Surgical management of adult hand macrodactyly in a 49-year-old patient:A case report

BACKGROUND Macrodactyly is a rare congenital malformation characterized by an increase in the size of all structures of a digit,accounting for less than 1%of all congenital upper extremity conditions.CASE SUMMARY We report a case involving a 49-year-old woman who presented for the first time with untreated,radial-sided hand macrodactyly.We performed soft tissue debulking,amputation,median nerve neurotomy and coaptation,and carpal tunnel release.At the 6-year follow-up,no significant growth was observed in the bone or soft tissue of the affected area.CONCLUSION Tissue overgrowth in patients with progressive macrodactyly can continue and progress excessively with age.Median nerve neurotomy and coaptation play a crucial role in preventing recurrence of the deformity.

The Clinical Study of a New Management Model Using Mobile Health for Senile Hypertension

Objective: To evaluate a new management model using mobile health for senile hypertension. Methods: This medical service combined traditional medical treatment with Mobile Health. We use it to explore a new and effective model of elderly hypertension management and the most effective and lowest cost management crowd. According to the randomized controlled design of trial, 105 old hypertensive patients participated in the study voluntarily in the Qingdao Municipal Hospital were randomly divided into the experimental group (75 cases) and control group (30 cases). Experimental group is divided into geriatric specialist group (25 cases), general practitioner group (25 cases) and nurse group (25 cases). Blood pressure was administered in experimental (with the new model) and control groups (with the traditional model) for 2 months to compare their blood pressure and the decrease of them. Results: Blood pressure was compared between the two groups before and after administration. The systolic blood pressure (SBP) of experimental group is 162.44 ± 13.970 mmHg before administration. SBP of experimental group is 147.69 ± 13.509 mmHg after administration, the difference is statistically significant (P = 0.000). The diastolic blood pressure (DBP) of experimental group is 91.58 ± 10.822 mmHg before administration. DBP of experimental group is 84.64 ± 10.412 mmHg after administration, P = 0.003. SBP of control group is 159.93 ± 15.238 mmHg before administration. The systolic blood pressure of control group is 152.33 ± 14.115 (mmHg) after administration. P is 0.167 (P > 0.05). The difference was not statistically significant. DBP of control group is 94.73 ± 12.401 (mmHg) before administration. DBP of control group is 90.60 ± 11.115 (mmHg) after administration. P is 0.345 (P > 0.05). The difference was not statistically significant. The decrease of SBP of geriatric specialist group, general practitioner group and nurse group is 18.40 ± 11.764 mmHg, 14.47 ± 9.44 mmHg, 10.80 ± 6.026 mmHg. The difference was not statistically significant (P > 0.05). The decrease of DBP of geriatric specialist group, general practitioner group and nurse group is 9.33 ± 7.451 mmHg vs. 5.33 ± 6.287 mmHg vs. 6.13 ± 5.069 mmHg (P > 0.05). Conclusion: The new model is effective and it works well for controlling blood pressure of elderly hypertensive patients. Especially with the doctors and patients’ families, the management effect has been obviously improved. Medical interventions make the new model more scientific. The management of geriatric specialists, general practitioners and nurses is equally valid.

The Economic Impact of Artificial Intelligence on Healthcare: A Literature Review

