The detection of driver gene mutations can determine appropriate treatment strategies for non-small cell lung cancer (NSCLC) by identifying the presence of an effective druggable target. Mutations in the gene encoding the epidermal growth factor receptor (EGFR) are common driver mutations in NSCLC that can be effectively targeted by the use of EGFR tyrosine kinase inhibitors (EGFR-TKIs). However, without the detection of driver mutations, appropriate therapeutic decisions cannot be made. The most commonly applied methods for detecting driver gene mutations are assays based on polymerase chain reaction (PCR). However, the underlying mechanism of PCR-based assays limits the detection of rare mutations. Therefore, patients harboring rare mutations may not receive optimal treatment. We report a heavily-treated patient with NSCLC who harbored a T751_I759delinsN mutation in exon 19 of EGFR that was not detected by real-time PCR but was successfully detected by next-generation sequencing (NGS). The detection of a driver mutation using NGS resulted in the administration of targeted therapy, leading to favorable progression-free survival for the patient. Our report highlights the importance and potential of routine NGS testing among NSCLC patients for whom traditional assays fail to detect driver mutations when determining treatment options.

Background and Objectives: Metabolic perturbations frequently occur during the acute phase of critical illness and may disrupt lipid homeostasis. Acute respiratory distress syndrome (ARDS) is a severe condition and is associated with high mortality in critically ill patients with sepsis. This study aimed to evaluate the association between conventional plasma lipid parameters and clinical outcomes in critically ill sepsis patients. Materials and Methods: We conducted a prospective observational cohort study of critically ill sepsis patients in Taiwan between October 2020 and July 2025. Conventional plasma lipid parameters and clinical variables were measured at intensive care unit admission. Clinical outcomes were compared between patients stratified by plasma HDL-C levels. Results: A total of 285 critically ill patients with sepsis were included. Pneumonia was the presumed source of infection in 91% of patients, and 78% met the criteria for ARDS. The overall hospital mortality rate was 37.9%. Patients with ARDS had significantly higher C-reactive protein (CRP) and interleukin-6 (IL-6) levels, higher risk of organ failure (i.e., APACHE II and SOFA scores), and lower plasma HDL-C levels (all p < 0.05). Non-survivors exhibited significantly greater organ failure severity and lower HDL-C levels compared with survivors (all p < 0.05). Patients with low HDL-C (≤17.5 mg/dL; n = 106, 37.2%) had significantly higher CRP and IL-6, greater organ failure severity, and increased 28-, 60-, 90-day, and hospital mortality, compared with those with high HDL-C (> 17.5 mg/dL; n = 179, 62.8%) (all p < 0.05). In multivariable analyses, lower HDL-C were independently associated with hospital mortality. Conclusions: Lower HDL-C levels were associated with hospital mortality in critically ill patients with sepsis, most of whom had pneumonia and concomitant ARDS. These findings suggest that HDL-C may have prognostic value in this selected critically ill population, although external validation in broader sepsis populations is warranted. An easily accessible and useful for early risk stratification.

Background and Objectives: Metabolic perturbations frequently occur during the acute phase of critical illness and may disrupt lipid homeostasis. Acute respiratory distress syndrome (ARDS) is a severe condition that contributes to multiple organ failure and is associated with high morbidity and mortality in critically ill patients with sepsis. This study aimed to evaluate the association between conventional plasma lipid parameters and clinical outcomes in critically ill sepsis patients. Materials and Methods: We conducted a prospective observational cohort study of critically ill sepsis patients in Taiwan between October 2020 and July 2025. Conventional plasma lipid parameters and clinical variables were measured at intensive care unit (ICU) admission. Clinical outcomes were compared between patients stratified by plasma HDL-C levels. Results: A total of 285 critically ill patients with sepsis were included. The overall all-cause hospital mortality rate was 37.9%. Patients with ARDS had significantly higher C-reactive protein (CRP) and interleukin-6 (IL-6) levels, higher risk of organ failure (i.e., APACHE II and SOFA scores), and lower plasma HDL-C levels (all p < 0.05). Non-survivors exhibited significantly greater organ failure severity and lower HDL-C levels compared with survivors (all p < 0.05). Patients with low HDL-C (≤ 22.5 mg/dL; n = 162, 56.8%) had significantly higher CRP and IL-6, greater organ failure severity, and increased 28-, 60-, 90-day, and hospital mortality, compared with those with high HDL-C (> 22.5 mg/dL; n = 123, 43.2%) (all p < 0.05). In multivariable logistic regression analyses, lower HDL-C were independently associated with hospital mortality. Conclusions: Plasma HDL-C levels at ICU admission are independently associated with hospital mortality in critically ill patients with sepsis. HDL-C may serve as a simple, accessible, and useful for early risk stratification in critically ill patients with sepsis.

Lung-protective mechanical ventilation using lower airway pressures remains a cornerstone of the management of acute respiratory distress syndrome (ARDS). However, positive pressure ventilation may contribute to positive fluid balance, which has been associated with adverse clinical outcomes. We prospectively enrolled patients with ARDS and collected clinical characteristics and mechanical ventilation parameters during the first 3 days after ARDS onset. The associations between airway pressures and cumulative fluid balance (CFB) were evaluated. The analysis included 287 patients with ARDS, and the all-cause hospital mortality rate was 45.6%. Patients were divided into the positive CFB group (n = 173, 60.3%) and the negative CFB group (n = 114, 39.7%). Compared with patients in the negative CFB group, those in the positive CFB group had a higher risk of organ failure, higher white blood cell counts, higher C-reactive protein levels, more severe hypoxemia, higher peak inspiratory pressures (Ppeak), and higher hospital mortality (all p < 0.05). Multivariable logistic regression analysis showed that higher Ppeak was independently associated with increased odds of positive CFB (adjusted OR, 1.076; p = 0.011). These findings highlight the potential relationship between airway pressures and fluid accumulation during mechanical ventilation in patients with ARDS.

Lung-protective mechanical ventilation using lower airway pressures remains a cornerstone of the management of acute respiratory distress syndrome (ARDS). However, positive pressure ventilation may contribute to positive fluid balance, which has been associated with adverse clinical outcomes. We prospectively enrolled patients with ARDS and collected clinical characteristics and mechanical ventilation parameters during the first 3 days after ARDS onset. The associations between airway pressures and cumulative fluid balance (CFB) were evaluated. The analysis included 287 patients with ARDS, and the all-cause hospital mortality rates was 45.6%. Patients were divided into the positive CFB group (n = 173, 60.3%) and the negative CFB group (n = 114, 39.7%). Compared with patients in the negative CFB group, those in the positive CFB group had a higher risk of organ failure, higher white blood cell counts, higher C-reactive protein levels, more severe hypoxemia, higher peak inspiratory pressures (Ppeak), and higher hospital mortality (all p < 0.05). Multivariable logistic regression analysis showed that higher Ppeak was independently associated with increased odds of positive CFB (adjusted OR, 1.076; p = 0.011). These findings highlight the potential relationship between airway pressures and fluid accumulation during mechanical ventilation in patients with ARDS.