Seminars in respiratory and critical care medicine最新文献

{"title":"New Markers for Management of Mesothelioma.","authors":"Alistair Nash,&nbsp;Tina Firth Née Phan,&nbsp;Jenette Creaney","doi":"10.1055/s-0043-1769097","DOIUrl":"https://doi.org/10.1055/s-0043-1769097","url":null,"abstract":"<p><p>In this review, we provide an update on the status of cancer biomarkers for the clinical management of pleural mesothelioma, an aggressive cancer associated with asbestos exposure. Mesothelioma can be difficult to diagnose, and response to treatment is transient, even with recently adopted immune checkpoint inhibitor (ICI) combinations. Identification of mesothelioma-specific biomarkers could facilitate early diagnosis and tailor treatment strategies. Mesothelioma is characterized by frequent loss or alteration of the tumor suppressor genes <i>cyclin-dependent kinase inhibitor 2A</i> (<i>CDKN2A</i>) and <i>BRCA1-associated protein-1</i> (<i>BAP1</i>)<i>.</i> Accumulating data show these genes and/or their related protein products will be valuable tissue-based biomarkers for mesothelioma. Loss of BAP1, CDKN2A, p16, or methylthioadenosine phosphorylase provide pathologists with a reliable means of differentiating between mesothelioma and reactive mesothelial cell proliferations. This can aid diagnosis in difficult cases and is requisite for the identification of the new pathological entity malignant mesothelioma in situ. However, limited progress in identifying clinically useful soluble biomarkers in this cancer type has been made, with mesothelin remaining the benchmark. To date, results from studies to identify predictive biomarkers for ICI response have been disappointing. A recent retrospective study demonstrated BAP1 loss was predictive of improved survival following combination pemetrexed- and platinum-based chemotherapy. Validation of this result could have important clinical implications. Clinical trials aimed at targeting therapy based on biomarker expression are generally in the early phase setting, with overall results being moderate. The identification of biomarkers for mesothelioma remains a key research question due to their potential to improve patient outcomes in this deadly cancer.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9794778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Review on Contemporary Management of Common Benign Pleural Effusions.","authors":"José M Porcel","doi":"10.1055/s-0043-1769096","DOIUrl":"https://doi.org/10.1055/s-0043-1769096","url":null,"abstract":"<p><p>Heart failure (HF) and cirrhosis are frequently associated with pleural effusions (PEs). Despite their apparently benign nature, both HF-related effusions and hepatic hydrothorax (HH) have poor prognosis because they represent an advanced stage of the disease. Optimization of medical therapy in these two entities involve not only the use of diuretics, but also other pharmacological therapies. For instance, all HF patients with reduced or mildly reduced left ventricular ejection fraction can benefit from angiotensin receptor-neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Conversely, it is better for HH patients to avoid nonselective beta blockers. Refractory cardiac- and cirrhosis-related PEs are commonly managed by iterative therapeutic thoracentesis. When repeated aspirations are needed, thereby diminishing quality of life, the insertion of an indwelling pleural catheter (IPC) may be warranted. However, in selected HH patients who are diuretic-resistant or diuretic-intractable, placement of transjugular intrahepatic portosystemic shunts should be considered as a bridge to liver transplantation, whereas in transplant candidates the role of IPC is debatable. Another benign condition, pleural tuberculosis (TB) is a serious health problem in developing countries. Diagnostic certainty is still a concern due to the paucibacillary nature of the infection, although the use of more sensitive nucleic acid amplification tests is becoming more widespread. Its treatment is the same as that of pulmonary TB, but the potential drug interactions between antiretroviral and anti-TB drugs in HIV-coinfected patients as well as the current recommended guidelines for the different types of anti-TB drugs resistance should be followed.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breathlessness with Pleural Effusion: What Do We Know?","authors":"Sanjeevan Muruganandan,&nbsp;Eleanor Mishra,&nbsp;Bhajan Singh","doi":"10.1055/s-0043-1769098","DOIUrl":"https://doi.org/10.1055/s-0043-1769098","url":null,"abstract":"<p><p>Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements in breathlessness. Impaired hemidiaphragm function and a compensatory increase in respiratory drive to maintain ventilation appear to be an important mechanism of breathlessness associated with pleural effusion. Thoracocentesis reduces diaphragm distortion and improves its movement; these changes appear to reduce respiratory drive and associated breathlessness by improving the neuromechanical efficiency of the diaphragm.