Background: This review delves into the effects of artificial intelligence (AI) on healthcare, which is a crucial aspect considering the increasing costs of healthcare worldwide. While there is potential for AI to enhance healthcare delivery and efficiency, there are still uncertainties surrounding its effectiveness, value, and broader adoption. This comprehensive literature review aims to explore and synthesize existing knowledge on the economic impact of AI in healthcare. The primary objective of this review is to understand the potential cost savings and efficiency improvements associated with the deployment of AI in healthcare settings. By highlighting the economic implications of AI, this review seeks to offer insights into the value proposition of investing in AI technologies for stakeholders such as healthcare providers, payers, and policymakers. Methods: To conduct this review, we conducted a search of literature from 2020 to 2023 across three databases: PubMed, Scopus and Google Scholar. We specifically focused on studies that discuss the impacts of AI in healthcare and include cost evaluations, using combinations of keywords related to AI, economics, healthcare, and cost evaluation. The inclusion criteria were studies that conducted some form of economic evaluation related to AI in healthcare settings, while exclusion criteria were studies without a cost evaluation component. Data extraction and quality assessment using the CASP checklist were undertaken on the final set of included studies. Results: After screening studies, we identified 10 out of a total of 28 studies and reports that met our criteria of outlining any form of economic impact and evaluation of AI in healthcare settings. Based on our findings, implementing AI in healthcare could potentially lead to cost savings. Several studies suggest savings ranging from $200 billion to $360 billion in the United States alone. The use of AI in healthcare sectors such as ophthalmology, radiology and disease screening has shown positive economic impacts. Conclusion: While AI has potential for cost savings and efficiency improvements, in healthcare settings, it’s crucial to conduct detailed context specific cost evaluations to optimize the adoption and implementation strategies of AI.

Self-assembly of differentiated dental pulp stem cells facilitates spheroid human dental organoid formation and prevascularization

BACKGROUND The self-assembly of solid organs from stem cells has the potential to greatly expand the applicability of regenerative medicine.Stem cells can self-organise into microsized organ units,partially modelling tissue function and regeneration.Dental pulp organoids have been used to recapitulate the processes of tooth development and related diseases.However,the lack of vasculature limits the utility of dental pulp organoids.AIM To improve survival and aid in recovery after stem cell transplantation,we demonstrated the three-dimensional(3D)self-assembly of adult stem cell-human dental pulp stem cells(hDPSCs)and endothelial cells(ECs)into a novel type of spheroid-shaped dental pulp organoid in vitro under hypoxia and conditioned medium(CM).METHODS During culture,primary hDPSCs were induced to differentiate into ECs by exposing them to a hypoxic environment and CM.The hypoxic pretreated hDPSCs were then mixed with ECs at specific ratios and conditioned in a 3D environment to produce prevascularized dental pulp organoids.The biological characteristics of the organoids were analysed,and the regulatory pathways associated with angiogenesis were studied.RESULTS The combination of these two agents resulted in prevascularized human dental pulp organoids(Vorganoids)that more closely resembled dental pulp tissue in terms of morphology and function.Single-cell RNA sequencing of dental pulp tissue and RNA sequencing of Vorganoids were integrated to analyse key regulatory pathways associated with angiogenesis.The biomarkers forkhead box protein O1 and fibroblast growth factor 2 were identified to be involved in the regulation of Vorganoids.CONCLUSION In this innovative study,we effectively established an in vitro model of Vorganoids and used it to elucidate new mechanisms of angiogenesis during regeneration,facilitating the development of clinical treatment strategies.

The Value of Modern Information Technology in Nursing Emergencies

In first aid, traditional information interchange has numerous shortcomings. For example, delayed information and disorganized departmental communication cause patients to miss out on critical rescue time. Information technology is becoming more and more mature, and as a result, its use across numerous industries is now standard. China is still in the early stages of developing its integration of emergency medical services with modern information technology;despite our progress, there are still numerous obstacles and constraints to overcome. Our goal is to integrate information technology into every aspect of emergency patient care, offering robust assistance for both patient rescue and the efforts of medical personnel. Information may be communicated in a fast, multiple, and effective manner by utilizing modern information technology. This study aims to examine the current state of this field’s development, current issues, and the field’s future course of development.

