Risk factors associated with clinically relevant pericardial effusion after primary cardiac implantable electronic device implantation.

INTRODUCTION: Pericardial effusion, a known complication to implantation of cardiac implantable electronic devices (CIED), may cause life-threatening cardiac tamponade. Limited knowledge is available about risk factors for clinically relevant procedural pericardial effusion. The aim is to identify the patient- and procedure-related risk factors associated with clinically relevant procedural pericardial effusion. METHOD: A nationwide observational cohort study based on data on 55 121 patients from the Danish Pacemaker Register between 2000 and 2018. We defined a clinically relevant procedural pericardial effusion related to the implantation if it occurred within 90 days after the primary CIED-procedure. Prespecified risk factors were analysed by multivariable logistic regression models to estimate the association with pericardial effusion. RESULTS: There were 115 (0.21%) patients diagnosed with clinically relevant procedural pericardial effusion, with a median age of 75 years and 38.3% were females. Of these, 80.9% lead to a subsequent pericardiocentesis procedure. In adjusted logistic regression analysis, an increased risk of clinically relevant pericardial effusion was associated with female sex (OR:1.49 [95%CI: 1.03-2.16]), heart failure (OR:1.54 [95%CI: 1.06-2.23]), previous cardiac surgery (OR:1.63 [95%CI: 1.05-2.55]), CRT-device (OR:2.05 [95%CI: 1.23-3.41]), tertiary-centres (OR:1.8 [95%CI: 1.18-2.73]), increased procedural volume per year (>1000) (OR:1.85 [95%CI: 1.03-3.30]), indication of device-implantation (atrioventricular block) (OR:2.37 [95CI: 1.45-3.87]), and increasing number of leads implanted (two leads (OR:2.39 [95%CI: 1.43-4.00]), three leads (OR:4.77 [95%CI: 2.50-9.10])). CONCLUSION: Clinically relevant procedural pericardial effusion is a rare complication after CIED-implantation in Denmark. This study reveals important patient- and procedure-related risk factors associated with clinically relevant procedural pericardial effusion.

Endoscopic vacuum assisted closure therapy for esophagopericardial fistula in a 16-year-old male: A case report.

BACKGROUND: Esophagopericardial fistula (EPF) is a rare, life-threatening condition with limited scientific literature and no established management guidelines. This case report highlights a successful multidisciplinary approach and the innovative use of endoscopic vacuum assisted closure (endoVAC) therapy in treating this complex condition. CASE SUMMARY: A 16-year-old male with a history of esophageal atresia and colon interposition presented with progressive chest pain, fever, and dyspnea. Imaging revealed an EPF with associated pleural and pericardial effusions. Initial management with an esophageal stent failed, prompting the use of an endoVAC system. The patient underwent multiple endoVAC device changes and received broad-spectrum antibiotics and nutritional support. The fistula successfully closed, and the patient recovered, demonstrating no new symptoms at a 6-month follow-up. CONCLUSION: EndoVAC therapy can effectively manage EPF, providing a minimally invasive treatment option.

Diagnostic accuracy of point-of-care ultrasound (PoCUS) for the diagnosis of hip effusion in the pediatric emergency department.

