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Management of Indwelling Tunneled Pleural Catheters: A Modified Delphi Consensus Statement
Gilbert, Christopher R; Wahidi, Momen M; Light, Richard W; Rivera, M Patricia; Sterman, Daniel H; Thomas, Rajesh; Shojaee, Samira; Shoham, Shmuel; Psallidas, Ionnis; Ost, David E; Molena, Daniela; Maskell, Nick; Maldonado, Fabien; Liberman, Moishe; Lee, Y C Gary; Lee, Hans; Herth, Felix Jf; Grosu, Horiana; Gorden, Jed A; Fysh, Edward Th; Corcoran, John P; Argento, A Christine; Akulian, Jason A; Rahman, Najib M; Yarmus, Lonny B
BACKGROUND:The management of recurrent pleural effusions remains a challenging issue for clinicians. Advances in management have led to increased use of indwelling tunneled pleural catheters (IPC) due to their effectiveness and ease of outpatient placement. However, with the increase in IPC placement there have also been increasing reports of complications, including infections. Currently there is minimal guidance in IPC related management issues after placement. RESEARCH QUESTION/OBJECTIVE:Our objective was to formulate clinical consensus statements related to perioperative and long-term IPC catheter management based on a modified Delphi process from experts in pleural disease management. STUDY DESIGN/METHODS:and Methods: Expert panel members utilized a modified Delphi process to reach consensus on common perioperative and long-term management options related to IPC use. Members were identified from multiple countries, specialties, and practice settings. A series of meetings and anonymous online surveys were completed. Responses were utilized to formulate consensus statements among panel experts using a modified Delphi process. Consensus was defined a priori as greater than 80% agreement among panel constituents. RESULTS:A total of twenty-five physicians participated in this project. The following topics were addressed during the process: definition of an IPC infection, management of IPC related infectious complications, interventions to prevent IPC infections, IPC related obstruction/malfunction management, assessment of IPC removal, and instructions regarding IPC management by patients and caregivers. Strong consensus was obtained on thirty-six statements. No consensus was obtained on twenty-nine statements. INTERPRETATION/CONCLUSIONS:The management of recurrent pleural disease with IPC remains complex and challenging. This statement offers statements for care in numerous areas related to indwelling tunneled pleural catheter management based on expert consensus, as well as identifying areas that lack consensus. Further studies related to long-term management of IPC are warranted.
PMID: 32561437
ISSN: 1931-3543
CID: 4492532
Value of metalloproteinases in predicting COPD in heavy urban smokers
Tsay, Jun-Chieh J; Hu, Yingjie; Goldberg, Judith D; Wang, Bin; Vijayalekshmy, Soumya; Yie, Ting-An; Bantis, Katrina; Sterman, Daniel H; Rom, William N
BACKGROUND:Emphysema in asymptomatic heavy smokers can be detected during CT-scan screening for lung cancer. Metalloproteinases (MMPs) have been found to play a role in the pathogenesis of chronic obstructive pulmonary disease and to possibly serve as biomarkers for emphysema. METHODS:The NYU Lung Cancer Biomarker Center enrolled study subjects over 50 years of age with lung cancer risk factors from January 1, 2010, to December 31, 2015. These subjects received chest multi-detector computed tomography, spirometry, and provided serum for immunoassays for metalloproteinases (MMP) -1, -2, -7, -9, -10 and tissue inhibitor of metalloproteinases (TIMP) -1 and -2. RESULTS:/FVC percent compared to smokers without emphysema (68 ± 11 (mean ± sd) versus 75 ± 8; p < 0.0001). Increased age and pack-years of smoking were associated with increased odds of emphysema. None of the metalloproteinases or tissue inhibitors of metalloproteinases were useful to predict the presence of emphysema in smokers. CONCLUSION/CONCLUSIONS:/FVC ratio).
