Current Challenges and Advances in Pleural Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 20 June 2024 | Viewed by 6214

Special Issue Editors


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Guest Editor
Division of Pulmonology, Sant'Anna Hospital of Como, University of Insubria, Varese, Italy
Interests: pleural diseases; interstitial lung diseases; severe asthma

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Guest Editor
Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA
Interests: interventional pulmonology, pleural diseases

Special Issue Information

Dear Colleagues,

We are pleased to introduce a Special Issue on pleural disease. Respiratory physicians, as well as many other healthcare professionals (e.g., surgeons, internists, oncologists, and infectious diseases specialists), frequently face pleural disorders during their career. They include simple or complicated pleural effusions, pneumothorax, and primary or secondary neoplasms.

Pleural effusion is the most common manifestation of pleural disease and can be due to a wide range of underlying disorders, including cardiovascular and liver diseases, pulmonary infections, malignancies, and systemic inflammatory pathologies.

Identification of the cause is essential to ensure the best treatment and provide prognostic indications.

In recent years, pleural effusion has aroused growing interest in the scientific community. The diagnostic approaches are faster and more accurate, as well as more applicable in most clinical contexts.

More and more therapeutic options are available in the management of pleural effusion and further progress can be expected in the near future regarding interventional techniques and intrapleural treatments to achieve fibrinolysis or pleurodesis.

However, there are still gaps to fill. Current microbiological investigations are negative in many pleural effusions due to tuberculosis or other infections, requiring additional studies and interventions. Integrated scores, including chest ultrasound findings, should be considered to determine the appropriateness of early medical thoracoscopy.

Comparisons should also be made between medical thoracoscopy and video-assisted thoracic surgery in terms of outcomes and complications obtained in different pleural pathologies.

Some pleural effusions remain idiopathic despite all diagnostic efforts and only follow-up clarifies the underlying pathology. Since this is sometimes malignant, reliable predictors are desirable.

Finally, in some circumstances, pleural fluid is evacuated with palliative intent and further evidence could help to understand when discomfort and risks of procedures (thoracentesis, chest tube, pleurodesis, and indwelling catheter) outweigh the benefit to the patient's symptoms.

Original articles and reviews on the diagnosis and management of pleural diseases are welcome in this Special Issue.

Dr. Claudio Sorino
Prof. Dr. David Feller-Kopman
Guest Editors

Manuscript Submission Information

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Keywords

  • pleural effusion
  • thoracoscopy
  • chest tube
  • thoracentesis
  • pleurodesis
  • thoracic ultrasound
  • pneumothorax
  • malignant pleural mesothelioma
  • chylothorax
  • hydrothorax

Published Papers (3 papers)

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Research

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8 pages, 1610 KiB  
Article
Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery
by Wongi Woo, Bong Jun Kim, Duk Hwan Moon, Du-young Kang, Sungsoo Lee and Tae Yun Oh
J. Clin. Med. 2023, 12(11), 3705; https://doi.org/10.3390/jcm12113705 - 27 May 2023
Cited by 1 | Viewed by 1049
Abstract
Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after [...] Read more.
Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome. Full article
(This article belongs to the Special Issue Current Challenges and Advances in Pleural Disease)
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Review