PURPOSE: A new limp or refusal to weight-bear are common symptoms in children presenting to the pediatric emergency department (ED). This poses a diagnostic challenge, particularly among toddlers and nonverbal patients. Point-of-care ultrasound (PoCUS) used by pediatric emergency medicine physicians may detect hip effusion, which dramatically aids diagnostic workup and management. There is limited literature regarding the accuracy of hip PoCUS conducted by pediatric emergency medicine physicians. This study aims to assess the diagnostic performance of pediatric emergency medicine physician-performed PoCUS in identifying hip effusion. METHODS: This prospective study was conducted in a single-center pediatric ED. Children presenting with limb pain or new limp were evaluated by pediatric emergency medicine physicians who also performed hip PoCUS and categorized findings as either "effusion" or "no effusion" based on standard sonographic definitions. Patients also underwent radiology department ultrasound reviewed by a pediatric radiologist. Diagnostic test characteristics with corresponding 95% confidence intervals (CI) were calculated using radiology department ultrasound findings as the reference standard. RESULTS: A total of 95 patients were enrolled by 8 pediatric emergency medicine physicians. Excellent agreement was observed between PoCUS performed by pediatric emergency medicine physicians and radiology department ultrasound for the presence or absence of hip effusion (kappa = 0.81 [95% CI 0.70-0.93]). Hip effusion was identified by PoCUS in 44 out of 49 effusion-positive patients, with a sensitivity of 89.8% (95% CI 77.7-96.6%), specificity of 91.3% (95% CI 79.2%-97.5%), positive likelihood ratio of 10.33 (95% CI 4.03-26.47), and negative likelihood ratio of 0.11 (95% CI 0.05-0.26). CONCLUSION: PoCUS performed by pediatric emergency medicine physicians has reasonably high sensitivity and specificity for diagnosing hip effusion among pediatric patients presenting to the pediatric ED with a limp or leg pain. This practice may potentially expedite both diagnosis and treatment within this patient population.

RéSUMé: OBJECTIF: Un nouveau boiteux ou un refus de porter le poids sont des symptômes courants chez les enfants qui se présentent à l'urgence pédiatrique (DE). Cela pose un défi diagnostique, en particulier chez les enfants en bas âge et les patients non verbaux. Les échographies de point de soins (PUCU) utilisées par les médecins des urgences pédiatriques peuvent détecter un épanchement de la hanche, ce qui facilite considérablement le diagnostic et la gestion. Il existe une littérature limitée concernant la précision des PUC de la hanche effectuée par les médecins urgentistes pédiatriques. Cette étude vise à évaluer la performance diagnostique des PUCU réalisées par un médecin en médecine d'urgence pédiatrique pour identifier l'effusion de la hanche. MéTHODES: Cette étude prospective a été menée dans un seul centre de DE pédiatrique. Les enfants présentant une douleur aux membres ou une nouvelle boiterie ont été évalués par des médecins pédiatriques d'urgence qui ont également effectué un PUCU de la hanche et ont classé les résultats comme "épanchement" ou "aucun épanchement" selon les définitions échographiques standard. Les patients ont également subi une échographie du service de radiologie examinée par un radiologue pédiatrique. Les caractéristiques des tests diagnostiques avec leurs intervalles de confiance (IC) correspondants à 95 % ont été calculées en utilisant les résultats d'échographie du service de radiologie comme norme de référence. RéSULTATS: Un total de 95 patients a été inscrits par huit médecins urgentistes pédiatriques. Une excellente concordance a été observée entre les ultrasons réalisés par les médecins pédiatriques d'urgence et ceux du service de radiologie pour la présence ou l'absence d'effusion de la hanche (kappa = 0.81 [IC à 95% 0.70­0.93]). Le épanchement de la hanche a été identifié par PUCU chez 44 des 49 patients ayant un épanchement positif, avec une sensibilité de 89,8 % (IC à 95%, 77.7 ­96.6 %), une spécificité de 91,3 % (IC à 95%, 79.2­97.5%), un rapport de vraisemblance positif de 10,33 (IC à 95 %, 4.03­26.47) et un rapport de vraisemblance négatif de 0,11 (IC à 95% 0.05-0.26) CONCLUSIONS: Le PUCU réalisé par des médecins pédiatriques d'urgence a une sensibilité et une spécificité raisonnablement élevées pour diagnostiquer l'épanchement de la hanche chez les patients pédiatriques présentant une lésion ou une douleur aux jambes. Cette pratique pourrait accélérer le diagnostic et le traitement dans cette population de patients.

Minimally invasive treatment of an internal pancreaticopleural fistula with massive pleural effusion: a case report.

