Since its release, ChatGPT, which is a novel artificial intelligence (AI) tool, has become a global phenomenon with its utilization in various fields of life. In particular, ChatGPT has many potential uses in the medical field, and its evidence base is expanding momentously. We thus aimed at synthesizing the evidence on medical applications of ChatGPT. After searching several databases, 4351 articles were initially retrieved, eventually yielding that we retrieved 42 systematic reviews or meta-analyses. The main fields of applications were medical education, medical research, and actual use in clinical practice. Additional areas addressed in the literature focused on ethics issues, using ChatGPT as assistance in medical writing and research, as well as ChatGPT's demonstrated medical knowledge. While these reviews demonstrated the potential transformative role of ChatGPT in the medical field, there were also common areas of concern expressed in the articles. A frequently noted concern was inaccuracy, as well as the risk of hallucination. Other key limitations were limited validity, reliability, and privacy issues. In conclusion, the totality of evidence suggests that ChatGPT can be a valuable tool in the medical field, with favorable applications ranging from generation to dissemination and application of clinical knowledge. However, further refinements are required to ensure that its output can be directly applied to medical activities while protecting patient safety and rights.
Medical journalism is undergoing rapid renewal in a digital environment that accelerates discovery, conversation, and scrutiny across borders. Its purpose extends beyond transmitting facts, aiming to transform evidence into comprehension and comprehension into responsible action for individuals, institutions, and policy. Journalists curate credibility by verifying claims, contextualizing uncertainty, and translating complex study designs, while clinicians expand their societal role by communicating clearly beyond clinical settings. Collaboration between these communities strengthens public understanding and aligns scientific accuracy with narrative clarity, particularly when stakes are high. Ethical foundations remain central: accuracy, independence, transparency, respect for privacy, and avoidance of harm guide reporting choices that shape trust. Interpreting evidence requires attention to design quality, bias, effect size, and clinical relevance, presenting findings in plain language without sensational framing. Healthcare institutions and research centers must also act as reliable anchors within this ecosystem, providing transparent, verifiable data and methodological clarity to support responsible communication. The infodemic challenges all participants, as misinformation spreads quickly through emotionally charged content and algorithmic amplification that reward novelty over truth. Restoring trust calls for humility, timely corrections, consistent messages, and investment in media literacy for citizens and professionals. Artificial intelligence (AI) introduces powerful capabilities for discovery, summarization, personalization, and verification, yet also new risks such as hidden bias and synthetic content. A responsible medical media ecosystem demands shared literacy, collaborative practice, and ethical stewardship today. In this regard, medical communication must increasingly be regarded as a public good, sustained by the joint responsibility of journalists, clinicians, healthcare institutions, and citizens.
Artificial intelligence (AI) has been increasingly integrated into medical publishing, hopefully improving efficiency and accuracy, but serious concerns persist regarding ethical implications, authorship attribution, and content reliability. We aimed at understanding the perspectives of editors of medical journals on AI. A structured online questionnaire was developed and distributed to editors-in-chief of medical journals worldwide. The survey comprised 27 concise questions exploring demographics, journal practices, and perspectives on AI in editorial workflows. Quantitative data were analyzed using descriptive statistics to summarize usage patterns, perceived benefits, risks, and future expectations. A total of 59 editors-in-chief completed the survey (response rate: 19%), with replies suggesting substantial variability in beliefs and attitudes toward AI for publication in medical journals. Artificial intelligence tools were already in use by 49% of journals, mainly for plagiarism detection (76%) and data verification (35%). Only 9% of responders reported that journals used AI for both scientific and linguistic review. Time savings (79%) and cost reduction (43%) were the most commonly cited benefits, and concerns included potential bias (71%) and lack of accountability (60%). Overall, 81% of responders anticipated a major role for AI in publishing within 10 years. Exploratory analyses suggested several potential associations between replies and respondent or journal features, requiring further validation in future surveys. In conclusion, this survey on attitudes toward AI in publication in medical journals suggests that editors-in-chief are cautiously adopting AI in their editorial workflow, supporting its operational use while explicitly calling for clear guidance to address ethical and regulatory concerns.