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy.","authors":"Terrence Wong,&nbsp;Alexander D Fuld,&nbsp;David J Feller-Kopman","doi":"10.1055/s-0043-1769092","DOIUrl":"https://doi.org/10.1055/s-0043-1769092","url":null,"abstract":"<p><p>Malignant pleural effusions (MPE) have historically been associated with a poor prognosis, and patients often require a series of invasive procedures and hospitalizations that significantly reduce quality of life at the terminus of life. However, advances in the management of MPE have coincided with the era of immunotherapies, and to a lesser extent, antiangiogenic therapies for the treatment of lung cancer. Landmark studies have shown these drugs to improve overall survival and progression-free survival in patients with lung cancer, but a paucity of phase III trial data exists for the impact of immune checkpoint inhibitors (ICI) on lung cancers associated with MPE. This review will focus on the leading studies investigating the impact of ICI and antiangiogenic therapies in patients with lung cancer and MPE. The diagnostic and prognostic values of vascular endothelial growth factor and endostatin expression levels in malignancy will also be discussed. These advancements are changing the paradigm of MPE management from palliation to treatment for the first time since 1767 when MPE was first reported. The future holds the promise of durable response and extended survival in patients with MPE.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indwelling Pleural Catheter: Management of Complications.","authors":"Calvin Sidhu,&nbsp;Helen E Davies,&nbsp;Sanjeevan Muruganandan,&nbsp;Macy M S Lui,&nbsp;Estee P M Lau,&nbsp;Y C Gary Lee","doi":"10.1055/s-0043-1769093","DOIUrl":"https://doi.org/10.1055/s-0043-1769093","url":null,"abstract":"<p><p>Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion or during drainage of IPC is easily manageable and must be distinguished from tumor-related chest wall pain. IPC-related infections require systemic antibiotics and often intrapleural fibrinolytic/deoxyribonuclease therapy. The removal of IPC for infection is usually unnecessary. Symptomatic loculation usually responds to fibrinolytics but may recur. Catheter tract metastases are common in mesothelioma patients and usually respond to radiotherapy without inducing damages to the IPC. Less common complications include dislodgement, irreversible blockage, and fractures (upon removal) of the catheter. Recommendations on the management of IPC complications by recent consensus statement/guideline are discussed. Expert opinions on management approaches are included in areas where evidence is lacking to guide care.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9792286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Global Burden of Pleural Diseases.","authors":"Erik Vakil,&nbsp;Niloofar Taghizadeh,&nbsp;Alain Tremblay","doi":"10.1055/s-0043-1769614","DOIUrl":"https://doi.org/10.1055/s-0043-1769614","url":null,"abstract":"<p><p>Pleural diseases include a spectrum of disorders broadly categorized into pneumothorax and pleural effusion. They often cause pain, breathlessness, cough, and reduced quality of life. The global burden of diseases reflects regional differences in conditions and exposures associated with pleural disease, such as smoking, pneumonia, tuberculosis, asbestos, cancer, and organ failure. Disease burden in high-income countries is overrepresented given the availability of data and disease burden in lower-income countries is likely underestimated. In the United States, in 2016, there were 42,215 treat-and-discharge visits to the emergency room for pleural diseases and an additional 361,270 hospitalizations, resulting in a national cost of $10.1 billion.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions.","authors":"Eleanor C Barton,&nbsp;Nick A Maskell,&nbsp;Steven P Walker","doi":"10.1055/s-0043-1769615","DOIUrl":"https://doi.org/10.1055/s-0043-1769615","url":null,"abstract":"<p><p>For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothorax, including persistent air leak, and suggest new directions for future research that can help provide patient-centered, evidence-based management for this challenging cohort of patients.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preface: Pleural Diseases Series.","authors":"Y C Gary Lee,&nbsp;Deirdre B Fitzgerald","doi":"10.1055/s-0043-1769613","DOIUrl":"https://doi.org/10.1055/s-0043-1769613","url":null,"abstract":"Pleural diseases affect 3,000 people per million population every year. Despite its prevalence, it is only in the past 20 years that pleuralmedicine has been viewed as a specialty in its own right.1 With that, we have seen an exponential growth in research on its better management. Pleural disease is a centuries-old condition, with Hippocrates writing many landmark papers on pleural infection more than 25 centuries ago. Pleural effusion can be caused by more than 60 pathologies.2 It is a dynamic field as its incidence, diagnosis, and management constantly evolve with advances in medical management of the underlying conditions. In this issue of the Seminars of Respiratory and Critical Care Medicine, we aim to provide important updates on contemporary issues of key aspects of pleural diseases from leading experts around theworld. The