BACKGROUND: A pancreatic duct rupture can lead to various complications such as a fistula, pseudocyst, ascites, or walled-off necrosis. Due to pleural effusion, pancreaticopleural fistula typically causes dyspnea and chest pain. Leaks of enzyme-rich pancreatic fluid forming a pleural effusion can be verified in a thoracocentesis following radiological imaging such as computed tomography or magnetic resonance tomography. While management strategies range from a conservative to endoscopic and surgical approach, we report a case with successful minimally invasive treatment of pancreaticopleural fistula and effusion. CASE PRESENTATION: We present a case of a patient with pancreaticopleural fistula and successful minimally invasive surgical treatment. A 62-year old Caucasian man presented with acute chest pain and dyspnea. A computed tomography scan identified a left-sided cystoid formation, extending from the abdominal cavity into the left hemithorax with concomitant pleural effusion. Pleural effusion analysis indicated significantly elevated pancreatic enzymes. Magnetic resonance cholangiopancreatography revealed a rupture of the pancreatic duct and nearby fluid accumulation. Endosonography later confirmed proximity to the tail of the pancreas, suggesting a pancreatic pseudocyst with visible tract into the pancreas. We assumed a pancreatic duct rupture with a fistula from the tail of the pancreas transdiaphragmatically into the left hemithorax with a commencing pleural empyema. A visceral and parietal decortication on the left hemithorax and a laparoscopic distal pancreatectomy with splenectomy was performed. The suspected diagnosis of a fistula arising from the pancreatic duct was confirmed histologically. CONCLUSION: Pancreaticopleural fistulas often have a long course and may remain undiagnosed for a long time. At this point diagnostic management and therapy demand a high level of expertise. In instances of unclear symptomatic pleural effusion, considering an abdominal focus is crucial. If endoscopic treatment is not feasible, minimally invasive surgery should strongly be considered, especially when located in the distal pancreas.

Challenging the Norm: Occurrence of Synchronous Pleural and Peritoneal Mesothelioma in a Female Patient.

Here, we present a unique case involving a female patient in her 40s with synchronous malignant pleural and peritoneal mesothelioma, despite lacking a history of asbestos exposure. The patient's initial symptoms included dyspnoea, chest pain, cough, fever, appetite loss, and weight loss over a month. Clinical evaluation led to the identification of right-sided pleural effusion, prompting consideration of differential diagnoses, such as tubercular or malignant pleural effusion. A thoracoscopy-guided biopsy, followed by histopathological examination and immunohistochemical staining, confirmed the diagnosis of mesothelioma. Chemotherapy was initiated as part of the treatment plan. The prognosis for this condition is generally bad; however, unusual cases of extended survival have been documented. The complexities of our case underscore the critical necessity for a thorough and aggressive evaluation of pleural effusion cases to unveil rare underlying causes, such as mesothelioma.

Mediastinal Hemangioma Mimicking as Bronchial NET.

We present a rare case of mediastinal capillary hemangioma in a 54-year-old female. She presented with back pain in the left suprascapular region, and the chest radiograph revealed left pleural effusion. On further workup with high-resolution computed tomography (CT) chest, a hypervascular pleural-based neoplastic lesion in the left upper hemithorax with gross left pleural effusion and subtotal collapse of the left lung was identified. 18F-fluorodeoxyglucose positron emission tomography/CT was suggestive of a weakly metabolic well-defined pleural-based soft tissue lesion in the left upper hemithorax along the mediastinal side. Neuroendocrine tumor was suspected. 68Ga-DOTATATE PET/CT was advised, which showed intense uptake in the lesion. The mass was resected completely. Histopathological examination established the final diagnosis as benign vascular tumor consistent with a capillary hemangioma.

Higher sensitivity of pericardial fluid cytology than biopsy in malignant effusions with potential explanation of false-negative cytology: A multi-institutional analysis.