Efficacy and safety of bamlanivimab in patients with COVID-19:A systematic review and meta-analysis

BACKGROUND Monoclonal antibodies(mAbs)have shown clinical benefits against coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Several studies have reported the use of bamlanivimab as a promising treatment option for COVID-19.AIM To synthesize the latest evidence for the efficacy and safety of bamlanivimab alone in the treatment of adult patients with COVID-19.METHODS A literature search was conducted in PubMed,Cochrane Library,Web of Science,medRxiv,and Google Scholar using“SARS-CoV-2”,“COVID-19”,“LY-CoV555”,and“Bamlanivimab”keywords up to January 25,2023.The quality of included studies was assessed using the Cochrane bias tools.The Comprehensive Meta-Analysis software version 3.0 was used to analyze the data.RESULTS A total of 30 studies involving 47368 patients were included.A significant difference was observed between the bamlanivimab and standard of care/placebo groups in terms of mortality rate[risk ratio(RR)=50,95%confidence interval(CI):0.36-0.70],hospitalization rate(RR=0.51;95%CI:0.39-0.68),and emergency department(ED)visits(RR=0.69;95%CI:0.47-0.99);while the two groups exhibited no significant difference in terms of intensive care unit(ICU)admission(P>0.05).Compared to other mAbs,bamlanivimab was associated with a higher rate of hospitalization(RR=1.44;95%CI:1.07-1.94).However,no significant difference was detected between the bamlanivimab and other mAbs groups in terms of mortality rate,ICU admission,and ED(P>0.05).The incidence of any adverse events was similar between the bamlanivimab and control groups(P>0.05).CONCLUSION Although the results suggest the efficacy and safety of bamlanivimab in COVID-19 patients,further research is required to confirm the efficacy of this drug for the current circulating SARS-CoV-2 variants.

A Study on the Feasibility of Total Quality Management Model and the Awareness and Attitude of the Managers of Health Care

Total Quality Management is not just an admirable phenomenon but it is any client’s right and can be done through contribution of the staff and the managers as well as the client’s of an organization. The purpose of the present study is to investigate the feasibility of TQM model and the attitude of the managers of health field of Yazd medical sciences university towards it. The present study was a descriptive and analytical one which was cross-section ally conducted from 2010 to 2011. The population under study consisted of the managers of the unit of staff vice-chancellor for health and treatment, the managers of health system and centers of cities and also the managers of Yazd’s public hospitals. 64 people were chosen using the formula for calculating the number of samples. A questionnaire with 48 questions was used. The questionnaire’s validity was approved by the faculty members whose major is management and its reliability by using α-cronbach 87%. To analyze the data, the software SPSS V.17 was used. Scoring method was based on likert. The findings of the study show that, considering feasibility of TQM, there is a significant relation between the awareness and attitude of the managers of health and treatment field on one side and the variables, age and University degree, on the other side p = 0.001. Considering binary logistic regression and the results obtained in the form of inter and backward stepwise, the most important factors affecting the feasibility of TQM among the managers of health and treatment field are the level of awareness and attitude with the predicted accuracy 79.3% and 87.9% respectively.

Emergence of taurine as a therapeutic agent for neurological disorders

Taurine is a sulfur-containing,semi-essential amino acid that occurs naturally in the body.It alternates between inflammation and oxidative stress-mediated injury in various disease models.As part of its limiting functions,taurine also modulates endoplasmic reticulum stress,Ca^(2+)homeostasis,and neuronal activity at the molecular level.Taurine effectively protects against a number of neurological disorders,including stro ke,epilepsy,cerebral ischemia,memory dysfunction,and spinal cord injury.Although various therapies are available,effective management of these disorders remains a global challenge.Approximately 30 million people are affected worldwide.The design of taurine fo rmation co uld lead to potential drugs/supplements for the health maintenance and treatment of central nervous system disorders.The general neuroprotective effects of taurine and the various possible underlying mechanisms are discussed in this review.This article is a good resource for understanding the general effects of taurine on various diseases.Given the strong evidence for the neuropharmacological efficacy of taurine in various experimental paradigms,it is concluded that this molecule should be considered and further investigated as a potential candidate for neurotherapeutics,with emphasis on mechanism and clinical studies to determine efficacy.