This systematic review aims to evaluate the efficacy, safety, and tolerability of oral tapentadol in the management of cancer-related pain in adults. It updates the 2015 Cochrane review on the same topic by including newer trials up to March 2024. A systematic search of Medline (via PubMed), the Cochrane Central Register of Controlled Trials, and references from the previous review was conducted. Randomized controlled trials comparing oral tapentadol with placebo or other opioids (e.g., morphine, oxycodone, tramadol/paracetamol) in adults with chronic cancer pain were included. The main outcomes assessed were pain reduction, need and dose of rescue medication, adverse events, treatment discontinuation, and patient-reported global impression of change. Risk of bias was evaluated using the Cochrane tool. Meta-analyses were performed using a random-effects model. Five randomized controlled trials comprising 1152 patients were included. Across all outcomes evaluated, there was no significant difference between tapentadol and comparator opioids. Pain reduction was comparable (MD=-0.06; 95% CI: [-0.44, 0.31]), as were adverse effects (RR=0.98; 95% CI: [0.90, 1.08]), need for rescue medication (RR=1.07; 95% CI: [0.93, 1.22]), and dropout rates (RR=1.10; 95% CI: [0.87, 1.40]). All outcomes were rated as inconclusive due to overlapping confidence intervals with the null effect. The overall risk of bias was high in three studies and unclear in two. Tapentadol demonstrated similar efficacy and safety compared to other opioids for cancer-related pain, with no evidence of superiority. Given the limited number and methodological quality of studies, further high-quality trials are needed to establish more robust conclusions.
Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive phenotype of steatotic liver disease that can lead to advanced fibrosis, cirrhosis and liver-related complications. Pirfenidone is a small synthetic molecule that was originally approved for idiopathic pulmonary fibrosis. It has pleiotropic antifibrotic, anti-inflammatory, antioxidant, and immunomodulatory properties. In preclinical liver models, pirfenidone reduces hepatic stellate cell activation, collagen deposition, oxidative stress and proinflammatory cytokine expression, largely through the modulation of transforming growth factor β (TGF-β), platelet-derived growth factor (PDGF), mitogen-activated protein kinases, and the Nrf2 axis. Early clinical trials, including the large prospective cohort PROMETEO, the randomized controlled trial in compensated cirrhosis ODISEA, and the translational trial in post-sustained viral response fibrosis MINERVA, show improvements in noninvasive fibrosis markers, liver function tests, quality of life, and parallel epigenetic remodeling. These data suggest that pirfenidone acts on central fibrogenic biology and may contribute to histological regression in advanced disease. Larger and longer trials, as well as rational combinations with metabolic agents, are needed to define its therapeutic role in MASH.
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Systemic arterial hypertension remains the leading modifiable risk factor for cardiovascular mortality, yet the optimal blood pressure target remains a subject of intense global debate. While recent American guidelines advocate for a lower diagnostic threshold (≥130/80 mmHg), European and Asian guidelines largely maintain a conservative threshold (≥140/90 mmHg). This narrative review addresses the central clinical question: "Is lower always better?" We synthesize evidence from landmark trials, including SPRINT and STEP, which demonstrate that intensive systolic blood pressure control (<120-130 mmHg) significantly reduces cardiovascular events and mortality, particularly in high-risk phenotypes such as resistant hypertension. However, this benefit is not without cost. We discuss the physiological "J-curve," the increased risk of adverse events such as hypotension and acute kidney injury, and emerging concerns regarding the long-term durability of stroke prevention observed in the ESPRIT trial. Furthermore, the dominant narrative of "intensification" is challenged by the recent STOP-Trial, which validated a framework for safe de-prescribing in low-risk hypertensive patients using home-based monitoring. Crucially, the divergent findings of the CREOLE and TOPSPIN trials reveal that therapeutic efficacy varies profoundly by ethnicity and geography, rendering a "one-size-fits-all" approach obsolete. We conclude that while intensive control is a life-saving opportunity for high-risk cohorts, it is not a universal mandate. The future of hypertension management lies in the transition from a single numerical target toward precision medicine - utilizing pharmacogenomics and population-specific strategies to maximize protection while minimizing harm, mandating development of "population-based guidelines" aiming for personalized blood pressure targets.