PMCID:7465798
PMID: 32878618
ISSN: 1465-993x
CID: 4583382
Clinical Outcomes in Critically Ill Coronavirus Disease 2019 Patients: A Unique New York City Public Hospital Experience
Mukherjee, Vikramjit; Toth, Alexander T; Fenianos, Madelin; Martell, Sarah; Karpel, Hannah C; Postelnicu, Radu; Bhatt, Alok; Deshwal, Himanshu; Kreiger-Benson, Elana; Brill, Kenneth; Goldlust, Sandra; Nair, Sunil; Walsh, B Corbett; Ellenberg, David; Magda, Gabriela; Pradhan, Deepak; Uppal, Amit; Hena, Kerry; Chitkara, Nishay; Alviar, Carlos L; Basavaraj, Ashwin; Luoma, Kelsey; Link, Nathan; Bails, Douglas; Addrizzo-Harris, Doreen; Sterman, Daniel H
To explore demographics, comorbidities, transfers, and mortality in critically ill patients with confirmed severe acute respiratory syndrome coronavirus 2.
PMCID:7437795
PMID: 32885172
ISSN: 2639-8028
CID: 4583592
Bronchoscopic intratumoural therapies for non-small cell lung cancer
DeMaio, Andrew; Sterman, Daniel
The past decade has brought remarkable improvements in the treatment of non-small cell lung cancer (NSCLC) with novel therapies, such as immune checkpoint inhibitors, although response rates remain suboptimal. Direct intratumoural injection of therapeutic agents via bronchoscopic approaches poses the unique ability to directly target the tumour microenvironment and offers several theoretical advantages over systemic delivery including decreased toxicity. Increases in understanding of the tumour microenvironment and cancer immunology have identified many potential options for intratumoural therapy, especially combination immunotherapies. Herein, we review advances in the development of novel bronchoscopic treatments for NSCLC over the past decade with a focus on the potential of intratumoural immunotherapy alone or in combination with systemic treatments.
PMID: 32554757
ISSN: 1600-0617
CID: 4510562
Improving electromagnetic navigation: One nodule at a time [Editorial]
Bessich, Jamie L; Sterman, Daniel H
PMID: 31344764
ISSN: 1440-1843
CID: 3987522
Lung Cancer Survival and Prognosis Is Affected by Lower Airway Oral Commensal Enrichment [Meeting Abstract]
Tsay, J.; Sulaiman, I.; Wu, B.; Gershner, K.; Schluger, R.; Meyn, P.; Li, Y.; Yie, T.; Olsen, E.; Perez, L.; Franca, B.; El-Ashmawy, M.; Li, H.; He, L.; Badri, M.; Morton, J.; Clemente, J.; Shen, N.; Imperato, A.; Scott, A. S.; Bessich, J. L.; Rafeq, S.; Michaud, G. C.; Felner, K.; Sauthoff, H.; Smith, R. L.; Moore, W. H.; Pass, H. I.; Sterman, D. H.; Bonneau, R.; Wong, K.; Papagiannakopoulos, T.; Segal, L. N.
ISI:000556393505233
ISSN: 1073-449x
CID: 4930102
Emerging Treatments for Malignant Pleural Mesothelioma: Where Are We Heading?
Cantini, Luca; Hassan, Raffit; Sterman, Daniel H; Aerts, Joachim G J V
Malignant pleural mesothelioma (MPM) is an uncommon but aggressive and treatment resistant neoplasm with low survival rates. In the last years we assisted to an exponential growth in the appreciation of mesothelioma pathobiology, leading several new treatments to be investigated both in the early stage of the disease and in the advanced setting. In particular, expectations are now high that immunotherapy will have a leading role in the next years. However, caution is required as results from phase II studies in MPM were often not replicated in larger, randomized, phase III trials. In this review, we describe the most promising emerging therapies for the treatment of MPM, discussing the biological rationale underlying their development as well as the issues surrounding clinical trial design and proper selection of patients for every treatment.