enormous global economical and health care burden of pleural diseases are coming to light, as is concisely summarized by Vakil et al.3 New pleural disease entities are also described including pleural complications of COVID-19.4 With new developments of anticancer treatments, clinicians need to keep abreast of their implications on management of the associated malignant pleural effusions. Wong et al outline the impact of immunotherapy and antiangiogenic therapy on malignant effusion management,5 whereas Agrawal et al highlight the emerging intrapleural therapy for controlled of the effusions in pleural malignancies.6 Advances in biomarker discovery in mesothelioma have uncovered new clinical diagnostic tests of which clinicians should be aware.7 Manyof these targetmoleculesmay also have prognostic and therapeutic implications. Through a series of Expert Reviews, we also outline the current debates and controversies on management of spontaneous pneumothorax,8 a subject of pro–con debates in several major respiratory conferences and on advances in the care of parapneumonic effusions.9 Benign pleural effusions remain the most common cause of pleural effusions that clinicians will encounter. Porcel provides a state-ofthe-art review10 on their diagnosis and management. Muruganandan et al highlight the new advances in our understanding of why patients with pleural effusion are breathless, which is of significant interest to clinicians.11 Indwelling pleural catheters (IPCs) are now an established management of recurrent, especially malignant, pleural effusions. The focus of research has shifted from their advantages to how best to manage, or prevent, complications of IPC use.12 Sidhu et al outline the latest clinical guidelines and, where evidence is lacking, the expert opinions onbest care strategies. We trust that this series will equip clinicians with the most up-to-date knowledge on contemporary topics in pleural medicine. These advances in pleural disease will form the foundation of future, much-needed, research in clinical care of various pleural diseases.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Review on Nonsurgical Management of Parapneumonic Effusion: Advances, Controversies, and New Directions.","authors":"Deirdre B Fitzgerald,&nbsp;Eva Polverino,&nbsp;Grant W Waterer","doi":"10.1055/s-0043-1769095","DOIUrl":"https://doi.org/10.1055/s-0043-1769095","url":null,"abstract":"<p><p>Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is the widespread uptake of pneumococcal vaccines, leading to the emergence of nonvaccine-type pneumococci and other bacteria. Early treatment with systemic antibiotics is essential but should be guided by local microbial guidelines and antimicrobial resistance patterns due to significant geographical variation. Thoracic ultrasound has emerged as a leading imaging technique in parapneumonic effusion, enabling physicians to characterize effusions, assess the underlying parenchyma, and safely guide pleural procedures. Drainage decisions remain based on longstanding criteria including the size of the effusion and fluid gram stain and biochemistry results. Small-bore chest drains appear to be as effective as large bore and are adequate for the delivery of intrapleural enzyme therapy (IET), which is now supported by a large body of evidence. The IET dosing regimen used in the UK Multicenter Sepsis Trial -2 has the most evidence available but data surrounding alternative dosing, concurrent and once-daily instillations, and novel fibrinolytic agents are promising. Prognostic scores used in pneumonia (e.g., CURB-65) tend to underestimate mortality in parapneumonic effusion/empyema. Scores specifically based on pleural infection have been developed but require validation in prospective cohorts.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19-Related Pleural Diseases.","authors":"Beenish Iqbal,&nbsp;Najib M Rahman,&nbsp;Rob J Hallifax","doi":"10.1055/s-0043-1769616","DOIUrl":"https://doi.org/10.1055/s-0043-1769616","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19)-related pleural diseases are now well recognized. Since the beginning of the pandemic, increasing cases of pleural diseases including pneumothorax, pneumomediastinum, and pleural effusion with severe COVID-19 infection have attracted the attention of physicians and are not incidental or due to barotrauma. The complicated course of COVID-19 illness highlights the complex pathophysiological underpinnings of pleural complications. The management of patients with pneumothorax and pneumomediastinum is challenging as the majority require assisted ventilation; physicians therefore appear to have a low threshold to intervene. Conversely, pleural effusion cases, although sharing some similar patient characteristics with pneumothorax and pneumomediastinum, are in general managed more conservatively. The evidence suggests that patients with COVID-19-related pleural diseases, either due to air leak or effusion, have more severe disease with a worse prognosis. This implies that prompt recognition of these complications and targeted management are key to improve outcomes.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}