Intrapleural Tenecteplase for Complicated Parapneumonic Pleural Effusion

Intrapleural thrombolytics have shown promising results in complicated parapneumonic pleural effusions reducing the need for surgical interventions. Until now, studies have evaluated primarily streptokinase, urokinase, and recently, alteplase. In this case series, we share our experience with tenecteplase—a tissue-specific plasminogen activator in 15 patients. We observed that tenecteplase is effective in 14/15 (93.3%) of our patients, and none of them had any bleeding episodes.

Diagnosis of Parapneumonia Pleural Effusion With Serum and Pleural Effusion Activin A

Background We aimed to evaluate the diagnostic value of Activin A levels in serum and pleural effusion on parapneumonic pleural effusion (PPE). Methods We collected serum and pleural effusion from 86 PPE and 37 non-PPE (NPPE) patients. Including Activin A, levels of biomarkers as lactate dehydrogenase (LDH), procalcitonin (PCT) and C-reactive protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by receiver operating characteristic (ROC) curve analysis. Results Levels of Activin A in serum and pleural effusion of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural effusion showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural effusion had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. Conclusion Activin A in pleural effusion correlated with disease severity could act to diagnosis PPE.

Pleural Fluid GSDMD Is a Novel Biomarker for the Early Differential Diagnosis of Pleural Effusion

ObjectiveGasdermin D (GSDMD), controlling pyroptosis in cells, has multiple physiological functions. The diagnostic role of GSDMD in pleural effusion (PE) remains unknown.MethodsSandwich ELISA kits that we developed were applied to measure the level of GSDMD for 335 patients with a definite cause of PE, including transudative PE, tuberculous pleural effusion (TPE), parapneumonic pleural effusion (PPE), and malignant pleural effusion (MPE). The diagnostic accuracy of Light’s criteria vs. the new marker GSDMD was performed. Clinical follow-up of 40 cases of PPE was conducted and divided into efficacy and non-efficacy groups according to the therapeutic outcome. Nucleated cells (NCs) in PE were isolated and further infected with bacteria to verify the cell source of GSDMD.ResultsThe diagnostic accuracy of GSDMD for the diagnosis of PE were 96% (sensitivity) and 94% (specificity). The receiver operating characteristic (ROC) curve indicated that GSDMD can be an efficient biomarker for the differential diagnosis of transudative PE and other groups (all AUC > 0.973). Noteworthily, the highest AUC belonged to tuberculosis diagnosis of 0.990, and the cut-off value was 18.40 ng/mL. Moreover, the same cut-off value of PPE and MPE was 9.35 ng/mL. The combination of GSDMD, adenosine deaminase (ADA), and lactate dehydrogenase (LDH) will further improve the diagnostic efficiency especially between TPE and PPE (AUC = 0.968). The AUC of GSDMD change at day 4, which could predict the therapeutic effect at an early stage, was 0.945 (P < 0.0001). Interestingly, bacterial infection experiments further confirm that the pleural fluid GSDMD was expressed and secreted mainly by the NCs.ConclusionGSDMD and its combination are candidates as a potentially novel biomarker not only to separate PEs early and effectively, but also monitor disease progression.

A study of the proteomic expression in patients with complicated parapneumonic pleural effusion

IntroductionThe present study aimed to investigate the differences in the proteomic expression between uncomplicated parapneumonic pleural effusion (UPPE) and complicated parapneumonic pleural effusion (CPPE).Material and methodsThere were 10 patients with UPPE and 10 patients with CPPE. These patients were combined due to the complication of pleural effusion and further divided into group A and group B. An LC-MS analysis was conducted with the extraction of high-abundance proteins, and proteins with 1.5-fold or higher difference multiples were identified as differential proteins. Then, gene ontology (GO) and KEGG analyses were conducted on the differential proteins between the groups.ResultsCompared with the UPPE group, there were 38 upregulated proteins and 29 downregulated proteins in the CPPE group. The GO analysis revealed that the CPPE group had enhanced expressions in monosaccharide biosynthesis, glucose catabolism, fructose-6-phosphate glycolysis, glucose-6-phosphate glycolysis, and NADH regeneration as well as reduced expressions in fibrinogen complexes, protein polymerization, and coagulation. Moreover, the KEGG analysis showed that the CPPE group had enhanced expressions in amino acid synthesis, the HIF-1 signalling pathway, and glycolysis/glyco-isogenesis and decreased expressions in platelet activation and complement activation.ConclusionsIn pleural effusion in patients with CPPE, there are enhanced expressions of proteins concerning glucose and amino acid metabolism, NADH regeneration, and HIF-1 signalling pathways together with decreased expressions of proteins concerning protein polymerization, blood coagulation, platelet activation, and complement activation.

Corticosteroids for the management of parapneumonic pleural effusion in children: a 15-year experience

Objective: Description of the use of corticosteroids for the management of parapneumonic pleural effusion in children. Methods: Retrospective monocenter cohort study of all children hospitalized with a discharge diagnosis of parapneumonic pleural effusion during a 15-year period. Results: We documented 97 cases of parapneumonic effusion during the study period, with a median age (interquartile range (IQR)) of 43 (33-61) months. Most of the children benefited from an evacuation of the pleural effusion (89/97, 91.8%): 21 patients (21.6%) were treated with needle thoracocentesis only, while a chest tube was inserted in 68 children (70.1%). Thirty-two patients (33%) were treated with intrapleural fibrinolysis. Fifty-five children (56.7%) received corticosteroids for persistent fever. The median time (IQR) between hospital admission and initiation of corticosteroids was 5.5 (4-7) days. When corticosteroids were initiated, children were febrile since 9 (IQR 8-11) days. The fever ceased in a median (IQR) of 0 (0-1) day after corticosteroids initiation. Only 1 patient required a video-assisted thoracoscopy that was provided because of morphological reasons (morbid obesity). No children treated with corticosteroids required surgery. All children were discharged alive from hospital. The median (IQR) hospital length of stay was 11 (8-14) days, with no difference between children with and without corticosteroids. Conclusion: Our results indicate that corticosteroids could be associated with a significant reduction in the use of surgical procedures and with a prompt clinical improvement. Corticosteroids could thus offer a non-invasive therapeutic alternative for children with parapnemonic effusions when antibiotics and pleural drainage are considered a failure.