Volume Of Effusion Research Articles

Simple approach to quantitation of pericardial volumes

Abstract Background Transthoracic echocardiography is the primary modality used for the assessment of the pericardial space. Guidelines recommend semi-qualitative assessment of the size of a pericardial effusion with characterization as trace, small, moderate or large. The reproducibility and association of this characterization is variable. Whether simple 2D-based quantitative measures of effusion size better associate with pericardial volumes is unclear. An accurate measure of pericardial volume would be helpful for tracking patients over time. Purpose To test whether 2D-based measures of the pericardial space could accurately predict pericardial volumes. Methods We retrospectively assessed a series of echos performed immediately prior to pericardiocentesis. 2D-based area tracings from the parasternal long and short axis at the papillary muscle level as well as 2D volumetric tracings from the apical 4 chamber view using the Simpson's method were tested with the operator blinded to the true pericardial volume (recorded at pericardiocentesis). Patients who underwent pericardiocentesis in setting of acute perforation were excluded as were patients where pericardiocentesis was unsuccessful or incomplete. Pericardial fluid area or volume was calculated by taking the difference between the measures obtained by tracing the epicardial border of the heart and pericardium (figure 1). Results The median pericardiocentesis (n=118) fluid volume was 500 mL (IQR 350 – 750 mL) with a range, 95–2300 mL. The pericardial fluid was serous (22%), sero-sanguineous (37%) and sanguineous in 41%. The effusion was malignant in 24 cases and due to inflammation in 42 cases. Pericardial area traces from either the parasternal short (r=0.56, p<.0001) or long axis (r=0.62, p<.0001) correlated modestly with measured pericardial volume. The average volume estimated echocardiographically by the Simpson’s method was 580 ± 359 mL (range, 85.8–2419 mL). There was stronger linear correlation between echocardiographic (apical 4-chamber measurement) and pericardiocentesis-derived volumes (r=0.92, p < 0.0001; figure 2A). Etiology of the pericardial effusion was not associated with estimates of pericardial volumes. There was a large overlap in pericardial volume amongst the reading physician qualitative grading of effusion size (figure 2B). Categorization of pericardial effusion size was improved when based on volumetric estimates (Kappa 0.65) rather than physician estimates (Kappa 0.32; Figure 2B). Variation between measured pericardial volume and actual pericardial volume was most related to the quality of the image and the likely extent to which the pericardial fluid was not entirely captured in the image window. Conclusion Two-dimensional transthoracic echocardiography using biplane Simpson’s method of disks can simply and reasonably accurately estimate the pericardial effusion volume. This technique may add value in the serial assessment of pericardial effusions. Figure 2

Accuracy of Fully Automated and Human-assisted Artificial Intelligence-based CT Quantification of Pleural Effusion Changes after Thoracentesis.

Quantifying pleural effusion change at chest CT is important for evaluating disease severity and treatment response. The purpose of this study was to assess the accuracy of artificial intelligence (AI)-based volume quantification of pleural effusion change on CT images, using the volume of drained fluid as the reference standard. Seventy-nine participants (mean age ± SD, 65 years ± 13; 47 male) undergoing thoracentesis were prospectively enrolled from October 2021 to September 2023. Chest CT scans were obtained just before and after thoracentesis. The volume of pleural fluid on each CT scan, with the difference representing the drained fluid volume, was measured by automated segmentation (fully automated measurement). An expert thoracic radiologist then manually corrected these automated volume measurements (human-assisted measurement). Both fully automated (median percentage error, 13.1%; maximum estimated 95% error, 708 mL) and human-assisted measurements (median percentage error, 10.9%; maximum estimated 95% error, 312 mL) systematically underestimated the volume of drained fluid, beyond the equivalence margin. The magnitude of underestimation increased proportionally to the drainage volume. Agreements between fully automated and human-assisted measurements (intraclass correlation coefficient [ICC], 0.99) and the test-retest reliability of fully automated (ICC, 0.995) and human-assisted (ICC, 0.997) measurements were excellent. These results highlight a potential systematic discrepancy between AI segmentation-based CT quantification of pleural effusion volume change and actual volume change. Keywords: CT-Quantitative, Thorax, Pleura, Segmentation Clinical Research Information Service registration no. KCT0006683 Supplemental material is available for this article. © RSNA, 2025.

A Randomized Controlled Trial on the Efficacy of 20% Human Albumin in Reducing Pleural Effusion After Cardiopulmonary Bypass.