OBJECTIVE: Malignant pericardial effusions are associated with a poor prognosis. Pericardial fluid cytology and pericardial biopsy are the primary methods for diagnosis. This study aimed to conduct a multi-institutional analysis to compare the diagnostic sensitivity of cytology and biopsy, and to investigate potential explanations for false-negative results in cytology. METHODS: A retrospective review of pericardial fluid cytology cases with concurrent biopsy was conducted across four different institutions. Results were compared using standard statistical methods with attention to sensitivity and histologic distribution. False-negative cytology cases were investigated for further exploration. RESULTS: A total of 309 cases were collected, of which 99 (32.0%) were confirmed malignant through repeat sampling or clinical history. Pericardial fluid cytology and biopsy identified 84 and 64 malignant cases, respectively. Our findings confirmed significantly higher sensitivity of cytology compared to biopsy (84.8% vs 65.7%). The most common sites of origin were lung, breast, and gastrointestinal, with adenocarcinoma being the most prevalent histologic subtype. Histologic review of 12 false-negative cytology cases revealed three key explanations; lymphoma was the most common missed diagnosis (33.3%); fibrinous pericarditis obscures neoplastic cells on the pericardial surface; and pericardial involvement can be seen without extension into the pericardial space. CONCLUSION: This study demonstrated diagnostic superiority of pericardial fluid cytology over biopsy in the evaluation of malignant pericardial effusions. We identified several limitations in fluid cytology causing false negatives. In the context of an underlying malignancy with pericardial effusion, pathologists should consider immunohistochemistry studies to aid on the diagnosis.

Role of thoracoscopy in diagnosis of tubercular pleural effusion in low ADA setting- A prospective, observational study.

BACKGROUND: Tubercular Pleural effusion (TBPE) is one of most common extrapulmonary tuberculosis. It can be difficult to diagnose due to low sensitivity of pleural fluid smear, culture and CBNAAT. Diagnosis of TBPE is then dependent on the level of pleural fluid Adenosine Deaminase (ADA). Thoracoscopic pleural biopsy gives definite diagnosis specially in Low Pleural fluid ADA setting. AIMS AND OBJECTIVE: This study was planned to find out the prevalence of tubercular etiology in patients of exudative pleural effusion with low ADA (ADA <40 IU/L). MATERIAL AND METHODS: A Prospective, observational study was carried out in a tertiary teaching institute in north India. Total 142 patients of pleural effusion with low ADA were enrolled. All patients underwent rigid thoracoscopy for confirmation of their diagnosis. RESULTS: Out of 142 patients, male were 78 (55%) and female were 64 (45%). Mean age of patients were 57.4 years. Tuberculosis was diagnosed as a cause of effusion in 22 (15.5%) out of 142 patients. Majority of TBPE patients had pleural thickening as thoracoscopic finding. Mean ADA level in TBPE was 27.36 ± 11.6 as compared to 18.55 ± 9.02 in non tubercular pleural effusion patients and this difference was significant statistically (P- 0.002). CONCLUSION: The diagnosis of patients having exudative, low ADA pleural effusion can be very easily confirmed by thoracoscopy guided pleural biopsy which has a very high diagnostic yield.

To correlate clinical and biochemical profile of pleural effusion: a retrospective study in tertiary care centre of central India.

BACKGROUND: Pleural effusion indicates an imbalance between pleural fluid formation and removal. Classified into exudative and transudative, with common symptoms of dry cough, dyspnea and pleuritic chest pain. Confirmed etiology has to be established for effective treatment. OBJECTIVE: Correlate clinical and biochemical profile of various etiologies of pleural effusion. MATERIALS & METHODS: Retrospective observational study of 2 years in the department of respiratory medicine, GMC Bhopal on 280 cases of pleural effusion. RESULTS: Most common etiology was tubercular 202 (72.4%) followed by malignant in 36 (12.8%). With respect to tubercular, malignant pleural effusion has relative risk (RR) of 0.138 (p value < 0.05) in the age group of 51-60 years, which is statistically significant. Patients of tuberculosis complained of fever 158 (78.2%) whereas with malignancy complained of chest pain 16 (44.4%) followed by hemoptysis 12 (33.3%). For hemoptysis, with respect to tubercular, malignant effusion has RR of 5.68 (p value < 0.05) which is significant. History of smoking was significant in malignant effusion with RR of 2.57 (p value < 0.05) as compared to tubercular. Pleural fluid ADA was >70 in 83.7% in tubercular effusion, glucose was <60 mg/dl in 79% tubercular, malignant and bacteriological cause, LDH was >1000 in 88.4% in bacteriological and 72.3% in malignant effusion. CONCLUSION: Lack of tools for confirming diagnosis leads to diagnostic dilemma and delay in treatment initiation, leading to deterioration and untoward fatality in some cases. Our goal is early diagnosis by correlating clinical symptoms with biochemical profile and help initiate rapid treatment.