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21 pages, 691 KiB  
Review
Pleural Mesothelioma: Advances in Blood and Pleural Biomarkers
by Claudio Sorino, Michele Mondoni, Giampietro Marchetti, Sergio Agati, Riccardo Inchingolo, Federico Mei, Sara Flamini, Filippo Lococo and David Feller-Kopman
J. Clin. Med. 2023, 12(22), 7006; https://doi.org/10.3390/jcm12227006 - 9 Nov 2023
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Abstract
Pleural mesothelioma (PM) is a type of cancer that is highly related to exposure to asbestos fibers. It shows aggressive behavior, and the current therapeutic approaches are usually insufficient to change the poor prognosis. Moreover, apart from staging and histological classification, there are [...] Read more.
Pleural mesothelioma (PM) is a type of cancer that is highly related to exposure to asbestos fibers. It shows aggressive behavior, and the current therapeutic approaches are usually insufficient to change the poor prognosis. Moreover, apart from staging and histological classification, there are no validated predictors of its response to treatment or its long-term outcomes. Numerous studies have investigated minimally invasive biomarkers in pleural fluid or blood to aid in earlier diagnosis and prognostic assessment of PM. The most studied marker in pleural effusion is mesothelin, which exhibits good specificity but low sensitivity, especially for non-epithelioid PM. Other biomarkers found in pleural fluid include fibulin-3, hyaluronan, microRNAs, and CYFRA-21.1, which have lower diagnostic capabilities but provide prognostic information and have potential roles as therapeutic targets. Serum is the most investigated matrix for biomarkers of PM. Several serum biomarkers in PM have been studied, with mesothelin, osteopontin, and fibulin-3 being the most often tested. A soluble mesothelin-related peptide (SMRP) is the only FDA-approved biomarker in patients with suspected mesothelioma. With different serum and pleural fluid cut-offs, it provides useful information on the diagnosis, prognosis, follow-up, and response to therapy in epithelioid PM. Panels combining different markers and proteomics technologies show promise in terms of improving clinical performance in the diagnosis and monitoring of mesothelioma patients. However, there is still no evidence that early detection can improve the treatment outcomes of PM patients. Full article
(This article belongs to the Special Issue Current Challenges and Advances in Pleural Disease)
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Other

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8 pages, 487 KiB  
Brief Report
Reducing Post-Operative Alveolo-Pleural Fistula by Applying PGA-Sheets (Neoveil) after Major Lung Resection: A Historical Case-Control Study
by Carolina Sassorossi, Maria Teresa Congedo, Dania Nachira, Diomira Tabacco, Marco Chiappetta, Jessica Evangelista, Adele di Gioia, Velia Di Resta, Claudio Sorino, Michele Mondoni, Fausto Leoncini, Giuseppe Calabrese, Antonio Giulio Napolitano, Adriana Nocera, Achille Lococo, Stefano Margaritora and Filippo Lococo
J. Clin. Med. 2023, 12(7), 2719; https://doi.org/10.3390/jcm12072719 - 5 Apr 2023
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Abstract
Alveolo-pleural fistula remains a serious post-operative complication in lung cancer patients after surgery, which is associated with prolonged hospital stay and higher healthcare costs. The aim of this study is to evaluate the efficacy of a polyglycol acid (PGA)-sheet known as Neoveil in [...] Read more.
Alveolo-pleural fistula remains a serious post-operative complication in lung cancer patients after surgery, which is associated with prolonged hospital stay and higher healthcare costs. The aim of this study is to evaluate the efficacy of a polyglycol acid (PGA)-sheet known as Neoveil in preventing post-operative air-leak in cases of detected intra-operative air-leak after lung resection. Between 11/2021 and 7/2022, a total of 329 non-small cell lung cancer (NSCLC) patients were surgically treated in two institutions. Major lung resections were performed in 251 cases. Among them, 44 patients with significant intra-operative air-leak at surgery were treated by reinforcing staple lines with Neoveil (study group). On the other hand, a historical group (selected by propensity score matched analysis) consisting of 44 lung cancer patients with significant intra-operative air leak treated by methods other than the application of sealant patches were considered as the control group. The presence of prolonged air-leak (primary endpoint), pleural drainage duration, hospital stay, and post-operative complication rates were evaluated. The results showed that prolonged air-leak (>5 days after surgery) was not observed in study group, while this event occurred in four patients (9.1%) in the control group. Additionally, a substantial reduction (despite not statistically significant) in the chest tube removal was noted in the study group with respect to the control group (3.5 vs. 4.5, p = 0.189). In addition, a significant decrease in hospital stay (4 vs. 6 days, p = 0.045) and a reduction in post-operative complications (2 vs. 10, p = 0.015) were observed in the study group when compared with the control group. Therefore, in cases associated with intra-operative air-leak after major lung resection, Neoveil was considered a safer and more effective aerostatic tool and represents a viable option during surgical procedures. Full article
(This article belongs to the Special Issue Current Challenges and Advances in Pleural Disease)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

1. Recent Advances and Persistent Challenges in Medical Thoracoscopy for Managing Infected Pleural Spaces

2. New perspectives for the treatment of Malignant Pleural Mesothelioma

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