Introduction: Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings. Patient concerns: Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps ( Vespa basalis ). Diagnosis: Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings. Interventions: Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17. Outcomes: Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2. Conclusion: In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.

Background Antiangiogenic therapy is widely used in advanced non-small cell lung cancer (NSCLC) patients. The purpose of this study was to investigate the incidence, risk factors, and outcome of advanced NSCLC patients receiving antiangiogenic therapy with thromboembolic events (TE). Methods This was a retrospective study, which included advanced NSCLC patients receiving antiangiogenic therapy from March 2013 to May 2021 at Taichung Veterans General Hospital. All TE were confirmed by objective image studies. We further categorized TE into disease-related and treatment-related according to the tumor control status when TE occurred. Results A total of 427 patients were included. The overall incidence of TE was 10.1% (n = 43); among these patients, 28 (6.6%) and 15 (3.5%) patients were categorized into disease- and treatment-related TE, respectively. Multivariate analysis suggested that the use of hormone and proteinuria independently predicted a higher TE incidence among patients with disease-related TE (adjusted odds ratio [aOR] 2.79 [95% CI 1.13 = 6.92]; P = 0.027) and treatment-related TE (aOR 4.30 [95% CI 1.13–16.42]; P = 0.033), respectively. As compared with patients without TE, disease-related TE significantly predicted a shorter median overall survival (21.6 vs. 31.4 months, adjusted hazard ratio [aHR] 1.30 [95% CI 1.05–1.61]; P = 0.017), but patients with treatment-related TE had comparable survival time (32.7 vs. 31.4 months; aHR 1.05 [95% CI 0.57–1.61]; P = 0.876). Conclusion Patients receiving antiangiogenic therapy with TE should be further differentiated whether it is treatment- or disease-related, because the two groups had different risk factors and influences on outcome.

Background: Acute respiratory distress syndrome (ARDS) is a common life-threatening condition in critically ill patients. It is also an important public health issue because it can cause substantial mortality and health care burden worldwide. The objective of this study was to investigate the incidence and outcomes of ARDS patients in a medical center in Taiwan. Methods: This was a single center, observational study which analyzed prospectively collected data from adults in 6 ICUs at Taichung Veterans General Hospital in Taiwan from October 1st2018 to September 30th 2019. Patients needing invasive mechanical ventilation and meeting the Berlin definition criteria were included for analysis.Results: A total of 1,788 subjects were screened in 6 adult ICUs and 370 patients fulfilled the criteria of ARDS in the first 24 hours of ICU admission. Among these patients, the incidence of ARDS was 20.8% and the overall hospital mortality rate was 42.2%. The mortality rates of mild, moderate and severe ARDS were 35.9%, 43.9% and 46.5%, respectively. In a multivariate logistic regression model, an increase of 1 cmH2O driving pressure was associated with an 11% increase in the mortality rate (adjusted odds ratio 1.100, 95% confidence interval 1.027- 1.179, p=0.007). Both oxygenation and driving pressure were independently associated with mortality in ARDS. Patients with worse oxygenation and a higher driving pressure had the highest hospital mortality rate (p<0.0001).Conclusions: ARDS is common in the ICU and the mortality rate remains high. Combining oxygenation and respiratory mechanics may better predict the outcomes of these ARDS patients.

Background The long-term outcome is currently a crucial issue in critical care, and we aim to address the association between culture positivity and long-term mortality in critically ill patients. Methods We used the 2015–2019 critical care database at Taichung Veterans General Hospital and Taiwanese nationwide death registration files. Multivariable Cox proportional hazards regression model was conducted to determine hazard ratio (HR) and 95% confidence interval (CI). Results We enrolled 4488 critically ill patients, and the overall mortality was 55.2%. The follow-up duration among survivors was 2.2 ± 1.3 years. We found that 52.6% (2362/4488) of critically ill patients had at least one positive culture during the admission, and the number of patients with positive culture in the blood, respiratory tract and urinary tract were 593, 1831 and 831, respectively. We identified that a positive culture from blood (aHR 1.233; 95% CI 1.104–1.378), respiratory tract (aHR 1.217; 95% CI 1.109–1.364) and urinary tract (aHR 1.230; 95% CI 1.109–1.364) correlated with an increased risk of long-term mortality after adjusting relevant covariates. Conclusions Through linking two databases, we found that positive culture in the blood, respiratory tract and urinary tract during admission correlated with increased long-term overall mortality in critically ill patients.

No abstract