Background/Objectives: Cardiopulmonary bypass can lead to hemodilution, causing a fluid shift to the interstitial space. Albumin helps counteract the intravascular fluid movement to the extravascular space and reduces the risk of complications associated with fluid imbalance. Our main objective was to evaluate the effectiveness of albumin addition in the cardiopulmonary bypass priming solution compared to standard priming, focusing on its role in reducing pleural effusion development. Methods: This was a single-center randomized controlled trial conducted at a tertiary care hospital specializing in cardiology and cardiac surgery. It involved 70 individuals scheduled for elective open-heart surgery. All cases were randomly assigned into two groups of 35 patients. The study group replaced 100 mL of standard CPB priming solution with 100 mL of 20% human albumin. We measured serum albumin levels before and after the surgery, 6 and 12 h after, and calculated colloid oncotic pressure. Thorax CT scans were performed on the first postoperative day to measure and calculate pleural effusion volume. Results: Albumin addition to cardiopulmonary bypass priming solution led to a significant reduction in pleural effusion development after CPB. An albumin level <35 g/L after the surgery showed a significant increase in pleural effusion development, and 100 mL of 20% albumin was sufficient to maintain serum albumin levels > 35 g/L. Conclusions: Our study suggests a link between postoperative hypoalbuminemia and the early development of pleural effusion after CPB, as well as the possible benefits of adding 100 mL of 20% albumin compared to standard crystalloid CPB priming to minimize postoperative pleural effusion development.

Management of pleural effusion in mechanically ventilated critically ill patients: A systematic review and guideline.

Mechanically ventilated critically ill patients often develop pleural effusions, which may impact lung compliance and expansion. This systematic review explores the management of pleural effusion in the critically ill population. A comprehensive literature search was performed. Quality of evidence rating and recommendation development utilized Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The full search retrieved 11,965 articles for screening, of which 28 studies ultimately met inclusion criteria. There were 15 cohort studies assessing oxygenation outcome and 17 cohort studies assessing pneumothorax outcome. Patients with drainage (n​=​418) had a pooled mean increase in PaO2/FiO2 ratio of 53 (P​<​0.00001, 95​% CI: 43-64, I2​=​0​%) compared to pre-drainage/no-drainage (n​=​432). In patients with drainage, the combined incidence of pneumothorax was 124/5995 (2.1​%). In mechanically ventilated critically ill adult patients with pleural effusion and hypoxia, we conditionally recommend drainage of pleural effusion to improve oxygenation. P:F ratio <200 and pleural effusion volume estimate >500​mL are conditions in which drainage would have most benefit.

A single left fourth intercostal thoracotomy approach for resolution of idiopathic chylothorax with thoracic duct ligation and pericardiectomy: a preliminary clinical study in two dogs.

Open surgical treatment of idiopathic chylothorax via thoracic duct ligation and pericardiectomy requires a lengthy procedure with two thoracotomy incisions. The objectives of this report were to describe an approach for thoracic duct ligation and pericardiectomy via a single thoracotomy at the left fourth intercostal space and to describe the clinical outcome in two dogs with idiopathic chylothorax. Dogs were prospectively enrolled in a pilot study to evaluate the clinical efficacy of thoracic duct ligation at the left fourth intercostal space, combined with subphrenic pericardiectomy performed through the same incision. Dogs had a preoperative CT lymphangiogram to evaluate the anatomy of the thoracic duct and its branching pattern prior to surgery. Recheck radiographs were performed every 2-4 weeks until effusion resolved. Pleural effusion became non-chylous by 5 days postoperatively. Pleural effusion volume decreased by day 5 postoperatively, allowing removal of thoracostomy tube and discharge from the hospital. Radiographically, effusion resolved within 6 weeks without a need for further drainage after discharge. Dogs remained symptom-free at last follow up (>11 months postoperatively). CT lymphangiograms were repeated >11 months postoperatively and revealed no recurrence of pleural effusion. No intraoperative or postoperative complications directly related to surgery were noted for either dog. Collateral lymphatic vessels were not identified on recheck CT lymphangiograms. The left fourth intercostal approach to thoracic duct ligation and pericardiectomy has potential to be a safe and effective alternative to an open approach requiring two lateral thoracotomies. Further investigation of this approach using open or minimally invasive techniques is warranted.

A novel minimally invasive surgical technique (LONG procedure) for treating chylopericardium.

