Envenoming by Protobothrops mucrosquamatus and Viridovipera stejnegeri accounts for the majority of venomous snakebites in Taiwan. We conducted a retrospective study to systematically examine the clinical manifestations and responses to antivenom therapy after P. mucrosquamatus and V. stejnegeri envenoming. Information on demographic characteristics, treatments, and systemic/local complications were abstracted from medical charts between 1991 and 2006. One hundred forty-nine patients with P. mucrosquamatus envenoming and 51 with V. stejnegeri envenoming were eligible for the final analysis, and they differed in terms of patient age, bite site, local bruising, proportion of patients needing >/= 3 vials of antivenom, and mean hospital stay. Univariate analysis revealed that P. mucrosquamatus envenoming had a higher risk of developing rhabdomyolysis, cellulitis, necrosis, and skin graft. Our findings suggested that P. mucrosquamatus envenoming was associated with a greater risk of severe clinical events, and monitoring for major clinical complications would be recommended.

Acute mountain sickness (AMS) occurs in up to 25% of unacclimatized persons who ascend to 3000 m and can result in high‐altitude pulmonary edema (HAPE). MicroRNAs (miRs) can regulate gene expression at the post‐transcriptional level. Hypoxia selectively disrupts endothelial tight junction complexes through a hypoxia‐inducible factor‐1α (HIF‐1α)‐dependent mechanism. Though increased HIF‐1α expression is associated with adaptation and protection from AMS development in the early stage of hypoxia, a downstream effector of HIF‐1a, VEGF, can induce overzealous endothelial barrier dysfunction, increase vascular permeability, and ultimately result in HAPE and high‐altitude cerebral edema. We hypothesized that the fine‐tuning of downstream effectors by miRs is paramount for the preservation of endothelial barrier integrity and the prevention of vascular leakage. We found that several miRs were up‐regulated in healthy volunteers who were subjected to a 3100‐m height. By reviewing the literature and using online bioinformatics prediction software, we specifically selected miR‐424 for further investigation because it can modulate both HIF‐1α and VEGF. Hypoxia‐induced miR‐424 overexpression is HIF‐1α dependent, and miR‐424 stabilized HIF‐1α, decreased VEGF expression, and promoted vascular endothelial cadherin phosphorylation. In addition, hypoxia resulted in endothelial barrier dysfunction with increased permeability; miR‐424 thus attenuated hypoxia‐induced endothelial cell senescence and apoptosis. miR‐322 knockout mice were susceptible to hypoxia‐induced pulmonary vascular leakage. miR‐322 mimics improved hypoxia‐induced pulmonary vascular leakage in vivo. We conclude that several miRs were up‐regulated in healthy adult volunteers subjected to hypobaric hypoxemia. miR‐424/322 could modulate the HIF‐1α‐VEGF axis and prevent hypoxia‐induced pulmonary vascular leakage under hypoxic conditions.—Tsai, S.‐H., Huang P.‐H., Tsai, H.‐Y., Hsu, Y.‐J., Chen, Y.‐W., Wang, J.‐C., Chen, Y.‐H., Lin, S.‐J. Roles of the hypoximir microRNA‐424/322 in acute hypoxia and hypoxia‐induced pulmonary vascular leakage. FASEB J. 33, 12565–12575 (2019). http://www.fasebj.org

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Low serum albumin level on ICU admission and high BUN level during ICU stay are two independent risk factors, especially their combination, of PI6M mortality in critically ill elderly patients requiring MV. Furthermore, patients with a reduction in high BUN have a better PI6M survival.

IntroductionFew studies have reported outcomes of lung cancer patients with acute respiratory failure (RF) using noninvasive positive pressure ventilation (NIPPV). The aim of this study was to investigate the prognostic factors in these patients.Materials and methodsThis retrospective observational study included all hospitalized lung cancer patients who received NIPPV for acute RF. It was conducted at a tertiary medical center in Taiwan from 2005 to 2010. The primary outcome was all cause mortality at 28 days after the initiation of NIPPV. Secondary outcomes included all-cause in-hospital mortality, weaning from NIPPV, intubation rate, tracheostomy rate, duration of NIPPV, hospital stay and intensive care unit stay.ResultsThe all-cause mortality rate at day 28 of the enrolled 58 patients was 39.66%. The 90-day and 1-year mortality rates were 63.79% and 86.21%, respectively. NIPPV as the first line therapy for RF had higher 28-day mortality rate than it used for post-extubation RF (57.6% versus 16.0%, p<0.05). Independent predictors of mortality at 28 days were progressive disease or newly diagnosed lung cancer (OR 14.02 95% CI 1.03–191.59, p = 0.048), combined with other organ failure (OR 18.07 95% CI 1.87–172.7, p = 0.012), and NIPPV as the first line therapy for RF (OR 35.37 95% CI 3.30–378.68, p = 0.003).ConclusionLung cancer patients using NIPPV with progressive or newly diagnosed cancer disease, combined with other organ failure, or NIPPV as the first line therapy for respiratory failure have a poor outcome.