local and systemic delivery of the gene product. This study aimed to evaluate the pleural mesothelial surface as a potential site for ectopic gene therapy. A secreted placental alkaline phosphatase (PALP) plasmid was injected bilaterally into the pleural spaces of seven rabbits via a chest tube, while an irrelevant reporter plasmid was injected into seven control rabbits. Blood was collected at baseline and at 24, 48, and 72 h after the injections. Pleural fluid was collected by lavage at 24, 48, and 72 h after the injections. The PALP level was measured by chemiluminesence. Significant expressions of PALP proteins were observed in the serum of the treatment rabbits, with a threefold increase over baseline at 24 h, a ninefold increase at 48 h, and a twofold increase at 72 h. The serum PALP levels in the control rabbits remained at baseline levels at all time points. The pleural fluid PALP levels peaked at 24 h and decreased over the next 72 h. Mimicking the in vivo pattern, pleural mesothelial cells transfected in vitro demonstrated a similar increase in PALP levels. The results of the present short-term pilot study suggest that pleural mesothelial cells can be successfully transfected with plasmids, with increases in both the local and systemic levels of the gene product. The pleural space should be further evaluated for ectopic gene therapy.
Publisher: Georg Thieme Verlag KG
Date: 06-2019
Abstract: Malignant pleural effusion (MPE) is a common and challenging problem. Patients affected by MPE have a poor prognosis and suffer from breathlessness and impaired quality of life. The management of MPE has barely changed for many decades however, recent research has driven new paradigms in the diagnosis and treatment of MPE and stimulated novel concepts that are being evaluated in many ongoing studies. This review provides an overview of recent advances in the diagnosis of MPE, including new cytopathology and imaging techniques, and the landmark studies that provide a solid evidence base to support the use of indwelling pleural catheters as first-line treatment in MPE. Lingering management dilemmas, including optimal chest drainage tube and role of surgery in MPE, and key knowledge gaps that are the focus of ongoing research are also highlighted.
Publisher: Springer Science and Business Media LLC
Date: 28-04-2017
DOI: 10.1007/S00520-017-3721-9
Abstract: Malignant pleural effusion (MPE) affects 1 million people worldwide annually and can significantly impair physical activity. Accelerometry is a validated method of objectively assessing physical activity. The purpose of this study was to determine the compliance in patients with MPE to accelerometry and describe their activity. Patients with MPE wore an Actigraph GT3X accelerometer over a 7-day continuous wear protocol. Compliance was measured as the percent of patients who had ≥4 valid days (i.e., 8-h/day of waking wear-time). Eastern Cooperative Oncology Group performance status was documented the day of actigraphy initialization. Forty-six patients with MPE received accelerometers 44 (95.7%) returned their device. No complications were reported on their use. Forty subjects (90.9%) had ≥4 valid days of wear-time. Patients spent most of their waking hours sedentary [mean 11.0 h (SD 1.95)], with limited participation in moderate and vigorous physical activity [mean 9.5 min (SD 14.16)]. Compared to patients with better performance status (n = 32), patients with poorer performance status (n = 11) spent significantly more hours/day sedentary [mean difference 2.1 (CI 0.86-3.32) p = 0.001], as did those who survived 12 months (n = 27) [mean difference 2.6 (CI 0.49-4.77) p = 0.013). Accelerometry was applied successfully in patients with MPE with high compliance and no adverse events. This is the first reported objectively measured physical activity in patients with MPE and revealed high sedentary behavior and low physical activity. The data reflected patient performance status and discriminated between survival groups. Accelerometry can provide a useful measure for future interventional studies in patients with MPE.
Publisher: Future Medicine Ltd
Date: 06-2011
DOI: 10.2217/FON.11.45
Abstract: Malignant pleural effusions (MPEs) are a common and important cause of cancer-related mortality and morbidity. Prompt diagnosis using minimally invasive tests is important because the median survival after diagnosis is only 4–9 months. Pleural fluid cytology is pivotal to current MPE diagnostic algorithms but has limited sensitivity (30–60%). Consequently, many patients need to undergo invasive diagnostic tests such as thoracoscopic pleural biopsy. Recent genomic, transcriptomic, methylation and proteomic studies on cells within pleural effusions have identified novel molecular diagnostic biomarkers that demonstrate potential in complementing cytology in the diagnosis of MPEs. Several challenges will need to be addressed prior to the incorporation of these molecular tests into routine clinical diagnosis, including validation of molecular diagnostic markers in well-designed prospective, comparative and cost–effectiveness studies. Ultimately, minimally invasive diagnostic tests that can be performed quickly will enable clinicians to provide the most effective therapies for patients with MPEs in a timely fashion.
