The impact of between analytical platform variability on the classification of pleural effusions into exudate or transudate using Light's criteria

Biomarkers and laboratory assessments for monitoring the treatment of patients with paroxysmal nocturnal hemoglobinuria: Differences between terminal and proximal complement inhibition

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening, acquired disease in which blood cells lacking complement regulatory proteins are destroyed because of uncontrolled complement activity. Since 2007, terminal complement inhibitors have revolutionized the treatment of this disease. However, patients treated with these inhibitors can still experience anemia because of C3-mediated extravascular hemolysis and clinically relevant levels of breakthrough or residual intravascular hemolysis. Proximal complement inhibitors, which are only just beginning to emerge, have the potential to address this problem by targeting components of the pathway upstream of C5, thereby protecting patients against both intra- and extravascular hemolysis. In this review, we describe different biomarkers that can be used to monitor complement pathway blockade and discuss key laboratory assessments for evaluating treatment efficacy. We also consider how these assessments are affected by each class of inhibitor and highlight how evolving treatment goals may influence the relative importance of these assessments.

Pleural fluid biochemical analysis: the past, present and future

Identifying the cause of pleural effusion is challenging for pulmonologists. Imaging, biopsy, microbiology and biochemical analyses are routinely used for diagnosing pleural effusion. Among these diagnostic tools, biochemical analyses are promising because they have the advantages of low cost, minimal invasiveness, observer independence and short turn-around time. Here, we reviewed the past, present and future of pleural fluid biochemical analysis. We reviewed the history of Light’s criteria and its modifications and the current status of biomarkers for heart failure, malignant pleural effusion, tuberculosis pleural effusion and parapneumonic pleural effusion. In addition, we anticipate the future of pleural fluid biochemical analysis, including the utility of machine learning, molecular diagnosis and high-throughput technologies. Clinical Chemistry and Laboratory Medicine (CCLM) should address the topic of pleural fluid biochemical analysis in the future to promote specific knowledge in the laboratory professional community.

Value of ultrasonography in determining the nature of pleural effusion: Analysis of 582 cases

To explore the value of ultrasonography in the auxiliary diagnosis of pleural effusion, we retrospectively analyzed the ultrasonographic findings of 275 exudates and 307 transudates and summarized the ultrasonographic image features of pleural effusion according to patients' primary diseases. The findings of thoracic ultrasonography performed before the initial thoracentesis in 582 patients with subsequently confirmed exudative/transudative pleural effusion were analyzed with regard to the sonographic features of pleural effusion. In 275 cases with exudates, thoracic ultrasonography showed a complex septate appearance in 19 cases (6.9%), complex nonseptate appearance in 100 cases (36.4%), complex homogenous sign in 46 cases (16.7%), and pleural thickness > 3 mm in 105 cases. In contrast, in 307 patients with transudates, most patients (97.1%) had bilateral pleural effusion. Ultrasonographic images displayed anechoic appearance and absence of pleural thickening in a vast majority of cases (306, 99.7%; 301, 98%). These positive findings in the exudate were statistically higher than those in their counterparts (P < .05). In the empyema subgroup, the proportion of complex septate appearance, complex nonseptate appearance, complex homogenous sign, and pleural thickening was the highest, at 19/41, 12/41, 10/41, and 30/41, respectively. Ultrasonography is valuable in defining the nature of pleural effusion. Some sonographic features of pleural effusion, such as echogenicity, septation, and pleural thickening, may indicate a high risk of exudative pleural effusion.

Characteristics and factors associated with treatment delay in pleural tuberculosis

BACKGROUND

Current strategies for the prevention, diagnosis and treatment of pleural TB have been inadequate, several challenges and issues related with pleural TB have been reported.

AIM

To summarize the main features of pleural tuberculosis (TB) and determine the risk factors in treatment delay.

DESIGN

Retrospective analysis of hospital records.

METHODS

Consecutive confirmed TB patients with pleural effusion were enrolled in the study. Demographic and epidemiological data were collected from electronic medical records. Treatment delay duration was stratified into two categories: <30 days and ≥30 days. Multivariate logistic regression analysis was used to evaluate risk factors for the delay.

RESULTS

From July 2011 to September 2015, a total of 723 patients were enrolled, 72.1% of patients had pulmonary TB, 8.9% had empyema, 8.9% were multidrug-resistant TB (MDR-TB). Multivariate analysis revealed that MDR-TB (odds ratios (OR) = 2.485, 95% confidence interval (CI) 1.347, 4.587), pulmonary TB (OR = 1.452, 95% CI 1.010, 2.087) and empyema (OR = 4.355, 95% CI 2.185, 8.680) were significant risk factors for treatment delay, while fever (OR= 0.519, 95% CI 0.362, 0.744) as well as pleural protein (≥45 g/l) (OR=0.470, 95% CI 0.332, 0.667) were the protective factors.

CONCLUSION

MDR-TB, pulmonary TB and empyema were significant risk factors for treatment delay, while fever and high pleural protein were protective factors. Tuberculous empyema remains a major problem in China, adequate awareness should be created for the management.