Purpose: Central venous catheter (CVC) insertion is a fundamental skill required for trainees to become proficient. Simulation-based training (SBT) has been shown to improve trainees’ CVC insertion performance effectively. However, implementing a CVC curriculum requires substantial costs and resources. Currently, there is a lack of validated CVC curricula that institutions can adopt as frameworks. This study aimed to evaluate the effectiveness of our institution’s CVC simulation curriculum in improving residents’ confidence and comfort with CVC insertion and management. Materials and Methods: First-year residents (n=118) participated in SBT between 2017 and 2023. Among them, 57 (48%) participants completed surveys before training and 6 months post-training to assess changes in comfort levels across various aspects of CVC insertion. Survey responses were analyzed to evaluate the overall changes in comfort by year and items. Results: Overall comfort increased from 42.1% before training to 81.3% after training (P<0.01), with notable improvements in nonprocedural aspects. Comfort with performing the unsupervised procedure increased by 16.7% (P<0.05) but remained low post-training (29.6%). Conclusion These findings suggest that the curriculum effectively enhances residents’ comfort, particularly in nonprocedural aspects, but only partially prepares them for unsupervised CVC insertions. This indicates a gap in procedural skill acquisition despite the overall positive trends. Implementing a similar CVC curriculum may help institutions reduce CVC insertion-associated complications.

Purpose: Central venous catheter (CVC) insertion is a fundamental skill required for trainees to become proficient. Simulation-based training (SBT) has been shown to improve trainees’ CVC insertion performance effectively. However, implementing a CVC curriculum requires substantial costs and resources. Currently, there is a lack of validated CVC curricula that institutions can adopt as frameworks. This study aimed to evaluate the effectiveness of our institution’s CVC simulation curriculum in improving residents’ confidence and comfort with CVC insertion and management. Materials and Methods: First-year residents (n=118) participated in SBT between 2017 and 2023. Among them, 57 (48%) participants completed surveys before training and 6 months post-training to assess changes in comfort levels across various aspects of CVC insertion. Survey responses were analyzed to evaluate the overall changes in comfort by year and items. Results: Overall comfort increased from 42.1% before training to 81.3% after training (P<0.01), with notable improvements in nonprocedural aspects. Comfort with performing the unsupervised procedure increased by 16.7% (P<0.05) but remained low post-training (29.6%). Conclusion These findings suggest that the curriculum effectively enhances residents’ comfort, particularly in nonprocedural aspects, but only partially prepares them for unsupervised CVC insertions. This indicates a gap in procedural skill acquisition despite the overall positive trends. Implementing a similar CVC curriculum may help institutions reduce CVC insertion-associated complications.

Purpose: Central venous catheter (CVC) insertion is a fundamental skill required for trainees to become proficient. Simulation-based training (SBT) has been shown to improve trainees’ CVC insertion performance effectively. However, implementing a CVC curriculum requires substantial costs and resources. Currently, there is a lack of validated CVC curricula that institutions can adopt as frameworks. This study aimed to evaluate the effectiveness of our institution’s CVC simulation curriculum in improving residents’ confidence and comfort with CVC insertion and management. Materials and Methods: First-year residents (n=118) participated in SBT between 2017 and 2023. Among them, 57 (48%) participants completed surveys before training and 6 months post-training to assess changes in comfort levels across various aspects of CVC insertion. Survey responses were analyzed to evaluate the overall changes in comfort by year and items. Results: Overall comfort increased from 42.1% before training to 81.3% after training (P<0.01), with notable improvements in nonprocedural aspects. Comfort with performing the unsupervised procedure increased by 16.7% (P<0.05) but remained low post-training (29.6%). Conclusion These findings suggest that the curriculum effectively enhances residents’ comfort, particularly in nonprocedural aspects, but only partially prepares them for unsupervised CVC insertions. This indicates a gap in procedural skill acquisition despite the overall positive trends. Implementing a similar CVC curriculum may help institutions reduce CVC insertion-associated complications.

Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.