Chest tube size selection for pleural effusion: from the perspective of thoracic surgeons and pulmonologists.

BACKGROUND: The current discourse within the thoracic surgical and pulmonological communities pertains to a contentious debate over the optimal selection criteria for thoracostomy tube diameters utilized in the management of pleural effusions. A comprehensive examination of the variables that inform the clinical decision-making paradigm for the determination of appropriate chest tube calibers is imperative to enhance patient management and elevate the prognostic results. OBJECTIVES: The objective of this inquiry is to elucidate the determinants that influence thoracic surgeons and pulmonologists in their selection of chest tube size for the management of pleural effusions. METHODS: This cross-sectional study was based on an electronic questionnaire that was sent to the targeted populations through e-mail or a professional WhatsApp. The survey assessed the considerations of chest tube size selection as well as the respective advantages, disadvantages, and potential complications related to each size. RESULTS: The conducted study encompassed participants, with a nearly even distribution between thoracic surgeons (49.1%) and pulmonologists (50.9%). Most of these practitioners are within tertiary-level medical institutions (82.1%). A preference for small-bore chest tubes (SBCT), defined as < 14 French (Fr), was indicated by 54.8% of participants. The drawbacks associated with SBCT, such as kinking (60%) and blockage (70%), influenced the decision-making process negatively, while pain was a significant factor in the selection against LBCT (64%). Ultrasound guidance was a positive influence for the selection of SBCT (55%). Complications associated with LBCT included visceral and vascular injuries (55.7%), wound infection (45.3%), re-expansion pulmonary edema (43.3%), and subcutaneous emphysema (57.5%). In contrast, malposition was a complication more commonly associated with SBCT (49.1%). CONCLUSION: The decision regarding chest tube size was influenced by several critical factors which included the nature of pleural effusion, the volume of pleural fluid, and potential complications specific to the size of the chest tube used.

Lemierre's Syndrome: An Atypical Case of Fusobacterium necrophorum Bacteraemia in the Absence of Internal Jugular Vein Thrombosis.

Lemierre's syndrome primarily affects healthy adolescents and young adults as a complication of oropharyngeal infection, most commonly pharyngitis or peritonsillar abscess. Fusobacterium necrophorum is the principal pathogen, and the infection presents with classic symptoms including fever, sore throat, and neck tenderness. However, atypical presentations can pose diagnostic challenges. This report discusses a patient in her early 60s, contrary to the typical demographic, who presented with a one-week history of varied symptoms including sore throat, pleuritic chest pain, and haemoptysis. Examination revealed mild neck tenderness and lung crepitations. Laboratory tests indicated leucocytosis, thrombocytopenia, and elevated C-reactive protein (CRP). Imaging revealed pulmonary infiltrates with cavitation. F. necrophorum was detected in blood culture, promoting a CT scan of the neck, which confirmed soft tissue swelling and a small peritonsillar collection, leading to the diagnosis of Lemierre's syndrome. The classical feature of jugular vein thrombus was absent, further underscoring the atypical nature of this case. The patient received immediate initiation of intravenous antibiotics, piperacillin/tazobactam, followed by meropenem. This was complemented by a carefully tailored 21-day intravenous course, followed by an eight-week regimen of oral antibiotics consisting of amoxicillin and metronidazole. The patient demonstrated significant clinical improvement in pulmonary complications. Follow-up imaging showed minor residual changes, and the patient remained asymptomatic. Lemierre's syndrome presents a diagnostic challenge due to diverse clinical manifestations. Key diagnostic markers include deep neck infections, septicemia, and metastatic infections. Timely utilization of diagnostic tools, such as blood cultures and imaging, aid in confirmation. Early diagnosis is crucial for prompt treatment and prevention of complications. This case emphasizes the importance of maintaining a high index of suspicion for Lemierre's syndrome, especially in atypical presentations. Increased awareness among healthcare providers is vital for timely diagnosis and optimal patient outcomes.