Hepatology is experiencing major shifts in disease etiologies and raising demand for multidisciplinary care. However, a globally harmonized framework defining core training content remains lacking. We aimed to develop a globally informed expert consensus framework for the content of core hepatology training, in order to provide a structured foundation for curriculum development. A two-round modified Delphi using the RAND/UCLA Appropriateness Method (RAM) was conducted. A comprehensive list of curriculum items was developed from international training standards, refined by a steering committee, and rated by a stratified international panel. Consensus was determined using medians and a disagreement index (DI), which classified curriculum items as essential, desirable, or optional. 456 experts completed Round 1, of whom 78.7% also completed Round 2. Consensus was strongest for foundational knowledge and core diagnostic skills, including interpretation of abnormal liver function and liver screening test results, and non-invasive fibrosis assessment (both DI=0). Management of major liver diseases was consistently prioritized as essential. Procedures with the highest endorsement for independent performance were paracentesis, transient elastography, variceal screening, and endoscopic variceal therapy. Consensus was limited for conventional ultrasonography and advanced interventions, reflecting regional variability in resources and scope of practice. Most experts (79.1%) supported formal training in research methodology, and the median recommended fellowship length was 24 months. Subgroup differences were mainly observed in selected resource-dependent or highly specialized items. This global consensus offers a priority-stratified outline of core hepatology training content providing a practical foundation for curriculum development and staged implementation across diverse health systems. Our study provides a consensus-based, priority-stratified framework for core hepatology training content that may inform curriculum development and local adaptation, given the growing global burden of liver disease and the heterogeneity of training standards. This framework may support curriculum mapping and local adaptation for trainees, program directors, professional societies, and policymakers, including in settings where structured hepatology training pathways are still evolving. In practical terms, these findings may assist educators and institutions in reviewing and refining national curricula and training structures. However, specific implementation decisions, including accreditation requirements and procedural training standards, will need to be adapted to local regulatory and resource contexts. Recognizing that these recommendations are based on expert consensus rather than outcome data and may be variably implementable in resource-limited settings, the next steps are pilot implementation in diverse settings, evaluation of trainee and patient outcomes, and iterative revision, supported by coordinated efforts from societies, governments, and training institutions.
Chronic lymphedema of the upper limb is a frequent and disabling consequence of breast cancer surgery. It is associated with swelling and reduced quality of life. While manual lymphatic drainage is a standard treatment, additional physical modalities have shown potential to enhance therapeutic outcomes. This study aimed to evaluate the effects of short-wave diathermy combined with manual lymphatic drainage on limb circumferential measurements and quality of life in women with chronic lymphedema following breast cancer surgery. This single-arm, pre-post, retrospective observational study included twenty female patients treated between January 2023 and January 2025. All participants received nine sessions of short-wave diathermy over four weeks, followed by manual lymphatic drainage, with concurrent compression therapy as per routine care. Limb circumference was measured at nine anatomical sites before and after treatment. Quality of life was assessed using the Italian version of the Lymphedema Quality of Life Questionnaire. Statistical analysis was performed using paired t-tests. Significant reductions in limb circumference were observed at seven of the nine measurement sites (P<0.05), particularly in the mid and proximal forearm and upper arm. The mean baseline overall score on the Lymphedema Quality of Life Questionnaire was 7.8, indicating moderate to severe impact. No adverse events were reported during the treatment period. Short-wave diathermy combined with manual lymphatic drainage appears to be a safe and effective adjunctive treatment for chronic upper limb lymphedema in breast cancer survivors. These findings support its integration into multidisciplinary rehabilitation programs.