Chylopericardium is a rare disease resulting from lymphatic system dysfunction and characterized by recurrent chylous pericardial effusion and cardiac compression. Traditional treatments like fasting, somatostatin injection and ligation of pericardial lymphatic vessels are less effective, with high recurrence rate. Fenestration is regarded as the last resort for treating chylopericardium. Our team designed a novel minimally invasive pericardial fenestration surgical technique (LONG procedure) for the treatment of chylopericardium. This study assessed its efficacy and technical characteristics, with the aim of providing valuable insights into the surgical treatment and management of chylopericardium. The clinical data of 7 patients with chylopericardium treated by the LONG procedure in the lymphatic surgery department from January 2018 to June 2024 were retrospectively analyzed. The data included the patients' medical history, imaging examination, pericardial effusion analysis, operative details, drainage output, length of hospital stay, and follow-up results. The indicators were analyzed to assess the technical characteristics of the LONG procedure. Seven male patients aged between 7 and 35 years were enrolled in this study. The duration of the disease course ranged from 3 months to 10 years. All patients had previously accepted pericardial drainage, a fat-free diet, and anti-infection treatments. Some patients had also undergone thoracic duct adhesiolysis, embolization, or lymphatic ligation; however, they experienced recurrent pericardial effusion. Upon admission, all patients presented with at least moderate volumes of pericardial effusion. The LONG procedure was successfully performed on all patients, with an operation time of 54 to 95 minutes and minimal intraoperative blood loss (1-5 mL). Chest tubes were removed once the drainage became clear, typically between 15 to 37 days postoperation. Patients were discharged after 1-2 weeks of observation, with no recurrence or complications observed during the follow-up period of up to 5 years. The LONG procedure seems to be effective for the treatment of chylopericardium with low postoperative recurrence rates, but more research and long-term observation are needed.

Comparison of watershed analysis with indocyanine green fluorescence staining and modified inflation-deflation method in single-port thoracoscopic complex pulmonary segmentectomy.

The increasing utilization of computed tomography (CT) scans has significantly elevated the detection rate of pulmonary nodules. Pulmonary segmentectomy has become the preferred surgical technique for peripheral non-small cell lung cancer (NSCLC) measuring 2 cm or smaller. Various methods for identifying the intersegmental planes (ISPs) are currently employed. This study aims to compare the short-term clinical safety and efficacy of the watershed analysis with indocyanine green (ICG) fluorescence staining to the modified inflation-deflation method in single-port thoracoscopic complex pulmonary segmentectomy. This retrospective study was conducted on patients who underwent single-port thoracoscopic complex pulmonary segmentectomy at The First Affiliated Hospital of Soochow University between January 2023 and December 2023. One cohort received treatment with the watershed analysis with ICG fluorescence staining, while the other cohort was treated with the modified inflation-deflation method. The study evaluated intraoperative and postoperative conditions, as well as the short-term impact on postoperative pulmonary function in both groups. The watershed analysis with ICG fluorescence staining group demonstrated less operating time (P<0.001), shorter ISPs visualization time (P<0.001), and reduced intraoperative blood loss (P<0.001). Postoperatively, 8 patients (16%) in this group experienced air leakage, compared to 20 patients (39%) in the modified inflation-deflation method group, indicating significant differences between the groups (P=0.009). Additionally, the watershed analysis with ICG fluorescence staining group had shorter postoperative drainage tube duration (P<0.001), shorter postoperative hospitalization (P<0.001), and less postoperative pleural effusion volume (P<0.001). There was no disparity observed in pulmonary function decline at three months after the surgery between the two cohorts. The watershed analysis with ICG fluorescence staining is associated with less operating time, fewer postoperative complications, and a lower risk of postoperative air leakage in complex pulmonary segmentectomy. The impact on pulmonary function was comparable to the traditional method. These findings suggest that the watershed analysis with ICG fluorescence staining is a more promising, safe, and effective approach for complex pulmonary segmentectomy.

Clinical efficacy observation of heat-sensitive moxibustion combined with intrapleural perfusion of cisplatin in treatment of malignant pleural effusion