Publisher: American Medical Association (AMA)
Date: 13-06-2012
Abstract: Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy. Palliation is achieved by fluid drainage, but the most effective first-line method has not been determined. To determine whether indwelling pleural catheters (IPCs) are more effective than chest tube and talc slurry pleurodesis (talc) at relieving dyspnea. Unblinded randomized controlled trial (Second Therapeutic Intervention in Malignant Effusion Trial [TIME2]) comparing IPC and talc (1:1) for which 106 patients with malignant pleural effusion who had not previously undergone pleurodesis were recruited from 143 patients who were treated at 7 UK hospitals. Patients were screened from April 2007-February 2011 and were followed up for a year. Indwelling pleural catheters were inserted on an outpatient basis, followed by initial large volume drainage, education, and subsequent home drainage. The talc group were admitted for chest tube insertion and talc for slurry pleurodesis. Patients completed daily 100-mm line visual analog scale (VAS) of dyspnea over 42 days after undergoing the intervention (0 mm represents no dyspnea and 100 mm represents maximum dyspnea 10 mm represents minimum clinically significant difference). Mean difference was analyzed using a mixed-effects linear regression model adjusted for minimization variables. Dyspnea improved in both groups, with no significant difference in the first 42 days with a mean VAS dyspnea score of 24.7 in the IPC group (95% CI, 19.3-30.1 mm) and 24.4 mm (95% CI, 19.4-29.4 mm) in the talc group, with a difference of 0.16 mm (95% CI, −6.82 to 7.15 P = .96). There was a statistically significant improvement in dyspnea in the IPC group at 6 months, with a mean difference in VAS score between the IPC group and the talc group of −14.0 mm (95% CI, −25.2 to −2.8 mm P = .01). Length of initial hospitalization was significantly shorter in the IPC group with a median of 0 days (interquartile range [IQR], 0-1 day) and 4 days (IQR, 2-6 days) for the talc group, with a difference of −3.5 days (95% CI, −4.8 to −1.5 days P < .001). There was no significant difference in quality of life. Twelve patients (22%) in the talc group required further pleural procedures compared with 3 (6%) in the IPC group (odds ratio [OR], 0.21 95% CI, 0.04-0.86 P = .03). Twenty-one of the 52 patients in the catheter group experienced adverse events vs 7 of 54 in the talc group (OR, 4.70 95% CI, 1.75-12.60 P = .002). Among patients with malignant pleural effusion and no previous pleurodesis, there was no significant difference between IPCs and talc pleurodesis at relieving patient-reported dyspnea. isrctn.org Identifier: ISRCTN87514420.
Publisher: Springer Science and Business Media LLC
Date: 19-04-2013
Publisher: Wiley
Date: 24-03-2014
DOI: 10.1111/RESP.12263
Publisher: Future Medicine Ltd
Date: 10-2014
DOI: 10.2217/LMT.14.27
Abstract: SUMMARY Mouse models of cancer are invaluable for obtaining detailed knowledge about tumor development and for screening therapeutic and preventive approaches. Mesothelioma is an unusual cancer because the same carcinogen, asbestos, causes a similar disease in both humans and animals. Unlike most other cancers, murine mesothelioma can therefore be regarded as a disease homolog, rather than a model as such. However, because asbestos-induced cancer has low penetrance and a long lag time, most translational studies have utilized more efficient models such as tumor transplantation. In consequence, many promising results have not translated into positive findings in patients. Here, we describe the widely used murine mesothelioma models and critically discuss their relative advantages and disadvantages. We emphasize the use of the appropriate model for the specific research question and the need to use multiple models in order to obtain robust and translatable data.
