Recent Advances in Clinical Practice
Background
Hepatocellular Carcinoma (HCC) is a major health concern:
1. Over 700,000 cases are diagnosed annually
2. One of the leading causes of cancer-related death
3. Main event leading ot deaeth in patients with cirrhosis
Risk Factors:
1. HBV
2. HCV
3. Alcohol-related cirrhosis
4. Non-alcoholic steatohepatitis
5. Smoking
6. Metabolic syndromes?
7. Coffee may diminish risk
Molecular Events: What Have We Learned?
Expectations from the biomedical community for genetic studies:
1. Easily risk-stratify patients
A. Risk for developing HCC
B. Risk for HCC recurrence following "curative: therapy
C. Disease prognostication for existing HCC
2. Identify common and dominant oncogenic pathways
A. Carcinogenesis
B. Invasion and metastases
3. Institute targeted and curative therapies using a personalised medicine approach
星期三, 5月 21, 2014
星期六, 5月 10, 2014
[Taipei 台北] 大安臨江街 Zoca Pizza 佐佧披薩屋 My Number One Place for Pizza in Taipei!
The Venezia Pizza with seafood and my favorite cheese，Mozzarella
Zoca Pizza 佐佧披薩屋
Address: 台北市安和路二段69巷3號 (信義安和站)
Phone: 02 2707 2212
Date: 2014/2
Price: + 10%，around 400~500 per person
Friends' Gathering (3J1K)
Since the start of the internship，our 3J1K group (Jason，Jeffrey，Joey and Kevin) hardly has the opportunity to meet up due to our different rotation schedules。Thus，we planned this date for us to meet up and relax from work。I have read about Zoca pizza from food blogs and thought that pizza is a nice break from eating pork chops，beef noodle soups，chicken drumsticks，and whatever other bentos are out there。Zoca Pizza is prestigious for their wood-fire Italian pizzas and classic Italian desserts。The owner is from Verona，Italy and has been making pizza and desserts since he was a boy。He offers over 40 kinds of different thin crust pizzas on the menu，which is spectacular。In the U.S., we usually get pepperoni，four cheese，supreme deluxe，mushroom or vegetarian。It is interesting to know that there are that many tasty combinations available。
星期五, 5月 02, 2014
OSCE必備影片! 各部位PE快速學習法! Essentials for Physical Examination
A very useful website for learning physical examination techniques! Thank you Geeky Medics!
https://www.youtube.com/user/geekymedics123
OSCE on Sunday and on duty Saturday...EEEKS! :(
https://www.youtube.com/user/geekymedics123
OSCE on Sunday and on duty Saturday...EEEKS! :(
星期三, 4月 30, 2014
14 Tips I Wished I Knew In High School, But Hey, It is Not Too Late Now!!
1. Start saving for retirement
2. Take care of your body now!
3. Learn to manage and balance your time. Do not put things off for later
4. Figure out who you really are and become independent early
5. Travel as much as you can, remember that a larger world exists beyond your doorstep. Do not buckled down!
6. Pursue passion, not money
7. Ignore the voice that tells you to give up
8. Accept your mistakes and learn from them
9. You cannot have everything. Focus on doing one or two things very well
10. Overcome complacence! You must continue to grow and develop yourself
11. Nobody knows what they are doing or if they are doing the right thing. Take risks! 不要當乖乖牌!!!
12. Get as much education as possible, be it in the classroom or not
13. Do not spend time with people who do not treat you well, and be good to the people you care about. Invest in Your Family, do not wait until it is too late!
14. Put down your smartphone. Save some time to think for yourself
星期六, 3月 22, 2014
Extracorporeal Membrane Oxygenation (ECMO) Current Use and Evolving Applications
Introduction
1. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for severe forms of respiratory failure.
2. Indications of ECMO have expanded beyond acute respiratory distress syndrome (ARDS) to include bridging therapy for pulmonary hypertensive crises, lung transplantations, and refractory hypoxemic/hypercarbic respiratory failure
Principles and Circuitry
1. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for severe forms of respiratory failure.