An Investigation on the Barriers and Facilitators of the Implementation of Electronic Health Records (EHR)

The application of technology in health care, in the form of electronic health records (EHR), is the most important and necessary issue in order to improve the quality of health care, and studies have shown that, not only is it a way to integrate information and represent the condition of patients, and a dynamic source for health care, however it leads to gain access to clinical information and records, electronic communications, comprehensive training and management, and ultimately enhancing the public health;the aim of this study is to investigate the factors influencing the implementation of EHR, which are known as barriers and facilitators. The research is conducted in the form of a review research, and with the help of the Keywords of EHR;barriers and facilitators, articles, from 2008 to 2013, were searched and studied in the Internet-databases. The results of the studies show that the most effective factors include: efficiency, motivation, management, and the participation of end users. Factors such as technical aspects ease of use, available resources, and human resources, have limited effects. And security and privacy, the expected output, lack of time, and workload have relative effects, and also the relation between the patient and clinical staff, has no effects in the process of implementing EHR.

A Comparative Assessment of Patient Safety Culture between Iranian Selected Hospitals and Agency for Healthcare Research and Quality (AHRQ) Report

Establishing a culture of patient safety can be effective in reducing the incidence of medical errors and solving concerns of safety inadequacy in health systems. The purpose of this study was to assess the culture of patient safety in the selected hospitals, and compare the results with published reports of AHRQ. This study was approved by the Ethical Committee of BPUMS. The subjects signed the informed consent form to participle in the study. Confidentiality was maintained throughout the study reports. Cross-sectional study was conducted in 2012;the study sample was composed of 364 staffs working at two selected hospitals affiliated to Bushehr University of Medical Sciences. Hospital Survey on Patient Safety Culture was used to collect data. Descriptive statistical analysis was used to analyze the data. No reports of events in both studied hospitals and benchmark were accounted for the most of the reported errors, although this indicator in studied hospitals was nearly 23% higher than that of the benchmark report. The highest patient safety grade in studied hospitals and benchmark was “acceptable” and “very good”, respectively. The highest percentage of positive response to patient safety dimension was organization learning and then teamwork within units in studied hospitals. Teamwork within units also was the highest average percent in benchmark report. Non-punitive response to errors had the lowest positive percentage of participant responses in both studies. To achieve the patient safety culture, we do not need to blame individual and apply punitive approach when errors occur. This makes person accept responsibility for their actions honestly and report errors in a timely manner to prevent reoccurrence of similar errors.

Zyxin promotes hepatocellular carcinoma progression via the activation of AKT/mTOR signaling pathway

Hepatocellular carcinoma(HCC)is a common malignancy that is driven by multiple genes and pathways.The aim of this study was to investigate the role and specific mechanism of the actin-interacting protein zyxin(ZYX)in HCC.We found that the expression of ZYX was significantly higher in HCC tissues compared to that in normal liver tissues.In addition,overexpression of ZYX in hepatoma cell lines(PLC/PRF/5,HCCLM3)enhanced their proliferation,migration and invasion,whereas ZYX knockdown had the opposite effects(SK HEP-1,Huh-7).Furthermore,the change in the expression levels of ZYX also altered that of proteins related to cell cycle,migration and invasion.Similar results were obtained with xenograft models.The AKT/mTOR signaling pathway is one of the key mediators of cancer development.While ZYX overexpression upregulated the levels of phosphorylated AKT/mTOR proteins,its knockdown had the opposite effect.In addition,the AKT inhibitor MK2206 neutralized the pro-oncogenic effects of ZYX on the HCC cells,whereas the AKT activator SC79 restored the proliferation,migration and invasion of HCC cells with ZYX knockdown.Taken together,ZYX promotes the malignant progression of HCC by activating AKT/mTOR signaling pathway,and is a potential therapeutic target in HCC.