Publisher: Elsevier BV
Date: 2022
Publisher: Elsevier BV
Date: 12-2000
Abstract: Recent studies have demonstrated high levels of vascular endothelial growth factor (VEGF) in exudative pleural effusions and a possible etiologic role. The factors regulating VEGF accumulation in the pleural space are unknown. Transforming growth factor (TGF)-beta is a potent stimulator of VEGF expression in vitro. We hypothesized that TGF-beta induces VEGF production in pleural tissues, and, hence, the pleural fluid VEGF levels should correlate with the levels of TGF-beta in pleural fluid of different etiologies. Seventy pleural fluid s les were analyzed. These included 20 malignant, 13 post-coronary artery bypass grafting (CABG), 8 parapneumonic, 11 miscellaneous exudative, and 18 congestive heart failure (CHF) pleural effusions. Pleural fluid VEGF levels showed good correlation with those of TGF-beta(1) (r = 0.58 p < 0. 0001), TGF-beta(2) (r = 0.43 p < 0.001), and lactate dehydrogenase (r = 0.65 p < 0.001). The levels of TGF-beta(1) and TGF-beta(2) also were correlated (r = 0.60 p < 0.0001). The median levels of TGF-beta(1) (2,480 pg/mL) and TGF-beta(2) (266 pg/mL) in the CHF group were significantly lower than those in the malignant (TGF-beta(1), 4,902 pg/mL TGF-beta(2), 428 pg/mL), post-CABG (TGF-beta(1), 5,456 pg/mL TGF-beta(2), 377 pg/mL), parapneumonic (TGF-beta(1), 5,024 pg/mL TGF-beta(2), 464 pg/mL), and miscellaneous exudate groups (TGF-beta(1), 7,690 pg/mL TGF-beta(2), 369 pg/mL). There was no significant difference in TGF-beta(1) and TGF-beta(2) levels among the four exudate groups. VEGF levels in pleural effusions are significantly correlated with the levels of TGF-beta(1) and beta(2) isoforms. VEGF, TGF-beta(1), and TGF-beta(2) levels were all higher in exudative effusions than in effusions secondary to CHF.
Publisher: BMJ
Date: 08-2016
Publisher: Wiley
Date: 2006
Publisher: Cambridge University Press (CUP)
Date: 15-07-2022
DOI: 10.1017/S0007114522002112
Abstract: Barrett’s oesophagus (BE) is the precursor of oesophageal adenocarcinoma, which has become the most common type of oesophageal cancer in many Western populations. Existing evidence on diet and risk of BE predominantly comes from case–control studies, which are subject to recall bias in measurement of diet. We aimed to investigate the potential effect of diet, including macronutrients, carotenoids, food groups, specific food items, beverages and dietary scores, on risk of BE in over 20 000 participants of the Melbourne Collaborative Cohort Study. Diet at baseline (1990–1994) was measured using a food frequency questionnaire. The outcome was BE diagnosed between baseline and follow-up (2007–2010). Logistic regression models were used to estimate OR and 95 % CI for diet in relation to risk of BE. Intakes of leafy vegetables and fruit were inversely associated with risk of BE (highest v . lowest quartile: OR = 0·59 CI: 0·38, 0·94 P -trend = 0·02 and OR = 0·58 CI: 0·37, 0·93 P -trend = 0·02 respectively), as were dietary fibre and carotenoids. Stronger associations were observed for food than the nutrients found in them. Positive associations were observed for discretionary food (OR = 1·54 CI: 0·97, 2·44 P -trend = 0·04) and total fat intake (OR per 10 g/d = 1·11 CI: 1·00, 1·23), the association for fat was less robust in sensitivity analyses. No association was observed for meat, protein, dairy products or diet scores. Diet is a potential modifiable risk factor for BE. Public health and clinical guidelines that incorporate dietary recommendations could contribute to reduction in risk of BE and, thereby, oesophageal adenocarcinoma.
Publisher: American Thoracic Society
Date: 07-2016
Publisher: European Respiratory Society (ERS)
Date: 20-02-2020
DOI: 10.1183/13993003.00980-2019
Abstract: Pathophysiology changes associated with pleural effusion, its drainage and factors governing symptom response are poorly understood. Our objective was to determine: 1) the effect of pleural effusion (and its drainage) on cardiorespiratory, functional and diaphragmatic parameters and 2) the proportion as well as characteristics of patients with breathlessness relief post-drainage. Prospectively enrolled patients with symptomatic pleural effusions were assessed at both pre-therapeutic drainage and at 24–36 h post-therapeutic drainage. 145 participants completed pre-drainage and post-drainage tests 93% had effusions ≥25% of hemithorax. The median volume drained was 1.68 L. Breathlessness scores improved post-drainage (mean visual analogue scale (VAS) score by 28.0±24 mm dyspnoea-12 (D12) score by 10.5±8.8 resting Borg score before 6-min walk test (6-MWT) by 0.6±1.7 all p .0001). The 6-min walk distance (6-MWD) increased by 29.7±73.5 m, p .0001. Improvements in vital signs and spirometry were modest (forced expiratory volume in 1 s (FEV 1 ) by 0.22 L, 95% CI 0.18–0.27 forced vital capacity (FVC) by 0.30 L, 95% CI 0.24–0.37). The ipsilateral hemi-diaphragm was flattened/everted in 50% of participants pre-drainage and 48% of participants exhibited paradoxical or no diaphragmatic movement. Post-drainage, hemi-diaphragm shape and movement were normal in 94% and 73% of participants, respectively. Drainage provided meaningful breathlessness relief (VAS score improved ≥14 mm) in 73% of participants irrespective of whether the lung expanded (mean difference 0.14, 95% CI 10.02–0.29 p=0.13). Multivariate analyses found that breathlessness relief was associated with significant breathlessness pre-drainage (odds ratio (OR) 5.83 per standard deviation ( sd ) decrease), baseline abnormal aralyzed aradoxical diaphragm movement (OR 4.37), benign aetiology (OR 3.39), higher pleural pH (OR per sd increase 1.92) and higher serum albumin level (OR per sd increase 1.73). Breathlessness and exercise tolerance improved in most patients with only a small mean improvement in spirometry and no change in oxygenation. Breathlessness improvement was similar in participants with and without trapped lung. Abnormal hemi-diaphragm shape and movement were independently associated with relief of breathlessness post-drainage.