Fenestrated over-the-needle catheter fracture during thoracocentesis in a cat.

Case summary: A 6-year-old castrated male domestic shorthair cat was evaluated for recurrent pleural effusion, atrial fibrillation and suspected congestive heart failure. During thoracocentesis, the fenestrated over-the-needle catheter became fractured and a catheter fragment remained in the patient's left pleural space. Later in the course of treatment, the patient acutely decompensated and was euthanized. There were no immediately observed complications associated with the retained catheter fragment. Relevance and novel information: To the authors' knowledge, there are no reports of over-the-needle catheter fractures with retained pleural catheter fragments in veterinary medicine. Similar cases in humans have been successfully managed with and without removal of catheter fragments. In veterinary medicine, the decision to attempt removal of a catheter fragment must consider both the likelihood of related morbidity and the patient's ability to tolerate an invasive procedure.

A Case of Pericardial Effusion in Association With Celiac Disease.

This is the case of a 22-year-old female with celiac disease-induced pericardial effusion. Celiac disease is a gastroenterological autoimmune condition that affects several organ systems. It is a disease found in both children and adults. As many systems are involved, this case presented with a unique presentation: pericardial effusion with symptoms overlapping those of cardiac chest pain such as substernal chest pain and shortness of breath. The patient had tachycardia, tachypnea, and jugular venous distention with distant S1 and S2 heart sounds. Cardiothoracic surgery was consulted and diagnosed the patient with pericardial effusion.

Anaplastic Plasma Cell Myeloma With Peritoneal Involvement.

Multiple myeloma (MM) is a B-cell neoplasm that rounds 15% of all hematological malignancies. The typical clinical presentation of MM includes hypercalcemia, renal failure, anemia and bone lesion (CRAB). Effusions due to MM may occur due to secondary involvement of other organs and rarely are present at the initial diagnosis. Anaplastic myeloma (AMM) is rare morphological variant of multiple myeloma with predisposition of extramedullary affection. Herein, we describe a case of malignant plasmacytic ascites at disease onset of anaplastic multiple myeloma.

Exploring an Uncommon Presentation of Kikuchi-Fujimoto Disease: Case Insights.

Kikuchi-Fujimoto disease (KFD) is a self-limiting, benign illness that is typified by cervical lymphadenopathy, typically accompanied by a low fever and night sweats. Loss of weight, nausea, vomiting, and sore throat are fewer common symptoms. KFD can have an acute or subacute start, and it usually develops over two to three weeks. Although viral aetiology is still a concept that needs further research, the clinical, histological, and immunohistochemical aspects seem to support it. Since specific diagnostic laboratory tests are not available, the diagnosis is frequently established by excising a sample of the affected lymph nodes. This case study features a 63-year-old male patient who first complained of fever and dyspnoea. Upon further investigation, the patient's condition was determined to be Kikuchi-Fujimoto disease, which was treated appropriately.

Comparison of five scores to predict mortality in malignant pleural effusion.

