Chest
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Prolonging life in the ICU increasingly is possible, so decisions to limit life-sustaining therapies frequently are made and communicated to patients and families or surrogates. Little is known about worldwide communication practices and influencing factors. ⋯ End-of-life communication with patients and families or surrogates varies markedly in different global regions. GEE analysis supports the hypothesis that communication may increase with ethical practice and an advance directive. Greater effort is needed to align treatment with patients' wishes.
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Excessive inflammation is pathogenic in the pneumonitis associated with severe COVID-19. Neutrophils are among the most abundantly present leukocytes in the inflammatory infiltrates and may form neutrophil extracellular traps (NETs) under the local influence of cytokines. NETs constitute a defense mechanism against bacteria, but have also been shown to mediate tissue damage in a number of diseases. ⋯ Abundant neutrophils undergoing NETosis are found in the lungs of patients with fatal COVID-19, but no correlation was found with viral loads. The strong association between NETs and IL-8 points to this chemokine as a potentially causative factor. The function of cytotoxic T-lymphocytes in the immune responses against SARS-CoV-2 may be interfered with by the presence of NETs.
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Observational Study
Pick your threshold: a comparison among different methods of anaerobic threshold evaluation in heart failure prognostic assessment.
In clinical practice, anaerobic threshold (AT) is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). AT of oxygen uptake (V.O2; V.O2AT) has been reported as an absolute value (V.O2ATabs), as a percentage of predicted peak V.O2 (V.O2AT%peak_pred), or as a percentage of observed peak V.O2 (V.O2AT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing. ⋯ In HF, V.O2AT%peak_pred is the best way to report V.O2 at AT in relationship to prognosis, with a prognostic power comparable to that of peak V.O2 and, remarkably, in patients with severe HF.
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Prognostic prediction of nontuberculous mycobacteria pulmonary disease using a deep learning technique has not been attempted. ⋯ The DL model we developed could predict the mid-term to-long-term mortality of patients with nontuberculous mycobacteria pulmonary disease using a baseline radiograph at diagnosis, and the predictability increased with clinical information.
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Previous studies have demonstrated an association between BMI and the development of sarcoidosis. We investigated this association and the association between OSA and the development of sarcoidosis in a US Veterans Health Administration database. ⋯ These findings suggest that increased BMI is not associated positively with a greater odds of sarcoidosis developing. Furthermore, these results suggest that the presence of OSA lowers the odds of sarcoidosis developing.