Publisher: BMJ
Date: 08-2010
Publisher: European Respiratory Society (ERS)
Date: 02-12-2021
DOI: 10.1183/23120541.00590-2021
Abstract: Intrapleural tissue plasminogen activator (tPA) combined with human recombinant DNase (DNase) could be an effective alternative to surgery in managing pleural infection, as demonstrated in the Multi-centre Intrapleural Sepsis Trial (MIST)-2. However, the optimal delivery regimen is still unknown. The aim of this survey was to identify the current practice of tPA/DNase use by physicians with published interests in pleural infection, and their opinions on dose de-escalation of tPA/DNase therapy. Potential participants were identified using four search strategies. Only practising physicians who were managing patients with pleural infections and either actively involved in pleural research and publications, or were members of relevant pleural disease guideline panels at the time of survey were included. An invitation email with the questionnaire was sent to 102 participants, of whom 49 (48%) responded. Most respondents (90%, n=44) have used tPA/DNase to manage pleural infection, but the dosing and delivery regimens employed varied. Many (86%, 38 out of 44) respondents have used 10 mg tPA, while 73% (n=32), 16% (n=7) and 9% (n=4) have used 5 mg, 2.5 mg and 1 mg doses, respectively. Most respondents instilled tPA/DNase concurrently (61%, n=27) and routinely administered six doses of tPA/DNase (52%, n=23) twice daily (82%, n=36). Respondents would consider using a lower starting dose of tPA (with the possibility of escalation if clinically needed) if a median 80% (interquartile range 50–80%) of patients could be successfully treated at that dose. This survey observed a large variation in the current treatment protocol of intrapleural tPA/DNase therapy worldwide and the need for more data on this subject.
Publisher: Massachusetts Medical Society
Date: 05-04-2018
Publisher: Wiley
Date: 03-07-2019
DOI: 10.1002/RCR2.457
Publisher: Elsevier BV
Date: 08-2012
Abstract: Patients with malignant pleural effusion (MPE) have limited prognoses. They require long-lasting symptom relief with minimal hospitalization. Indwelling pleural catheters (IPCs) and talc pleurodesis are approved treatments for MPE. Establishing the implications of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment. Therefore, our objective was to compare patients with MPE treated with IPC vs pleurodesis in terms of hospital bed days (from procedure to death or end of follow-up) and safety. In this prospective, 12-month, multicenter study, patients with MPE were treated with IPC or talc pleurodesis, based on patient choice. Key end points were hospital bed days from procedure to death (total and effusion-related). Complications, including infection and protein depletion, were monitored longitudinally. One hundred sixty patients with MPE were recruited, and 65 required definitive fluid control 34 chose IPCs and 31 pleurodesis. Total hospital bed days (from any causes) were significantly fewer in patients with IPCs (median, 6.5 days interquartile range [IQR] = 3.75-13.0 vs pleurodesis, mean, 18.0 IQR, 8.0-26.0 P = .002). Effusion-related hospital bed days were significantly fewer with IPCs (median, 3.0 days IQR, 1.8-8.3 vs pleurodesis, median, 10.0 days IQR, 6.0-18.0 P < .001). Patients with IPCs spent significantly fewer of their remaining days of life in hospital (8.0% vs 11.2%, P < .001, χ(2) = 28.25). Fewer patients with IPCs required further pleural procedures (13.5% vs 32.3% in pleurodesis group). There was no difference in rates of pleural infection (P = .68) and protein (P = .65) or albumin loss (P = .22). More patients treated with IPC reported immediate (within 7 days) improvements in quality of life and dyspnea. Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis. Safety profiles and symptom control were comparable.