Evaluation of International Standards of Management of Communication and Information Technology (MCIT) in Khorasan Razavi Hospitals from the Perspective of Managers

The general goal of the management of communication and information technology (MCIT) in the health sector, is to accelerate collecting, achieving and supporting the health system processes, and effective decision-making for managing this system;because preparing and providing health care services for society is very complex, and highly dependent on the information system. The aim of this investigation is to determine the mean scores of the possibility of implementing the MCIT standards in Khorasan Razavi hospitals, from the perspective of managers. This was a cross sectional descriptive-analytic study conducted in two steps in all hospitals. In the first step, the applicability of the standards in hospitals was studied. In the second step, the current status of hospitals was compared with international standards MCIT. In order to determine the validity of the questionnaires, opinions of professors and experts were acquired. Regarding the reliability, the SPSS V. 12 calculated the value of Cronbach’s to be 0.95 for the first questionnaire and 0.86 for the second questionnaire. Data were analyzed using statistic tests of one way ANOVA and t-test. The level of significance was fixed at 0.5. In the 16 hospitals studied, the mean and standard deviation of MCIT were (57.25 ± 13.74). The MCIT standards are applicable in hospitals of Khorasan Razavi according to half (49.4%) of managers;nonetheless, their application requires greater efforts by the hospitals.

Self Evaluation in Department of Communicable Diseases, Faculty of Medicine, Tehran University of Medical Sciences

Introduction: Self evaluation is a process that defines and collects required data to judge about decision making issues at educational system on whether the educational department is fit to educate students? The objective of this study was determining the quality of the structural elements of the department of Communicable Diseases & determining the strengths, weaknesses, opportunities and threats to improve the quality of activities in the department under research. Materials and Methods: The employed method was Mixed methods (qualitative & quantitative research), on the basis of 10 procedural steps and within 8 sections dealing with evaluated factors;such as 1) organizational and management structure 2) scientific board members 3) students 4) Manpower 5) Space of educational research and health care 6) Equipment 7) curriculum 8) satisfaction of graduates, which were studied using 61 criteria and 172 indicators. Five-point Likert Scale was used for the responses in the questionnaire (1 - 1.75 = undesirable, to 4.2 - 5 completely desirable). Finally the data were analyzed using descriptive statistics indices and the assessment software of the Educational Development Center of TUMS. The instruments used in this method included assessment software, interview, observation and self-prepared questionnaire which consisted of 7 questionnaires and 2 check lists. Finding: The results of the research showed that general average of 8 investigating sections was 56.9% as a rather desirable research work. Conclusions: Therefore, it was concluded that function of the educational management in that group was directly in line with evaluation process, but continuing the process of evaluation seems necessary.

Evaluation of Comparative Management of Expanded Program Immunization for Children in Iran and in the World

Background: EPI is one of the most cost-effective public health interventions that have already been identified. Mass vaccination is one of the most effective public health strategies that lead to a dramatic reduction in the incidence of many infectious diseases. This is a descriptive study (eco-logical exploratory) where data about the status of routine immunization of children under 6 years in 6 selected countries in terms of the routine immunization programs in each country, the coverage and reported cases of vaccine-preventable diseases from 2006 to 2008 were collected assuming that each country is a representative of a Continent;data about the status of Iran were also collected and a comparative study was performed in the next step. It is worth mentioning that selecting these countries was according to health experts to consolidate the data. Collection tools are data of international (WHO and UNICEF) and national organizations of the above countries. In all countries surveyed, triple vaccine, vaccines of polio, hepatitis B, measles, rubella and mumps are part of the routine immunization program for children under the age of 6 years, with the explanation that in South Africa only measles vaccine is injected instead of measles, rubella and mumps vaccines. The coverage rate of the vaccine and other vaccines in Iran was the best compared to other countries. This represents the widespread activity of health care systems of the country in the field of vaccination and tireless efforts of healthcare workers and health centers.