2. Indications of ECMO have expanded beyond acute respiratory distress syndrome (ARDS) to include bridging therapy for pulmonary hypertensive crises, lung transplantations, and refractory hypoxemic/hypercarbic respiratory failure
Principles and Circuitry
N
Engl J Med 2011; 365:1905-1914
星期五, 3月 07, 2014
Daily Fluids and Nutrition
Fluid Management
1. Total body water (TBW): 60% of lean body weight in men, 50% in women
A. 2/3 Intracellular fluid (ICF), 1/3 Extracellular fluid (ECF)
B. TBW: 0.6 x W = X
C. Intravascular compartment: 1/4 x ECF = Y
D. Interstitial compartment: 3/4 x ECF = Z
2. Disturbances in TBW change serum osmalality and electrolyte concentrations. Majority of water contained in intracellular space, the loss of water alone does not typically result in hemodynamic changes.
3. Total body Na+: 85~90% of total body Na+ is extracellular, and constitutes predominate solute in ECF. Changes lead to contraction or expansion of ECF, manifests as volume depletion or expansion.
4. Maintenance fluids:
A. Minimum water requirements for daily fluid balance = U/O + Stool water loss + insensible losses + drain losses
a. Minimum urine output necessary = solute per day/(maximum amount of solute that can be excreted/L urine)
1) ~600 - 800 mOsm/d / 1, 200 mOsm/L in healthy kidneys = > 0.5 L/d
b. Water loss in stool ~ 200 mL/d
c. Insensible water losses:
1) Skin + respiratory tract: ~400 - 500 mL/d
2) Endogenous metabolism: ~250 - 350 mL/d
B. Total: 1400 mL/d or 60 mL/hr
C. 75 - 175 mEq Na+/d (2 g Na+ diet gives 86 mEq Na+/d)
a. 0.9%: 154 mEq/L
b. 0.45% 77 mEq/L
D. 20 - 60 mEq K+/d for normal renal function
E. 100 - 150 g/d dextrose given to minimize protein catabolism and prevent starvation keotacidosis
a. D5W 50 g dextrose/L
1. Total body water (TBW): 60% of lean body weight in men, 50% in women
A. 2/3 Intracellular fluid (ICF), 1/3 Extracellular fluid (ECF)
B. TBW: 0.6 x W = X
C. Intravascular compartment: 1/4 x ECF = Y
D. Interstitial compartment: 3/4 x ECF = Z
2. Disturbances in TBW change serum osmalality and electrolyte concentrations. Majority of water contained in intracellular space, the loss of water alone does not typically result in hemodynamic changes.
3. Total body Na+: 85~90% of total body Na+ is extracellular, and constitutes predominate solute in ECF. Changes lead to contraction or expansion of ECF, manifests as volume depletion or expansion.
4. Maintenance fluids:
A. Minimum water requirements for daily fluid balance = U/O + Stool water loss + insensible losses + drain losses
a. Minimum urine output necessary = solute per day/(maximum amount of solute that can be excreted/L urine)
1) ~600 - 800 mOsm/d / 1, 200 mOsm/L in healthy kidneys = > 0.5 L/d
b. Water loss in stool ~ 200 mL/d
c. Insensible water losses:
1) Skin + respiratory tract: ~400 - 500 mL/d
2) Endogenous metabolism: ~250 - 350 mL/d
B. Total: 1400 mL/d or 60 mL/hr
C. 75 - 175 mEq Na+/d (2 g Na+ diet gives 86 mEq Na+/d)
a. 0.9%: 154 mEq/L
b. 0.45% 77 mEq/L
D. 20 - 60 mEq K+/d for normal renal function
E. 100 - 150 g/d dextrose given to minimize protein catabolism and prevent starvation keotacidosis
a. D5W 50 g dextrose/L
星期六, 3月 01, 2014
[Taipei 台北] 忠孝復興 Caldo Cafe 咖朵咖啡 舒芙蕾 抹茶熔岩蛋糕 Soufflé and Matcha Green Tea Molten Lava Cake
Classic Soufflé with Caramel sauce and Mango Sorbet
Caldo Cafe 咖朵咖啡
Address: 台北市大安區復興南路一段107巷5弄2號 (忠孝復興站)
Phone: (02) 2731 8023
Website: https://www.facebook.com/caldocafe
Date: 2014/2/23 11:00 AM
Price: 680 NT + 10% = 748 NT
Father and Son Bonding Time
Dad has been very busy lately so I thought I would take him to a restful environment for him to relax for a bit。Caldo Cafe came to mind, because of the big popularity online。Plus, several colleagues have gone and highly recommend their coffee，souffle and molten lava cake。Once dad informed me that he was coming to Taipei to visit me，I immediately made the reservation。This place will be packed in the afternoon，and there are no time restraints on weekdays，so make sure you make the reservation early，like a couple of days before。
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