Publisher: Elsevier BV
Date: 09-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2020
Publisher: BMJ
Date: 09-2016
DOI: 10.1136/BMJOPEN-2016-011826
Abstract: Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP. This multicentre, prospective, randomised, open label, parallel group, non-inferiority study will randomise 342 participants with a first large PSP to conservative or interventional management. To maintain allocation concealment, randomisation will be performed in real time by computer and stratified by study site. Conservative management will involve a period of observation prior to discharge, with intervention for worsening symptoms or physiological instability. Interventional treatment will involve insertion of a small bore drain. If drainage continues after 1 hour, the patient will be admitted. If drainage stops, the drain will be cl ed for 4 hours. The patient will be discharged if the lung remains inflated. Otherwise, the patient will be admitted. The primary end point is the proportion of participants with complete lung re-expansion by 8 weeks. Secondary end points are as follows: days in hospital, persistent air leak, predefined complications and adverse events, time to resolution of symptoms, and pneumothorax recurrence during a follow-up period of at least 1 year. The study has 95% power to detect an absolute non-inferiority margin of 9%, assuming 99% successful expansion at 8 weeks in the invasive treatment arm. The primary analysis will be by intention to treat. Local ethics approval has been obtained for all sites. Study findings will be disseminated by publication in a high-impact international journal and presentation at major international Emergency Medicine and Respiratory meetings. ACTRN12611000184976 Pre-results.
Publisher: BMJ
Date: 09-01-2015
Publisher: European Respiratory Society (ERS)
Date: 30-09-2009
Publisher: Wiley
Date: 03-12-2021
DOI: 10.1002/RCR2.694
Publisher: American Thoracic Society
Date: 05-2022
Publisher: Elsevier BV
Date: 10-2009
Abstract: Pseudochylothorax (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion that is commonly associated with chronic inflammatory disorders such as tuberculosis or rheumatoid arthritis. Until now, there were only 15 published cases of arthritis-associated pseudochylothorax in the English language literature. Previous literature has suggested that pleural fluid cholesterol enrichment occurs in the context of grossly thickened (fibrotic) pleura over a prolonged period, usually > 5 years. We present six well-characterized cases of arthritis-associated pseudochylothorax, each notable due to their minimal pleural thickening. The median duration of symptoms (or arthritis, in the case of asymptomatic effusions) was 15 months. Such findings cast significant doubt on the conventional concepts of the pathogenesis of rheumatoid-associated pseudochylothorax. Clinicians should consider pseudochylothorax even in short-duration nonfibrotic pleural effusions.
Publisher: American Thoracic Society
Date: 15-06-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
Publisher: Elsevier BV
Date: 09-2018
Publisher: Wiley
Date: 11-2017
Publisher: European Respiratory Society
Date: 03-2020
Publisher: Elsevier BV
Date: 09-2022
Publisher: American Society for Clinical Investigation
Date: 03-08-2009
DOI: 10.1172/JCI33288
Publisher: Elsevier BV
Date: 04-2011
Publisher: BMJ
Date: 30-04-2010
Abstract: BACKGROUND Thoracic ultrasound-guided pleural procedures are associated with fewer adverse events than 'blind' procedures for patients with pleural effusion. Ultrasound is increasingly practised by respiratory physicians but there has been no prospective assessment of its safety and diagnostic accuracy when delivered by respiratory physicians. METHODS The activity level, safety and diagnostic accuracy of thoracic ultrasound delivered by respiratory physicians were prospectively assessed. Diagnostic accuracy was assessed using a stepwise pragmatic approach (recording if pleural fluid was obtained or effusion was present on another radiological modality). In the absence of the above, ultrasound clips were reviewed by a blinded radiologist. The number of ultrasounds referred to radiologists and adverse events within 1 week were recorded. The complication rate was compared with the published literature. RESULTS 960 ultrasound scans occurred over a 3 year period. The activity of the service increased over time, as a result of increased use of interventional ultrasound. The referral rate to radiology remained constant over the study period (mean proportion 4.0%). Physician-delivered ultrasound correctly identified the presence/absence of pleural fluid in 951 of 955 evaluable scans (99.6% CI 98.9% to 99.9%). The major complication rate was 3/558=0.5% (95% CI 0.1% to 1.6%), which compared favourably with the identified published literature. CONCLUSION Respiratory physician-delivered thoracic ultrasound appears to be safe and effective in the diagnosis/intervention of pleural effusion, and is associated with a major complication rate comparable with that of published studies. Continued liaison with the radiology service has here been demonstrated as a requirement for a physician-based service.
Location: Australia
No related grants have been discovered for Yun Chor Gary Lee.