To investigate the clinical efficacy of heat-sensitive moxibustion combined with intrapleural perfusion of cisplatin in comparison with simple intrapleural perfusion of cisplatin on malignant pleural effusion (MPE). Forty patients with MPE, in compliance with the inclusion criteria, were randomly divided into an observation group (20 cases) and a control group (20 cases). In the control group, cisplatin solution (60 mg/m2) was injected into the thoracic cavity after pleural drainage under B-ultrasound positioning, once a week for 4 weeks. In the observation group, based on the intervention as the control group, the heat-sensitive moxibustion was delivered at the back and lumbar region (where Feishu ［BL13］, Pishu ［BL20］ and Shenshu ［BL23］ are located) and the chest-abdomen region (where Danzhong ［CV17］, Guanyuan ［CV4］ and Shuidao ［ST28］ are located), for 30 min to 90 min, once daily (the treatment was discontinued on Saturday and Sunday) and for 4 weeks. Before and after treatment, in the two groups, the pleural effusion volume was detected using B ultrasound, the activity of daily living was evaluated with Karnofsky performance statue (KPS) scale and TCM symptoms with TCM syndrome grading scale. The clinical therapeutic effect was evaluated in the two groups. According to the classification criteria table for acute and subacute toxicity of anticancer drugs made by WHO, the toxic and side reaction was judged. After treatment, the pleural effusion volume was reduced in comparison with that before treatment in the two groups (P<0.01, P<0.001), and the volume in the observation group was lower than that of the control group (P<0.05). KPS score was increased in the two groups after treatment compared with that before treatment (P<0.001), and the score in the observation group was higher than that of the control group (P<0.05). After treatment, the total score of TCM syndromes and the scores for dyspnea, cough and chest pain were lower than those before treatment in the two groups (P<0.001), and the scores in the observation group were lower than those of the control group (P<0.001, P<0.05). The scores for anorexia and lassitude were reduced in comparison with those before treatment in the observation group (P<0.001)；and the scores in the observation group were lower than those in the control group after treatment (P<0.001, P<0.01). After treatment, the effective rate of the observation group was 65.0%(13/20), which was higher than that of the control group (30.0%, 6/20, P<0.05). The incidence of bone marrow suppression in the observation group was 15.0%(3/20), lower than that in the control group (55.0%, 11/20, P<0.05). The incidence of gastrointestinal reactions in the observation group was 30.0%, lower than that in the control group (65.0%, 13/20, P<0.05). Heat-sensitive moxibustion combined with intrapleural infusion of cisplatin is superior to intrapleural infusion of cisplatin in the aspects of the amelioration of pleural effusion, daily-living activity and TCM syndromes in patients with MPE. This combined therapy presents the synergism by cooperating with chemotherapeutics and reduces the incidence of toxic and side effects implicated in chemotherapy so as to attenuate the toxicity of chemotherapeutics.

Volume and Distribution of Early Knee Effusion After TKA with a PEEK-Based Knee Prosthesis: Correlation with Changes in Serum Inflammation Marker Levels, Knee Functional Score, and Range of Motion.

Early knee effusion is a common phenomenon after total knee arthroplasty (TKA), with potential clinical implications. Unlike traditional alloy knee prostheses, the polyetheretherketone (PEEK) knee system has radiographic transparency on magnetic resonance (MR) scans, which allows analysis of prosthetic knee effusion. We aimed to identify the distribution and volume of knee effusion after TKA with the PEEK prosthesis with use of MR imaging and to analyze whether dynamic changes in effusion were correlated with serum inflammatory marker changes and knee function recovery. Nine patients with osteoarthritis who were 59 to 74 years old underwent unilateral TKA with the PEEK prosthesis between June 2021 and August 2021. Dynamic early postoperative changes in the volume and distribution of knee effusion were evaluated with use of 3D MR stereoscopic images. Serum inflammatory markers were measured via blood tests, and joint function was evaluated with use of the subjective functional score of the Knee Society Score (KSS) and knee range of motion (ROM). Linear regression analyses were performed to assess for correlations between knee effusion volume and inflammatory markers and between knee effusion volume and joint function. The mean serum inflammatory marker levels increased significantly at 1 week after TKA with the PEEK prosthesis and then gradually decreased with time from 1 to 6 months. The mean total knee effusion volume gradually decreased over time. Concurrently, the mean KSS subjective functional score and mean knee ROM improved with time. Total knee effusion volume was positively correlated with C-reactive protein level (R2 = 0.16; p = 0.007) and negatively correlated with the change in KSS score between the preoperative and postoperative time points (R2 = 0.19; p = 0.003). Using the 1-week total knee effusion volume as a reference, a positive correlation was observed between the reduction in total knee effusion volume and the actual value of the ROM (R2 = 0.36; p = 0.0001) from 3 to 24 months postoperatively. Through 3D MR imaging, the precise distribution and volume of, and dynamic changes in, knee effusion after TKA with the PEEK prosthesis were confirmed and were found to be correlated with inflammation and joint function in the early postoperative period. The results demonstrate the potential clinical benefit of the PEEK-based knee system for future use. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Suspected hepatic hydrothorax secondary to cirrhosis in a dog

AbstractAn 8‐year‐old, entire, female labrador retriever presented with a 2‐week history of abdominal distension. Biochemistry identified hepatic dysfunction (elevated hepatobiliary markers, hypocholesterolaemia). Abdominal ultrasonography documented an irregular liver and a large volume of anechoic peritoneal effusion, which laboratory analysis confirmed as a protein‐poor transudate. Thoracic computed tomography identified a moderate volume of pleural effusion with a similar composition to the peritoneal fluid. Hepatic histopathology was consistent with cirrhosis secondary to chronic hepatitis and, in the absence of another cause for the pleural effusion, hydrothorax secondary to the hepatic disease was suspected. The patient was started on ciclosporin for treatment of the underlying liver disease, but developed signs consistent with disseminated intravascular coagulopathy 24 hours later and was humanely euthanased. As reported in humans, hydrothorax may therefore occur secondary to cirrhosis in dogs and should be considered as a differential diagnosis for pleural effusion in patients with advanced hepatic disease and concurrent peritoneal effusion.