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Oropharyngeal dysphagia is common in Parkinson's disease, but it may remain clinically silent until complications occur. Bedside screening is widely used in routine care, although its diagnostic accuracy remains uncertain. Submental ultrasonography has emerged as a non-invasive adjunct for bedside assessment of swallowing-related structures and movement. In this retrospective cross-sectional study, institutional records of adults with Parkinson's disease assessed between October 2021 and June 2023 were analyzed. Bedside swallowing screening was performed with the Gugging Swallowing Screen. Submental ultrasonography was used to measure tongue thickness and hyoid-thyroid approximation during swallowing. Videofluoroscopic swallowing study served as the reference standard. Swallowing safety was classified as safe or unsafe according to the Penetration-Aspiration Scale, with unsafe swallowing defined as a score of 3-8. The primary outcome was the diagnostic performance of the Gugging Swallowing Screen for identifying unsafe swallowing on videofluoroscopic swallowing study. Thirty-nine participants were enrolled, and 36 completed videofluoroscopic swallowing study. A positive Gugging Swallowing Screen result was observed in 7 of 36 participants, corresponding to 19.4%, whereas unsafe swallowing on videofluoroscopic swallowing study was observed in 12 of 36 participants, corresponding to 33.3%. The Gugging Swallowing Screen showed moderate discriminative ability, with an area under the curve of 0.792. Sensitivity was 58.3%, specificity was 100%, overall accuracy was 86.1%, positive predictive value was 100%, and negative predictive value was 82.8%. Participants with unsafe swallowing had lower tongue thickness and shorter resting and minimum hyoid-thyroid distances. In Parkinson's disease, the Gugging Swallowing Screen may help prioritize referral for instrumental assessment, particularly when abnormal, but it cannot reliably exclude unsafe swallowing when used in isolation. Submental ultrasonographic measures differed between videofluoroscopy-defined swallowing-safety groups; however, their diagnostic utility, optimal cut-offs, and incremental value over the Gugging Swallowing Screen require prospective validation.
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Recurrent laryngeal nerve (RLN) dysfunction represents one of the most feared complications of thyroid surgery, with significant impacts on patients' quality of life due to the potential paralysis of the vocal cords. Although nerve transection is rare, functional loss - non-structural and invisible to the human eye - is the primary cause of this complication. Intraoperative nerve monitoring (IONM), introduced more than 50 years ago and significantly improved over the past decade, represents a crucial tool for preventing this outcome. This retrospective observational study involves patients undergoing total or partial thyroidectomy at a specialized center in Italy from 2023 to the present and aims to compare the predictive effectiveness of vagus nerve (VN) stimulation versus RLN stimulation, evaluating three techniques (C-IONM, I-IONM, and No-IONM). All patients were monitored using a NIM system (NIM Avalanche SI2), with pre- and postoperative laryngoscopic evaluation. Among 378 patients undergoing thyroid surgery, no significant differences in baseline demographics were observed among groups. The absence of intraoperative neuromonitoring was associated with a significantly higher risk of permanent vocal cord paralysis compared with I-IONM (OR 4.84, P=0.012). C-IONM showed no cases of permanent paralysis and was associated with significantly shorter operative time and reduced length of hospital stay compared with both intermittent monitoring and no monitoring. I-IONM significantly improves neurological safety in thyroid surgery. C-IONM provides the most favorable overall profile, combining comparable safety with improved operative efficiency and postoperative recovery, and represents a promising strategy for further optimization of surgical outcomes.
Premature ovarian insufficiency (POI) is a critical condition affecting young women before the median age of menopause and consisting of spontaneous oligo-amenorrhea for at least four months associated with follicle stimulating hormone (FSH) levels ≥25 UI/L detected before 40 years of age. Several causes like genetic abnormalities, autoimmune diseases, drugs and/or pelvic surgery may favor this condition that is associated with a deeper clinical impact on women's health compared to physiological menopause. Specifically, cardiovascular and musculoskeletal systems as well as brain could be especially affected by the early loss of ovarian hormones. Therefore, appropriate treatment is necessary to adequately narrow the biological gap with the average age of menopause. Hormone replacement therapy (HRT) is the treatment of choice, regardless of the presence of neurovegetative symptoms. Transdermal high dosage of natural estradiol is generally preferred to guarantee the preservation of cardio-metabolic and bone health. When contraception is required, oral estroprogestins (EPs) maybe considered. A referral to reproductive experts for fertility preservation techniques should be considered case by case.
