Journal of thoracic disease
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Hyperlactatemia has long been associated with poor clinical outcome in varieties of intensive care unit (ICU) patients. However, the impact of temporal changes in lactate has not been well established and there are some shortcomings in model building in previous studies. The present study aims to investigate the association of initial lactate and normalization time with hazard by using fractional polynomial Cox proportional hazard model. ⋯ Initial lactate on ICU admission is associated with death hazard and the relationship follows a fractional polynomial pattern with the power of -2 and -1. Delayed normalization of lactate is predictive of high risk of death when it is measured within 150 hours after ICU admission.
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In sepsis, risk assessment is as crucial as early and accurate diagnosis. In this study, we aimed to evaluate the prognostic value of mid-regional proadrenomedullin (MR-proADM) with other scoring systems in severe sepsis and septic shock patients due to community acquired pneumonia (CAP). ⋯ The MR-proADM does not correlate with mortality or disease severity to predict mortality. The combination of SOFA, APACHE II scores, and MR-proADM was efficient to predict prognosis and mortality rate in severe sepsis or septic shock patients.
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Video-assisted thoracoscopic (VATS) biopsy is the gold standard to achieve diagnosis in undetermined interstitial lung disease (ILD). VATS lung biopsy can be performed under thoracic epidural anesthesia (TEA), or more recently under simple intercostal block. Comparative merits of the two procedures were analyzed. ⋯ Uniportal VATS biopsies under intercostal block can provide better intraoperative and postoperative outcomes compared to TEA. They allow the indications for VATS biopsy in patients with undetermined ILD to be extended.