J Formos Med Assoc
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To investigate the association of skeletal muscle mass and quality with survival outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with lenvatinib (LEN). ⋯ LSMM and myosteatosis are independent prognostic factors for PFS and OS in advanced patients with HCC who received LEN and may exert synergistic effects on these survival outcomes.
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Shortened door-to-balloon time (D2B) has been documented to confer cardiovascular benefits for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). However, prolonged myocardial ischemic duration usually negates the beneficial effects due to delayed symptom-to-door time (S2D). In this study, we sought to investigate the joint effect of S2D-D2B in predicting clinical outcomes. ⋯ The reductions of both D2B and S2D were associated with improved mortality rates in STEMI patients receiving PPCI, especially in younger populations. The findings call for community and healthcare system efforts to address these critical time intervals to enhance survival rates in STEMI patients.
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The competency-based Internal Medicine Milestones (IMM) assesses physician training outcomes through six key competencies. This pilot study introduced IMM concepts through an echocardiography report interpretation course for postgraduate students (PGYs) and residents (Rs). We aimed to help young physicians understand and track competency development as they receive cardiovascular training, with a view to expanding IMM usage for all junior physicians. ⋯ The significant post-course scores improvements indicate that the course was taught effectively and the test questions were well-formulated. Course participants showed improvements in IMM scores as they continued clinical training. Our results offer a reference for future curriculum design and competency development for junior physicians in internal medicine.
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Cirrhotic patients with refractory ascites exhibit severe portal hypertension and hemodynamic disturbances. The risks associated modest-volume paracentesis (<5 L) for refractory ascites remains unclear. We aimed to explore the impact of modest-volume paracentesis in refractory ascites. ⋯ Cirrhotic patients with refractory ascites face a high risk of complications from modest-volume paracentesis, even with albumin infusion. Paracentesis ≥3 L increases AKI risks, while higher MELD scores are linked to greater overall complications, leading to poor short-term survival.