Malignant pleural effusion (MPE) is a complication of malignancy. Treatment of MPE is based on predicted outcome. The aim of this study was to compare the performance characteristics of LENT, PROMISE, RECLS, AL and pNLR scores for prediction of mortality in lung cancer patients who have MPE. Patients who were diagnosed with MPE that was associated with underlying lung cancer between January 2010 and December 2019 were included and analyzed retrospectively in a single center. Outcomes considered were 30-day, 6 months, and 1-year mortality. A total of 180 patients were examined. For 30-day mortality, the areas under the ROC curves (AUC) (95% CI) were: LENT 0.83 (0.76-0.87), RECLS 0.71 (0.63-0.77), and PROMISE 0.70 (0.17-0.38). For 6-month and 1-year mortality the order of these AUCs was similar. Cox regression showed that none of the scores were significantly associated with 30-day mortality, but LENT and RECLS were significantly associated with 6-month and 1-year mortality. Comparison of - 2log likelihood ratios showed that LENT score was more, strongly associated with 6-month mortality than PROMISE (p = 0.001) or RECLS (p = 0.02). LENT score was also more strongly associated with 1-year mortality than PROMISE (p = 0.001) but there was no difference between LENT and RECLS score (p = 0.64). We observed that the LENT score was more predictive than the other scores in mortality in patients who have lung cancer and MPE. The LENT and RECLS scores have similar performance characteristics for prediction of 1-year mortality in these patients.

Characterization of mesothelin gene expression in dogs and overexpression in canine mesotheliomas.

Introduction: Canine mesotheliomas are uncommon malignant tumors typically detected late. Minimally invasive diagnostic biomarkers would facilitate diagnosis at earlier stages, thereby improving clinical outcomes. We hypothesized that mesothelin could be used as a reliable diagnostic biomarker for canine mesotheliomas since it has been used as a cancer biomarker for human mesothelioma. We aimed to explore and characterize mesothelin gene expression in dogs and assess its use as a diagnostic biomarker for canine mesotheliomas. Materials and methods: We quantified expressed canine mesothelin transcripts via reverse transcription polymerase chain reaction (RT-PCR) and sequenced them using ribonucleic acid (RNA) extracted from a canine mesothelioma cell line. After confirming mesothelin expression, we assessed its levels in major organ tissues and compared them with those in the mesothelioma tissues using quantitative PCR (qPCR). Mesothelin overexpression in mesotheliomas was detected, and we further compared its levels using qPCR between mesotheliomas and non-mesotheliomas using tumor tissues and clinical sample effusions, confirming its significance as a diagnostic biomarker for canine mesothelioma. Results: Mesothelin complementary deoxyribonucleic acid (cDNA) was amplified via RT-PCR, yielding a single band of expected upon DNA electrophoresis. Sequence analyses confirmed it as a predicted canine mesothelin transcript from the genome sequence database. Comparative sequence analysis of the deduced amino acid sequence of the expressed canine mesothelin demonstrated molecular signature similarities with the human mesothelin. However, the pre-sequence of canine mesothelin lacks the mature megakaryocyte potentiating factor (MPF) portion, which is typically cleaved post-translationally with furin. Mesothelin expression was quantified via qPCR revealing low levels in the mesothelial and lung tissues, with negligible expression in the other major organs. Canine mesothelin exhibited significantly higher expression in the canine mesotheliomas than in the noncancerous tissues. Moreover, analysis of clinical samples using qPCR demonstrated markedly elevated mesothelin expression in canine mesotheliomas compared to non-mesothelioma cases. Discussion and conclusion: Canine mesothelin exhibits molecular and biological characteristics akin to human mesothelin. It could serve as a vital biomarker for diagnosing canine mesotheliomas, applicable to both tissue- and effusion-based samples.

A retrospective study to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema.

