Journal of the Formosan Medical Association最新文献

Purpose: To investigate the association of skeletal muscle mass and quality with survival outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with lenvatinib (LEN).

Methods: In this retrospective study, LEN-treated patients with HCC were enrolled. Sarcopenia and myosteatosis were evaluated on the basis of baseline skeletal muscle index and mean muscle attenuation, respectively, on computed tomography at the L3 level. Low skeletal muscle mass (LSMM) was determined on the basis of index value, and bioinformatics tools were used to determine reliable cutoff values. Myosteatosis was defined on the basis of mean Hounsfield unit values and predefined cutoff values. A logrank test and Cox proportional hazards model were used to compare overall survival (OS) and progression-free survival (PFS).

Results: A total of 81 patients were included. Patients with LSMM exhibited significantly lower PFS (p = 0.003) and OS (p = 0.010) than did patients without LSMM. Patients with myosteatosis exhibited significantly lower PFS (p = 0.012) and OS (p < 0.001) than did patients without myosteatosis. In multivariate analysis adjusted for tumor extent and liver function reserve, LSMM and myosteatosis remained independent predictors of low PFS (p = 0.028, p = 0.031) and OS (p = 0.027, p = 0.001), respectively.

Conclusion: 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.

Background: 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.

Methods: This study retrospectively enrolled 342 consecutive STEMI patients receiving PPCI. The baseline demographic data, clinical features, S2D, D2B, and S2B were compared between survivors and non-survivors. We further analyzed the relationships between mortality rates and S2D/D2B in patients with different age categories.

Results: The receiver-operating characteristic curves analysis revealed D2B time 65. Mins, S2D time 125 min, and S2B time 170 min had the greatest predictive power for mortality rate. Patients with D2B < 65min and S2D time <125 min had the lowest mortality rate (1.62%). Whereas, patients with a D2B ≥ 65 min and S2D ≥ 125 min had the highest mortality rate (21%, P = 0.0004). Multiple variate analyses showed that combined D2B ≥ 65 min and S2D ≥ 125 min was an independent predictor for a higher mortality rate (HR 9.44, P = 0.0111). Shorter S2B time was also associated with a lower mortality rate in overall and younger populations.

Conclusions: 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.

Background: 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.

Methods: Cirrhotic patients with refractory ascites undergoing paracentesis <5 L with albumin infusion were retrospectively enrolled. Patients were categorized into two groups based on the volume of paracentesis: ≥3 L and <3 L. Logistic regression analyses were used to determine risk factors for post-paracentesis complications, while Kaplan-Meier analysis was used to assess 28-day survival rates.

Results: Among 116 patients, 40 (34.5%) experienced post-paracentesis complications within one week, predominantly acute kidney injury (AKI) (19.8%). Twenty patients had paracentesis ≥3 L and 96 patients had <3 L. Overall complications were comparable between two groups (50% vs. 31.3%, p = 0.109), but ≥3 L group had more AKI (40% vs. 15.6%, p = 0.013). Additionally, paracentesis ≥3 L is an independent risk factor for AKI [Odds ratio (OR) = 4.15, p = 0.012], while higher MELD scores (OR = 1.14, p = 0.001) and older age (OR = 1.03, p = 0.047) are risk factors for overall complications. Furthermore, patients with post-paracentesis complications had significantly poorer 28-day survival.

Conclusion: 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.

The coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted long-term care facilities (LTCFs), revealing vulnerabilities due to residents' advanced age, comorbidities, and facility infrastructures. In Taiwan, the Central Epidemic Control Center implemented a range of strategies to protect LTCF residents. These included early containment measures to allow time for preparing pharmaceutical intervention, the establishment of infection prevention and control guidelines, the implementation of comprehensive screening and testing protocols, the prioritization of vaccination for both residents and staff, and the expansion of the national stockpile of oral antiviral agents. Measures also addressed protective personal equipment shortages, staffing challenges, integration between social and healthcare services, and accessibility of oral anti-viral agents. All measures were made and adjusted based on community prevalence, evolving knowledge about the virus, and balancing the negative impacts on LTCF residents. These multifaceted efforts effectively mitigated transmission, maintained essential healthcare services, and supported LTCF staff, demonstrating the critical importance of coordinated, adaptive strategies in managing the impact of COVID-19 on vulnerable populations in LTCFs. By learning from the COVID-19 pandemic, we can develop more effective and resilient responses for managing future epidemics in LTCFs in Taiwan.