Weakly Supervised Multiple Instance Learning Model With Generalization Ability for Clinical Adenocarcinoma Screening on Serous Cavity Effusion Pathology

Accurate and rapid screening of adenocarcinoma cells in serous cavity effusion is vital in diagnosing the stage of metastatic tumors and providing prompt medical treatment. However, it is often difficult for pathologists to screen serous cavity effusion. Fixed agglutination cell block can help to improve diagnostic sensitivity in malignant tumor cells through analyzing larger volumes of serous cavity effusion, although it could accordingly lead to screening of more cells for pathologists. With the advent of whole slide imaging and development of artificial intelligence, advanced deep learning models are expected to assist pathologists in improving diagnostic efficiency and accuracy. In this study, so far as we know, it is the first time to use cell block technology combined with a proposed weakly supervised deep learning model with multiple instance learning method to screen serous adenocarcinoma. The comparative experiments were implemented through 5-fold cross-validation, and the results demonstrated that our proposed model not only achieves state-of-the-art performance under weak supervision while balancing the number of learnable parameters and computational costs and reduces the workload of pathologists but also presents a quantitative and interpretable cellular pathologic scene of serous adenocarcinoma with superior interpretability and strong generalization capability. The performances and features of the model indicate its effectiveness in the rapid screening and diagnosis of serous cavity effusion and its potential in broad clinical application prospects, eg, in precision medical applications. Moreover, the constructed 2 real-world pathologic data sets would be the first public whole slide imaging data sets of serous cavity effusion with adenocarcinoma based on cell block sections, which can help assist colleagues.

Ultrasound Assessment of Pleural Effusions After Orthotopic Pig‐to‐Baboon Cardiac Xenotransplantation

ABSTRACTBackgroundPleural effusions develop frequently after cardiac surgery in humans. Lung ultrasound is an essential non‐invasive tool in the diagnosis and treatment of these effusions. Pleural effusions also develop regularly after preclinical cardiac xenotransplantation experiments. Unlike in the human setting, modern ultrasound devices lack pre‐installed tools for calculating the volume of pleural effusions in baboons. The aim of this study was to analyze ultrasound examinations of pleural effusions after orthotopic pig‐to‐baboon cardiac xenotransplantation experiments in order to develop a formula for calculating the effusion volume based on ultrasound measurements.MethodsHearts from seven genetically modified (GGTA1‐KO, hCD46/hTBM transgenic) juvenile pigs were orthotopically transplanted into male baboons. Postoperatively, the baboons were tested regularly for the development of pleural effusions using ultrasound. When thoracocentesis was required, the drained effusion volume (EV) was compared to ultrasound‐derived calculations using various formulas. These calculations were based on measuring the distance between lung and diaphragm at the effusions’ maximum height (Hmax). Subsequently, the most promising formula was used to describe the interobserver variability between trained and untrained staff members to predict effusion volumes based on ultrasound measurements.ResultsUltrasound measurement correlated very strongly with the absolute EV (r = 0.9156, p &lt; 0.0001), with EV indexed to total body weight (r = 0.9344, p &lt; 0.0001) and with EV indexed to body surface area (BSA) (r = 0.9394, p &lt; 0.0001). The ratio between Hmax and EV increased with total body weight and BSA and also depended on the baboon species. The sonographic measurements taken by an experienced and an inexperienced observer showed only low interobserver variability. A Bland–Altman plot of both observers’ measurements showed an overall bias of –2.39%.ConclusionUltrasound imaging provides a simple and non‐invasive tool for measuring pleural effusion quantity in baboons. This facilitates simple and efficient monitoring even in the hands of untrained personnel and may guide the decision‐making to perform thoracocentesis.