Female Genital Cut in Relation to Its Value and Health Risks among the Kisii of Western Kenya

Background: The practice of female genital cutting as a cultural obligation is widespread in Kenya but there is little consensus about its effects on health. Some of the health risks associated with female genital cut range from minor and short-term to major and long-term effects including pain, bleeding, infections, and, in the extreme, death. Female genital cut is widespread among the Kisii but there is no adequate information about how it is currently practised and the value people attach to it. Objective: The objective was to establish the value of female genital cut as well as the health risks associated with the practice among the Kisii community of western Kenya. Methods: This was a cross-sectional study, which employed a mixed method approach to generate both quantitative and qualitative data. The quantitative data were obtained from a randomly selected sample of 373 respondents while quantitative data were generated from focus group discussions as well as key informants interviews. Results: The Kisii consider female genital cut a cultural identifier inherited from past generations and whose main value is a rite of passage from girlhood to womanhood. Majority (63%) had heard of the health risks associated with female genital cut including transmission of infections, excessive bleeding and pain. But most of the community did not seem to know the long-term health consequences associated with female genital cut. Even though knowledge on the campaigns to eradicate the practice was found to be wide spread, the community’s response toward the campaigns was less than positive. Conclusions: The authors conclude that female genital cut continues to persist in this community because of its value as a rite of passage, which currently has no substitute. This cultural demand by far outweighs the health risks associated with female genital cut, which are being mitigated through medicalization of the practice. For intervention programmes to succeed a more culturally sensitive campaign that is acceptable or appropriate alternative rite of passage is required.

Patient safety practices and medical errors: Perception of health care providers at Jimma University Specialized Hospital, Southwest Ethiopia

Background: Even though evidences are limited in developing countries, the probability of patients being harmed in hospitals when receiving care might be much greater than that of the industrialized nations. Thus, aim of this study was to assess patient safety practice and the perceived prevalence of medical errors at Jimma University Specialized Hospital, Southwest Ethiopia. Methods: A facility based cross-sectional study was conducted during June, July and August 2010 in Jimma University Specialized Hospital. Patient safety grade and the perceived prevalence of medical errors were computed descriptively. Then, the effect of various independent variables on patient safety grade was assessed using multiple linear regressions analysis. Result: The overall patient safety grade as rated by the participants was excellent (7.2%), very good (20.7%), acceptable (36.0%), poor (30.0%) and failing (6.4%). Complications related to anesthesia occurred sometimes, rarely and never according to 30.8%, 43% and 15.8% of the respondents, respectively. Death in low mortality patients was reported to occur most of the time by 10.4% of the respondents. In addition, failure to rescue, infection due to medical care, postoperative hemorrhage, postoperative sepsis, birth injury to the neonate, obstetric trauma to the mother were reported to happened. Supervisor expectation and actions promoting patient safety (p < 0.001), and communication openness and feedback about errors (p = 0.002) had positive correlation with patient safety grade. Conclusion: this study indicated that poor patient safety practice and potentially preventable medical errors in the hospital.

Going toward Green Hospital by Sustainable Healthcare Waste Management: Segregation, Treatment and Safe Disposal

Hospitals have always been the focal point of social systems identity. Thus, they acte as the mirror of the community and should be responsible for it. Hospitals have been recognized as a significant source of contamination all around the world, therefore helping to endanger public health on an unintentional process. Although, the main mission of the hospital is to promote human health, it cannot be assumed as an island apart from its urban environment. “Green Hospital”, as an approach to address environmental challenges and to meet communities need in health issues, has emerged recently as a try to improve the health, in line with its main mission. In this approach, all the environmental aspects of waste management are important and to be addressed. Hospitals’ administrators can manage wastes disposal through composting, recycling and better supplying methods (downsizing packaging, using reusable products instead of disposables and using recycled products). This article is a review of the subject matter, in nature, using many library and online sources;it discusses about the need to move towards the green hospital approach, the administration and leadership role in its establishment, the environmental impact of hospital operations and assessment of the effects, wastes management and control, and also the methods in wastes disposal and treatment.

