High-throughput concentration of rare malignant tumor cells from large-volume effusions by multistage inertial microfluidics

On-chip concentration of rare malignant tumor cells (MTCs) in malignant pleural effusions (MPEs) with a large volume is challenging. Previous microfluidic concentrators suffer from a low concentration factor (CF) and...

Th1/Th2 Cytokine Profiles Differentiating Tuberculous from Malignant Pleural Effusions: A Systematic Review and Meta-Analysis

To clarify which one has a different predominance of Th1 and Th2 immune responses in malignant and tuberculous pleural effusions. We did a meta-analysis of the results published previously to assess the levels of Th1/Th2 cytokines in two types of pleural effusion, and evaluated its ability to distinguish TPE from MPE. We queried the PubMed and Embase databases for studies indexed from 2000 up to March 2021. We included studies that (a) diagnosis of TPE and MPE by on culture, or pleural biopsy tissue provided; (b) compared levels of Th1/Th2 cytokines in pleural effusion between TPE and MPE. Pooled data by using a random-effects model or fixed-effects model, standardized mean differences (SMD) across studies comparing TPE and MPE. We also performed Egger test to assess of publication bias. Of 917 identified studies, a total of 42 studies were selected in the meta-analysis. Compared with malignant subjects, tuberculous subjects had a significant higher level of TNF-α [2.22, (1.60–2.84)], an elevated level of IFN-γ [3.30, (2.57–4.40)] in pleural effusion, a situation where the Th1 immune response dominates. Conversely, Interleukin-4 (IL-4) and IL-10 (Th2 cytokines) levels were higher in MPE than TPE. Besides, they were shown to be statistically insignificant tiny effects were [-0.15, (-0.94–0.63)], [-0.04, (-0.21–0.12)] respectively. We confirmed that pleural effusions caused by tuberculosis, a situation in which the Th1 cytokines are predominant. The slight preponderance of Th2 cytokines in malignant pleural effusions, which are not convincing enough to prove.

Indwelling Pleural Catheters

Indwelling pleural catheters (IPC) are now being considered worldwide for patients with recurrent pleural effusions. It is commonly used for patients with malignant pleural effusions (MPE) and can be performed as outpatient based day care procedure. In malignant pleural effusions, indwelling catheters are particularly useful in patients with trapped lung or failed pleurodesis. Patients and care givers are advised to drain at least 3 times a week or in presence of symptoms i.e. dyspnoea. Normal drainage timing may lasts for 15–20 min which subsequently improves their symptoms and quality of life. Complications which are directly related to IPC insertion are extremely rare. IPC’s are being recently used even for benign effusions in case hepatic hydrothorax and in patients with CKD related pleural effusions. Removal of IPC is often not required in most of the patients. It can be performed safely as a day care procedure with consistently lower rates of complications, reduced inpatient stay. They are relatively easy to insert, manage and remove, and provide the ability to empower patients in both the decisions regarding their treatment and the management of their disease itself.