{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:43:21Z","timestamp":1790739801140,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pleural infection is life\u2010threatening and increasingly prevalent. In addition to usual care, twice\u2010daily, separate administration of tissue plasminogen activator and deoxyribonuclease (tPA\u2010DNase) reduces radiological pleural opacity with lower surgical referral rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This retrospective cohort study examines the use of once\u2010daily, concurrent administration of tPA\u2010DNase for complex parapneumonic pleural effusion and empyema.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with pleural infection who received intrapleural tPA\u2010DNase between October 2014 and July 2020 at Logan Hospital, where it is given concurrently and once\u2010daily as salvage therapy, were retrospectively identified. Radiographic opacification, inflammatory markers, clinical response and complications were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010one patients were identified. Mean age was 48.8\u2009years (standard deviation [SD], 17.2). Median tPA\u2010DNase administration was 3 (interquartile range [IQR], 2\u20133). Chest x\u2010ray pleural opacity decreased significantly (<jats:italic>P<\/jats:italic> =\u20090.047) from a median of 39.6% (IQR, 28.8\u201365.7%) to 9.7% (IQR, 2.5\u201323.2%), a median relative reduction of 75.5% (IQR, 47.7\u201393.9%). White cell count and C\u2010reactive protein improved significantly (<jats:italic>P<\/jats:italic> =\u20090.002 and <jats:italic>P<\/jats:italic> =\u20090.032, respectively) from a median of 16.3 \u00d7\u200910<jats:sup>9<\/jats:sup>\/L (IQR, 11.8\u201320.6 \u00d7\u200910<jats:sup>9<\/jats:sup>\/L) to 9.9 \u00d7\u200910<jats:sup>9<\/jats:sup>\/L (IQR, 8.0\u201312.3 \u00d7\u200910<jats:sup>9<\/jats:sup>\/L) and 311.0 mg\/L (IQR, 218.8\u2013374.0 mg\/L) to 69.0 mg\/L (IQR, 36.0\u2013118.0 mg\/L), respectively. No patients experienced significant bleeding or died. Five patients (16.1%) were referred for surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is pilot evidence that a practical regimen of concurrent, once\u2010daily intrapleural tPA\u2010DNase improved pleural opacification and inflammatory markers without bleeding or mortality. The surgical referral rate was higher than in studies assessing twice\u2010daily administration, though the validity of this outcome as a measure of treatment success is limited, and further studies are needed to assess the optimal dose and frequency of intrapleural therapy and indications for surgical referral.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.16084","type":"journal-article","created":{"date-parts":[[2023,4,8]],"date-time":"2023-04-08T20:43:42Z","timestamp":1680986622000},"page":"2313-2318","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Intrapleural tissue plasminogen activator and deoxyribonuclease administered concurrently and once daily for complex parapneumonic pleural effusion and empyema"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8134-8812","authenticated-orcid":false,"given":"Dugal","family":"Smith","sequence":"first","affiliation":[{"name":"Respiratory Department Logan Hospital  Logan City Queensland Australia"},{"name":"School of Medicine and Dentistry Griffith University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Shaw","sequence":"additional","affiliation":[{"name":"Respiratory Department Logan Hospital  Logan City Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Ryder","sequence":"additional","affiliation":[{"name":"Respiratory Department Logan Hospital  Logan City Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/89.4.285"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.09.038"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012740"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.117.6.1728"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1334486"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201602-127OC"},{"key":"e_1_2_7_8_1","first-page":"999","article-title":"Intrapleural tissue plasminogen activator and deoxyribonuclease therapy for pleural infection","volume":"7","author":"Piccolo F","year":"2015","journal-title":"J Thorac Dis"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0000000000000334"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2022.06.008"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201711-848PS"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201609-673OC"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.14261"},{"key":"e_1_2_7_14_1","article-title":"Rethinking the doses of tissue plasminogen activator and deoxyribonuclease administrated concurrently for intrapleural therapy for complicated pleural effusion and empyema","volume":"10","author":"Innabi A","year":"2018","journal-title":"Cureus"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000443334"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-020-05210-2"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0000000000000461"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01204.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-21-1083"},{"key":"e_1_2_7_20_1","unstructured":"Australian Bureau of Statistics.2021 Logan Census All persons QuickStats. ABS; 2021."}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.16084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T06:18:28Z","timestamp":1704521908000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.16084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":19,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1111\/imj.16084"],"URL":"https:\/\/doi.org\/10.1111\/imj.16084","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,26]]},"assertion":[{"value":"2022-11-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}