TREATMENT OF EXPERIMENTAL GENERALIZED PURULENT PERITONITIS WITH SILVER NANOPARTICLES AND LOW-FREQUENCY ULTRASOUND

Summary. Generalized purulent peritonitis (GPP) remains one of the most serious complications in abdominal surgery and, in terms of its severity, occupies a leading place among urgent surgical diseases. Sanitation of the abdominal cavity (AC) is the most important stage in the complex treatment of GPP. Low-frequency ultrasound is one of the safe and promising methods of physical antisepsis with many advantages in the sanitation of purulent foci, and silver nanoparticles (AgNPs) have pronounced bactericidal properties against a wide range of multidrug-resistant microorganisms. This study aims to search for new pathogenetically substantiated methods and approaches to treating GPP that provide adequate sanitation of AC and effectively influence the AC microflora in the postoperative and/or interoperative period. Aim. To investigate the effectiveness of treatment of experimental GPP with the combined use of AgNPs and low-frequency US. Materials and methods. The study was performed on an experimental model of GPP in 60 laboratory rats. All test animals were divided into 3 groups: in the first group, planned sanitation of the AC was carried out with low-frequency ultrasound and saline solution, in the second group - with low-frequency ultrasound and SNP solution, in the third, control group – with a 0.05% aqueous solution of chlorhexidine. The number of necessary sanitation, the timing of laparostomy closure, the abdominal cavity index (ACI), the dynamics of systemic endotoxicosis (clinically), the number of complications, mortality, the volume and nature of effusion into the AC, the presence of necrotic tissue and limited purulent foci, changes of the parental and visceral peritoneum, fibrinous layers and intestinal condition was assessed during the treatment. Results and discussion. During the experiment, a significant decrease in the number of necessary sanitation was noted in the AgNPs/US (3.13±0.64) and US (4.63±0.92) groups compared to the control group (6.38±1.6), as well as the timing of laparostomy closure (5.33±1.51) days, (8.33±2.07) days and (11.33±2.94) days, respectively). The difference in ACI was observed starting from day 5: on day 5 in the AgNPs/US group ACI was 9±2.24 and was significantly different from the US group (15±1.58) and the control group (16±2.92); on the seventh day the HPI was, respectively, (5±1.0) in the AgNPs/US group, 12±2.92 in the US group and 15±1.58 in the control group. The use of low-frequency US made it possible to reduce the number of complications in the US and AgNPs/US groups (2 in the AgNPs/US group, 3 in the US group, 14 in the control group) and the mortality rate (35%, 45%, and 60%, respectively). The use of low-frequency US and AgNPs solution contributed to faster and better cleaning of the AC from the purulent peritoneal exudate and fibrin deposition, a reduction in inflammatory manifestations of the visceral and parietal peritoneum, and more rapid normalization of intestinal function. Conclusions. The combined use of AgNPs and low-frequency US leads to a more rapid elimination of purulent-inflammatory processes in the AC, a decrease in the ACI, a reduction in the number of necessary planned sanitation, and the timing of laparostomy closure. Planned sanitation of the AC using low-frequency US and an antiseptic solution of AgNPs helps to reduce the number of complications, the mortality rate and improves the results of treatment of experimental GPP, which allows us to consider the proposed treatment method as promising. Funding. This study was carried out with grant support from the National Research Foundation of Ukraine (project No. 2023.04/0109) and is part of the research work, funded by the Ministry of Education and Science of Ukraine No. 0124U000540.

Ultrasound quantification of pleural effusion volume in supine position: comparison of three model formulae

BackgroundTo investigate the accuracy of three model formulae for ultrasound quantification of pleural effusion (PE) volume in patients in supine position.MethodsA prospective study including 100 patients with thoracentesis and drainage of PE was conducted. Three model formulae (single section model, two section model and multi-section model) were used to calculate the PE volume. The correlation and consistency analyses between calculated volumes derived from three models and actual PE volume were performed.ResultsPE volumes calculated by three models all showed significant linear correlations with actual PE volume in supine position (all p < 0.001). The reliability of multi-section model in predicting PE volume was significantly higher than that of single section model and slightly higher than that of two section model. When compared with actual drainage volume, the intra-class correlation coefficients (ICCs) of single section model, two section model and multi-section model were 0.72, 0.97 and 0.99, respectively. Significant consistency between calculated PE volumes by using two section model and multi-section model existed for full PE volume range (ICC 0.98).ConclusionBased on the convenience and accuracy of ultrasound quantification of PE volume, two section model is recommended for pleural effusion assessment in routine clinic, though different model formulae can be selected according to clinical needs.