PMCID:7080957
PMID: 32226777
ISSN: 2234-943x
CID: 4370012
Mesothelioma: Is chemotherapy alone a thing of the past?
Bibby, A C; Blyth, K G; Sterman, D H; Scherpereel, A
Treatment of mesothelioma is evolving, with recent randomised trial data supporting the addition of bevacizumab to pemetrexed and cisplatin therapy. Single-agent immune checkpoint inhibitors have failed to demonstrate survival benefits in randomised trials; however, using a combination of programmed death receptor/ligand 1 (PD-(L)1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antagonists may be more effective. Use of immunotherapy agents in the front-line setting may also yield better results. Other immunotherapeutic approaches, such as oncolytic viruses and chimeric antigen receptor (CAR) T-cells, are progressing closer to evaluation in full-scale clinical trials, as are targeted agents, particularly those focussed on mesothelin. Arginine deprivation may be effective in patients with poor prognosis, non-epithelioid tumours. It is likely that the next decade will yield substantial progress, and the future of mesothelioma treatment looks more hopeful than it has for decades.
Copyright
EMBASE:2004626517
ISSN: 2312-508x
CID: 4634192
DIAGNOSTIC AND MANAGEMENT CHALLENGES IN A CASE OF INSIDIOUS PNEUMOCYSTIS JIROVECII PNEUMONIA (PCP) WITH RESULTANT FULMINANT LUNG DESTRUCTION IN A NON-HIV IMMUNOCOMPROMISED PATIENT [Meeting Abstract]
Magda, G; Mahmoudi, M; Sterman, D
SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30
EMBASE:2002983300
ISSN: 1931-3543
CID: 4119212
Tumor-draining lymph nodes demonstrate a suppressive immunophenotype in patients with non-small cell lung cancer assessed by endobronchial ultrasound-guided transbronchial needle aspiration: A pilot study
Murthy, Vivek; Katzman, Daniel P; Tsay, Jun-Chieh J; Bessich, Jamie L; Michaud, Gaetane C; Rafeq, Samaan; Minehart, Janna; Mangalick, Keshav; de Lafaille, M A Curotto; Goparaju, Chandra; Pass, Harvey; Sterman, Daniel H
OBJECTIVES/OBJECTIVE:Tumor draining lymph nodes (TDLN) are key sites of early immunoediting in patients with non-small cell lung cancer (NSCLC) and play an important role in generating anti-tumor immunity. Immune suppression in the tumor microenvironment has prognostic implications and may predict therapeutic response. T cell composition of draining lymph nodes may reflect an immunophenotype with similar prognostic potential which could be measured during standard-of-care bronchoscopic assessment. In this study, we compared the immunophenotype from different sites within individuals to primary tumor characteristics in patients with NSCLC to see whether there were tumor-regional differences in immunophenotype which could be evaluated from transbronchial needle aspirates. MATERIALS AND METHODS/METHODS:Twenty patients were enrolled in this study and had tissue (lymph node aspirates and/or peripheral blood) obtained during standard of care bronchoscopy with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for diagnosis or staging of known or suspected NSCLC. Aspirates and blood underwent flow-assisted cell sorting and a subset of sorted effector T cells underwent RNA quantitation to determine feasibility of this approach. Immunophenotypic patterns from twelve patients with paired data from tumor-draining and non-tumor draining lymph nodes (NDLN) were compared relative to one another and based on PD-L1 immunohistochemistry and primary tumor histology. RESULTS: T cell depletion compared to patients with PD-L1 expression <50% (-35.98% vs -1.89%, p = 0.0357; negative values represent absolute difference between paired TDLN and NDLN). CONCLUSIONS:In patients with NSCLC, TDLN have a suppressive immunophenotype correlating with tumor PD-L1 status and can be assessed during routine EBUS-TBNA.
PMID: 31563736
ISSN: 1872-8332
CID: 4115612