Purpose: Central venous catheter (CVC) insertion is a fundamental skill required for trainees to become proficient. Simulation-based training (SBT) has been shown to improve trainees’ CVC insertion performance effectively. However, implementing a CVC curriculum requires substantial costs and resources. Currently, there is a lack of validated CVC curricula that institutions can adopt as frameworks. This study aimed to evaluate the effectiveness of our institution’s CVC simulation curriculum in improving residents’ confidence and comfort with CVC insertion and management. Materials and Methods: First-year residents (n=118) participated in SBT between 2017 and 2023. Among them, 57 (48%) participants completed surveys before training and 6 months post-training to assess changes in comfort levels across various aspects of CVC insertion. Survey responses were analyzed to evaluate the overall changes in comfort by year and items. Results: Overall comfort increased from 42.1% before training to 81.3% after training (P<0.01), with notable improvements in nonprocedural aspects. Comfort with performing the unsupervised procedure increased by 16.7% (P<0.05) but remained low post-training (29.6%). Conclusion These findings suggest that the curriculum effectively enhances residents’ comfort, particularly in nonprocedural aspects, but only partially prepares them for unsupervised CVC insertions. This indicates a gap in procedural skill acquisition despite the overall positive trends. Implementing a similar CVC curriculum may help institutions reduce CVC insertion-associated complications.

Purpose: Central venous catheter (CVC) insertion is a fundamental skill required for trainees to become proficient. Simulation-based training (SBT) has been shown to improve trainees’ CVC insertion performance effectively. However, implementing a CVC curriculum requires substantial costs and resources. Currently, there is a lack of validated CVC curricula that institutions can adopt as frameworks. This study aimed to evaluate the effectiveness of our institution’s CVC simulation curriculum in improving residents’ confidence and comfort with CVC insertion and management. Materials and Methods: First-year residents (n=118) participated in SBT between 2017 and 2023. Among them, 57 (48%) participants completed surveys before training and 6 months post-training to assess changes in comfort levels across various aspects of CVC insertion. Survey responses were analyzed to evaluate the overall changes in comfort by year and items. Results: Overall comfort increased from 42.1% before training to 81.3% after training (P<0.01), with notable improvements in nonprocedural aspects. Comfort with performing the unsupervised procedure increased by 16.7% (P<0.05) but remained low post-training (29.6%). Conclusion These findings suggest that the curriculum effectively enhances residents’ comfort, particularly in nonprocedural aspects, but only partially prepares them for unsupervised CVC insertions. This indicates a gap in procedural skill acquisition despite the overall positive trends. Implementing a similar CVC curriculum may help institutions reduce CVC insertion-associated complications.

Background: In non-alcoholic fatty liver disease (NAFLD), transient elastography (TE) is an accurate non-invasive method to identify patients at risk of advanced fibrosis (AF). We developed a diabetes-specific, non-invasive liver fibrosis score based on TE to facilitate AF risk stratification, especially for use in diabetes clinics where TE is not readily available. Methods: Seven hundred sixty-six adults with type 2 diabetes and NAFLD were recruited and randomly divided into a training set (n=534) for the development of diabetes fibrosis score (DFS), and a testing set (n=232) for internal validation. DFS identified patients with AF on TE, defined as liver stiffness (LS) ≥9.6 kPa, based on a clinical model comprising significant determinants of LS with the lowest Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NFS, FIB-4, and APRI), using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (NPV). Results: DFS comprised body mass index, platelet, aspartate aminotransferase, high-density lipoprotein cholesterol, and albuminuria, five routine measurements in standard diabetes care. Derived low and high DFS cut-offs were 0.1 and 0.3, with 90% sensitivity and 90% specificity, respectively. Both cut-offs provided better NPVs of >90% than conventional fibrosis scores. The AUROC of DFS for AF on TE was also higher (P<0.01) than the conventional fibrosis scores, being 0.85 and 0.81 in the training and testing sets, respectively. Conclusion Compared to conventional fibrosis scores, DFS, with a high NPV, more accurately identified diabetes patients at-risk of AF, who need further evaluation by hepatologists.

Cryopreservation impairs sperm quality and functions, including motility and DNA integrity. Antioxidant additives in sperm freezing media have previously brought improvements in postthawed sperm quality. Green tea extract (GTE) is widely considered as an excellent antioxidant, and its beneficial role has been proven in other human cells. This study aims to evaluate the GTE as a potential additive in cryopreservation media of human spermatozoa. In part one, the semen of 20 normozoospermic men was used to optimize the concentration of GTE that maintains sperm motility and DNA integrity against oxidative stress, induced by hydrogen peroxide (H

Background: The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. Methods: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. Results: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. Conclusion Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

Background: The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. Methods: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. Results: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. Conclusion Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.