Autologous, oncolytic virus-activated killer (VAK) cell therapy to treat malignant pleural and peritoneal effusions.

e20549 Background: OH2 is an attenuated oncolytic Herpes Simplex-2 virus expressing GM-CSF. OH2 replicates only in cancer cells, causing their lysis, which reverses the immunosuppressive tumor microenvironment, leading to tumor regression. OH2 monotherapy is safe and efficacious in phase I-III trials of 300+ patients across several cancer indications. We previously showed that OH2 treated briefly with UV light (UV-OH2) is unable to form plaques yet still able to infect cancer cells and to potently activate human PBMCs, leading to increased antitumor activity in vitro and in animal models. Methods: Translating these findings in humans, 12 stage IV lung cancer patients with malignant pleural or peritoneal effusions were enrolled in an Investigator-Initiated Trial (NCT05565014). Lymphocytes from each patient’s effusions were isolated, incubated in vitro with UV-OH2 for 36-48h, and then re-infused into the patient's pleural or peritoneal cavity. Each patient received 2 cycles of 3 or up to 6 infusions of this Virus Activated Killer (VAK) Autologous Cell Therapy. Results: Effusion volume (EV) measurement and local and whole-body tumor assessments were performed at the beginning and 28 days post VAK treatment. On D28, EV remained stable in 3 patients (SD), whereas 4 of 12 patients recorded a reduction of EV (PR). Notably, subject S004’s PR was maintained for 210 days post-treatment. Evaluation of target lesions per RECIST revealed 4 subjects with PR and 7 with an SD in target lesions. There was no toxicity or treatment-related adverse events. The median patient OS was 384 days (12.8 months), which is up to 4 times the average published OS for stage IV lung cancer with malignant pleural effusions. RNA-Seq analysis indicated increased expression of many T and NK cell effectors and NK cell activating receptors. Importantly, average autologous CD8+ T lymphocytes rose from 53% to 74% in the effusions post VAK-treatment, thereby confirming activation of the patient’s immune system by UV-OH2 (preliminary clinical PoC). Conclusions: In sum, our VAK therapy offers a cost-effective, extremely safe, and patient-friendly autologous treatment that dramatically increases overall survival in patients with essentially no options. Larger scale studies are in the works. Clinical trial information: NCT05565014 .

Hydropericardium in hypothyroidism. Features of the clinic, diagnosis and treatment

Thyroid hormone deficiency negatively affects the state of the cardiovascular system, causing the formation of a «myxedematous heart». The frequency and clinical features of primary hypothyroidism in 84 patients discharged from the endocrinology department of the RCH in 2017-2022 were retrospectively analyzed. Pericardial effusion was registered in 9 people (10.7%). Massive effusion with separation of pericardial leaflets from 30 to 50 mm and the threat of tamponade was in 4 out of 9 patients. Even with a large volume of pericardial effusion, classic symptoms such as shortness of breath, orthopnea, chest pain, and a feeling of fullness were absent or poorly expressed. Differential diagnosis with diseases accompanied by accumulation of fluid in the pericardial cavity was required. Indicators of thyroid status made it possible to associate the hydropericardium with decompensation or hypothyroidism for the first time. Thyroid hormone replacement therapy led to the disappearance of hypothyroidism symptoms and a decrease in the hydropericardium. With a high risk of tamponade in 3 patients, therapy was supplemented with pericardiocentesis. A clinical observation of successful treatment with thyroid hormones in combination with pericardiocentesis of severe newly diagnosed hypothyroidism against the background of autoimmune thyroiditis with massive pericardial effusion is presented.

Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view. Part 2.

In recent years, lung ultrasound (LUS) has developed rapidly, and it is gaining growing popularity in various scenarios. There are constant attempts to introduce it to new fields. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemics. In the first part of this review we discuss lines, signs and pheno-mena, profiles, some applications, and misconceptions. An aim of the second part of the review is mainly to discuss some advanced applications of LUS, including lung elastography, lung spectroscopy, colour and spectral Doppler, contrast-enhanced ultrasound of lung, speckled tracking of pleura, quantification of pulmonary oedema, predicting success of talc pleurodesis, asthma exacerbations, detecting chest wall invasion by tumours, lung biopsy, estimating pleural effusion volume, and predicting mechanical ventilatory weaning outcome. For this purpose, we reviewed literature concerning LUS.

