Risk factors for pleural effusion recurrence in patients with malignancy

BACKGROUND AND OBJECTIVE: The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE. METHODS: Retrospective multicentre cohort study of patients who underwent first thoracentesis was performed. The primary outcome was time to fluid recurrence requiring intervention in patients with evidence of metastatic disease. We used a cause-specific hazard model to identify risk factors associated with fluid recurrence. We also developed a predictive model, utilizing Fine-Gray subdistribution hazard model, and externally validated the model. RESULTS: A total of 988 patients with diagnosed metastatic disease were included. Cumulative incidence of recurrence was high with 30% of patients recurring by day 15. On multivariate analysis, size of the effusion on chest X-ray (up to the top of the cardiac silhouette (hazard ratio (HR): 1.84, 95% CI: 1.21-2.80, P = 0.004) and above the cardiac silhouette (HR: 2.22, 95% CI: 1.43-3.46, P = 0.0004)), larger amount of pleural fluid drained (HR: 1.06, 95% CI: 1.04-1.07, P \u3c 0.0001) and higher pleural fluid LDH (HR: 1.008, 95% CI: 1.004-1.011, P \u3c 0.0001) were associated with increased hazard of recurrence. Negative cytology (HR: 0.52, 95% CI: 0.43-0.64, P \u3c 0.0001) was associated with decreased hazard of recurrence. The model had low prediction accuracy. CONCLUSION: Pleural effusion size, amount of pleural fluid drained, LDH and pleural fluid cytology were found to be risk factors for recurrence

First Experience with the Standard Diagnostics at the European XFEL Injector

International audienceThe injector of the European XFEL is in operation since December 2015. It includes, beside the gun and the accelerating section, containing 1.3 and a 3.9 GHz accelerating module, a variety of standard diagnostics systems specially designed for this facility. With very few exceptions, all types of diagnostics systems are installed in the injector. Therefore the operation of the injector is served to validate and prove the diagnostics characteristics for the complete European XFEL. Most of the standard diagnostics has been available for the start of beam operation and showed the evidence of first beam along the beam line. In the following months the diagnostics has been optimized and used for improvements of beam quality. First operational experiences and results from the standard beam diagnostics in the injector of the European XFEL will be reported in this contribution

First Experience with the Standard Diagnostics at the European XFEL Injector

The injector of the European XFEL started beam operation in December 2015. Besides the gun and the accelerating section, containing a 1.3 and a 3.9 GHz accelerating module, it contains a variety of standard diagnostics systems specially designed for this facility. With very few exceptions, all types of diagnostics systems of the whole XFEL are installed in the injector. Therefore the injector operation allows validating and proving of the diagnostics performances for the entire facility. Most of the standard diagnostics have been available from the very beginning of the beam operation and have been used for the monitoring of the first beam. In the following months the diagnostics have been optimized and used for improvements of beam quality. In this contribution, the first results and the operation experience of the standard beam diagnostics of the European XFEL are reported