A Novel Krill Herd Based Random Forest Algorithm for Monitoring Patient Health

Artificial Intelligence(AI)is finding increasing application in healthcare monitoring.Machine learning systems are utilized for monitoring patient health through the use of IoT sensor,which keep track of the physiological state by way of various health data.Thus,early detection of any disease or derangement can aid doctors in saving patients’lives.However,there are some challenges associated with predicting health status using the common algorithms,such as time requirements,chances of errors,and improper classification.We propose an Artificial Krill Herd based on the Random Forest(AKHRF)technique for monitoring patients’health and eliciting an optimal prescription based on their health status.To begin with,various patient datasets were collected and trained into the system using IoT sensors.As a result,the framework developed includes four processes:preprocessing,feature extraction,classification,and result visibility.Additionally,preprocessing removes errors,noise,and missing values from the dataset,whereas feature extraction extracts the relevant information.Then,in the classification layer,we updated the fitness function of the krill herd to classify the patient’s health status and also generate a prescription.We found that the results fromthe proposed framework are comparable to the results from other state-of-the-art techniques in terms of sensitivity,specificity,Area under the Curve(AUC),accuracy,precision,recall,and F-measure.

Glymphatic function and its influencing factors in different glucose metabolism states

BACKGROUND Dysfunction of the glymphatic system in the brain in different stages of altered glucose metabolism and its influencing factors are not well characterized.AIM To investigate the function of the glymphatic system and its clinical correlates in patients with different glucose metabolism states,the present study employed diffusion tensor imaging along the perivascular space(DTI-ALPS)index.METHODS Sample size was calculated using the pwr package in R software.This crosssectional study enrolled 22 patients with normal glucose metabolism(NGM),20 patients with prediabetes,and 22 patients with type 2 diabetes mellitus(T2DM).A 3.0T magnetic resonance imaging was used to evaluate the function of the glymphatic system.The mini-mental state examination(MMSE)was used to assess general cognitive function.The DTI-ALPS index of bilateral basal ganglia and the mean DTI-ALPS index was calculated.Further,the correlation between DTI-ALPS and clinical features was assessed.RESULTS The left-side,right-side,and mean DTI-ALPS index in the T2DM group were significantly lower than that in the NGM group.The right-side DTI-ALPS and mean DTI-ALPS index in the T2DM group were significantly lower than those in the prediabetes group.DTI-ALPS index lateralization was not observed.The MMSE score in the T2DM group was significantly lower than that in the NGM and prediabetes group.After controlling for sex,the left-side DTI-ALPS and mean DTI-ALPS index in the prediabetes group were positively correlated with 2-hour postprandial blood glucose level;the left-side DTI-ALPS index was negatively correlated with total cholesterol and low-density lipoprotein level.The right-side DTI-ALPS and mean DTI-ALPS index were negatively correlated with the glycosylated hemoglobin level and waist-to-hip ratio in the prediabetes group.The left-side,right-side,and mean DTI-ALPS index in the T2DM group were positively correlated with height.The left-side and mean DTIALPS index in the T2DM group were negatively correlated with high-density lipoprotein levels.CONCLUSION Cerebral glymphatic system dysfunction may mainly occur in the T2DM stage.Various clinical variables were found to affect the DTI-ALPS index in different glucose metabolism states.This study enhances our understanding of the pathophysiology of diabetic brain damage and provides some potential biological evidence for its early diagnosis.

Conversion therapy for unresectable hepatocellular carcinoma:Advances and challenges

Recently,the World Journal of Gastrointestinal Oncology published an article entitled“Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy:A case report and review of the literature”,in which the authors shared their successful experience with complete surgical resection after multidisciplinary conversion therapy.The study by Chu et al demonstrates the great challenges that the advanced hepatocellular carcinoma(HCC)poses to surgical oncology,reveals the complexity of conversion therapy for unresectable HCC,emphasizes the important role of a multidisciplinary management model in conversion therapy,and enriches our understanding of the dynamics of personalized treatment for different patients.At present,conversion therapy is a hot research topic in the treatment of unresectable HCC,which has brought new hope to many patients with moderately advanced HCC.However,there are still many urgent problems to be solved in conversion therapy.Here,we would like to further discuss the advances and challenges of conversion therapy for unresectable HCC with the authors and the general readers.