Acute kidney injury in hospitalized patients with nonmalignant pleural effusions: a retrospective cohort study

BackgroundNonmalignant pleural effusion (NMPE) is common and remains a definite health care problem. Pleural effusion was supposed to be a risk factor for acute kidney injury (AKI). Incidence of AKI in NMPE patients and whether there is correlation between the size of effusions and AKI is unknown.ObjectiveTo assess the incidence of AKI in NMPE inpatients and its association with effusion size. Study design and methodWe conducted a retrospective cohort study of inpatients admitted to the Chinese PLA General Hospital with pleural effusion from 2018-2021. All patients with pleural effusions confirmed by chest radiography (CT or X-ray) were included, excluding patients with diagnosis of malignancy, chronic dialysis, end-stage renal disease (ESRD), community-acquired AKI, hospital-acquired AKI before chest radiography, and fewer than two serum creatinine tests during hospitalization. Multivariate logistic regression and LASSO logistic regression models were used to identify risk factors associated with AKI. Subgroup analyses and interaction tests for effusion volume were performed adjusted for the variables selected by LASSO. Causal mediation analysis was used to estimate the mediating effect of heart failure, pneumonia, and eGFR < 60 ml/min/1.73m2 on AKI through effusion volume. ResultsNMPE was present in 7.8% of internal medicine inpatients. Of the 3047 patients included, 360 (11.8%) developed AKI during hospitalization. After adjustment by covariates selected by LASSO, moderate and large effusions increased the risk of AKI compared with small effusions (moderate: OR 1.47, 95%CI 1.11-1.94 p = 0.006; large: OR 1.86, 95%CI 1.05-3.20 p = 0.028). No significant modification effect was observed among age, gender, diabetes, bilateral effusions, and eGFR. Volume of effusions mediated 6.8% (p = 0.005), 4.0% (p = 0.046) and 4.6% (p < 0.001) of the effect of heart failure, pneumonia and low eGFR on the development of AKI respectively. ConclusionThe incidence of AKI is high among NMPE patients. Moderate and large effusion volume is independently associated with AKI compared to small size. The effusion size acts as a mediator in heart failure, pneumonia, and eGFR.

A Cross-Sectional Study of Factors Predicting the Duration of the Efficacy of Viscosupplementation in Knee Osteoarthritis.

Background: An advanced radiological stage and obesity are predictive of poorer and shorter responses to viscosupplementation in patients with knee osteoarthritis (OA). Very little is known regarding the impact of other factors such as sport practice, comorbidities, or anatomical features of OA. Methods: This study aimed to investigate patients' and OA characteristics associated with the duration of the effectiveness (DE) of viscosupplementation in patients with knee OA. It was a cross-sectional, single-centre clinical trial in patients with knee OA treated with intra-articular (IA) hyaluronic acid (HA) injection(s) within the previous 3 years. The investigators collected data regarding demographic and radiographic features (Kellgren-Lawrence grade and involved knee compartments), dosing regimen (single or repeat injections), the presence and volume of joint effusion, previous or concomitant IA corticosteroid injection, the number of previous viscosupplementations, and comorbidities. Patients completed a questionnaire including the self-assessment of DE (the number of weeks during which viscosupplementation was effective on symptoms), the activity level (sedentary, active, or athletic), and the level of sport activity (light, moderate, or intensive). Predictors of the DE were studied in bivariate and multivariate analyses. Results: In total, 105 patients (149 knees) were analysed (62% women, mean age 66.1 ± 13.2 years, mean BMI 27.5 ± 7.5 kg/m2). The mean DE was 48.2 ± 24.8 weeks. In bivariate analysis, the predictors of a shorter DE were BMI > 27.5 kg/m2, more than three previous viscosupplementations, Kellgren-Lawrence grade 4, sedentary patients, and multicompartmental involvement. In the multivariate analysis, four independent factors remained associated with a shorter DE: BMI > 27.5 kg/m2, multicompartmental knee involvement, number of viscosupplementations >3, and sedentary lifestyle. A statistically significant association between a longer DE and arterial hypertension was found, suggesting a beneficial effect of certain antihypertensive medications. Conclusions: This study confirms that being overweight significantly reduces the duration of the effectiveness of viscosupplementation. It also shows that viscosupplementation is more lastingly effective in unicompartmental OA and among active or athletic patients. The duration of effectiveness decreases when the treatment is repeated more than three times.

OMERACT validation of a deep learning algorithm for automated absolute quantification of knee joint effusion versus manual semi-quantitative assessment

ObjectiveTo begin evaluating deep learning (DL)-automated quantification of knee joint effusion-synovitis via the OMERACT filter. MethodsA DL algorithm previously trained on Osteoarthritis Initiative (OAI) knee MRI automatically quantified effusion volume in MRI of 53 OAI subjects, which were also scored semi-quantitatively via KIMRISS and MOAKS by 2–6 readers. ResultsDL-measured knee effusion correlated significantly with experts’ assessments (Kendall's tau 0.34–0.43) ConclusionThe close correlation of automated DL knee joint effusion quantification to KIMRISS manual semi-quantitative scoring demonstrated its criterion validity. Further assessments of discrimination and truth vs. clinical outcomes are still needed to fully satisfy OMERACT filter requirements.