INTRODUCTION: Medical treatment of pediatric empyema consists of appropriate antibiotics, chest tube insertion, and intrapleural fibrinolytic drugs to facilitate pleural drainage. There is a lack of consensus about the drug of choice for fibrinolytic therapy, so this study was designed to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema. MATERIAL AND METHODS: The medical records of all children with empyema treated with intrapleural alteplase at a university hospital between January 2016 and December 2020 were retrospectively reviewed. Efficacy outcomes were assessed by chest tube output before and after the first dose of alteplase, pleural fluid volume before and after therapy, a need for surgical intervention, and length of hospital stay. Safety was assessed by the frequency and severity of side effects. RESULTS: 40 children aged 2 months to 9 years hospitalized with empyema received intrapleural alteplase. Thirty patients (75%) experienced full recovery after three doses of intrapleural alteplase. The median length of hospital stay was 16 days. Chest tube output increased significantly after the first dose of alteplase. Pleural fluid volume decreased significantly after treatment. The most common side effect was pain (30%). Two patients experienced severe complications: 1 had a pulmonary hemorrhage and the other experienced a bronchopleural fistula. These patients recovered fully spontaneously. CONCLUSIONS: According to our results, the administration of intrapleural alteplase was safe and effective in facilitating pleural drainage in pediatric patients with empyema. However, further clinical trials will be needed to determine the optimal dose, frequency, and duration of intrapleural alteplase treatment.

Deep Learning-Based Joint Effusion Classification in Adult Knee Radiographs: A Multi-Center Prospective Study.

Knee effusion, a common and important indicator of joint diseases such as osteoarthritis, is typically more discernible on magnetic resonance imaging (MRI) scans compared to radiographs. However, the use of radiographs for the early detection of knee effusion remains promising due to their cost-effectiveness and accessibility. This multi-center prospective study collected a total of 1413 radiographs from four hospitals between February 2022 to March 2023, of which 1281 were analyzed after exclusions. To automatically detect knee effusion on radiographs, we utilized a state-of-the-art (SOTA) deep learning-based classification model with a novel preprocessing technique to optimize images for diagnosing knee effusion. The diagnostic performance of the proposed method was significantly higher than that of the baseline model, achieving an area under the receiver operating characteristic curve (AUC) of 0.892, accuracy of 0.803, sensitivity of 0.820, and specificity of 0.785. Moreover, the proposed method significantly outperformed two non-orthopedic physicians. Coupled with an explainable artificial intelligence method for visualization, this approach not only improved diagnostic performance but also interpretability, highlighting areas of effusion. These results demonstrate that the proposed method enables the early and accurate classification of knee effusions on radiographs, thereby reducing healthcare costs and improving patient outcomes through timely interventions.

Identifying Early Risk Factors for Postoperative Pulmonary Complications in Cardiac Surgery Patients.

Background and Objectives: Postoperative pulmonary complications (PPCs) are common in patients who undergo cardiac surgery and are widely acknowledged as significant contributors to increased morbidity, mortality rates, prolonged hospital stays, and healthcare costs. Clinical manifestations of PPCs can vary from mild to severe symptoms, with different radiological findings and varying incidence. Detecting early signs and identifying influencing factors of PPCs is essential to prevent patients from further complications. Our study aimed to determine the frequency, types, and risk factors significant for each PPC on the first postoperative day. The main goal of this study was to identify the incidence of pleural effusion (right-sided, left-sided, or bilateral), atelectasis, pulmonary edema, and pneumothorax as well as detect specific factors related to its development. Materials and Methods: This study was a retrospective single-center trial. It involved 314 adult patients scheduled for elective open-heart surgery under CPB. Results: Of the 314 patients reviewed, 42% developed PPCs within 12 h post-surgery. Up to 60.6% experienced one PPC, while 35.6% developed two PPCs. Pleural effusion was the most frequently observed complication in 89 patients. Left-sided effusion was the most common, presenting in 45 cases. Regression analysis showed a significant association between left-sided pleural effusion development and moderate hypoalbuminemia. Valve surgery was associated with reduced risk for left-sided effusion. Independent parameters for bilateral effusion include increased urine output and longer ICU stays. Higher BMI was inversely related to the risk of pulmonary edema. Conclusions: At least one PPC developed in almost half of the patients. Left-sided pleural effusion was the most common PPC, with hypoalbuminemia as a risk factor for effusion development. Atelectasis was the second most common. Bilateral effusion was the third most common PPC, significantly related to increased urine output. BMI was an independent risk factor for pulmonary edema development.