Transcatheter aortic valve implantation (TAVI) has become the preferred therapeutic option for patients with severe aortic stenosis (SAS) at high or intermediate surgical risk. Despite its minimally invasive nature, TAVI is frequently associated with post-procedural complications, among which acute kidney injury (AKI) represents a major clinical concern. Early identification of patients at increased risk for AKI remains a critical unmet need. This retrospective, observational, single-center study enrolled consecutive patients with severe aortic stenosis who underwent TAVI between December 2022 and December 2023. The primary endpoint was to identify independent predictors of acute kidney injury (AKI) within 48 hours after TAVI. Secondary endpoint was to identify independent predictors of hospitalization for heart failure (HHF) during follow-up. Predictive modeling was conducted using the eXtreme Gradient Boosting (XGBoost) algorithm, with interpretability enhanced via SHapley Additive exPlanations (SHAP). A total of 116 patients were included (mean age 76±6.5 years; 57% male). Comorbidities were common, including heart failure (41%), coronary artery disease (32%), atrial fibrillation (41%), diabetes mellitus (29%), and chronic kidney disease (34%). Median EuroSCORE II was 2.1 (IQR 1.5-3.9). Median ferritin was 99.5 ng/mL (IQR 40-129), mean hemoglobin 12.3±1.7 g/dL and mean eGFR was 69.9±24.9 mL/min/1.73 m2. After TAVI procedure, AKI occurred in 9% of patients within 48 h. According to the SHAP analysis, ferritin and TSAT emerged as the two most influential features in AKI prediction. The machine learning model achieved high sensitivity (96%) and an F1-score of 0.98, suggesting strong clinical utility for early risk stratification. In patients undergoing TAVI, iron deficiency, as reflected by low ferritin and TSAT levels, emerged as independent predictors of early post-procedural AKI.
Post-stroke patients with nasogastric tubes are at higher risk of aspiration pneumonia. In such cases, prokinetics have been linked with improved gastric emptying and reduced reflux, even though their effectiveness is controversial. This research aims to assess the application of prokinetics for the prevention of post-stroke pneumonia. We searched the databases Cochrane, PubMed, Embase, Web of Science and Scopus for RCTs up to November 2024. The outcome of interest was incidence pneumonia, and we assessed bias using RoB 2 and ROBINS-1. Overall, 326 articles were screened and 3 RCTs, comprising 600 patients, were included. There were 291 patients in the intervention group and 309 in the control group. Risk ratio for pneumonia was 0.80 (95% CI: 0.50-1.27, P>0.05), which showed no significant reduction. High heterogeneity was observed (I2=87%, P<0.001). Thirty- and 90-day mortality was not significantly different (RR=0.93, 95% CI: 0.75-1.17, P=0.349, I2=5%). Functional independence (mRS) was marginally better in some cases but not of clinical significance, with high heterogeneity (I2=82.2%). Neurological improvement (NIHSS) had variable results, with no overall benefit that reached statistical significance (pooled effect size = -0.05, 95% CI: -0.62-0.51, P=0.057, I2=72.4%). The variation observed limits the confidence in these findings. Prokinetics have no relationship with pneumonia in patients with nasogastric tubes according to the existing evidence. More trials are needed since there are no established guidelines.
Recombinant human prourokinase (rhPro-UK) has been investigated as an alternative thrombolytic agent to alteplase for acute ischemic stroke (AIS). While alteplase remains the standard of care, uncertainties persist regarding whether rhPro-UK provides similar efficacy and safety outcomes. This systematic review and meta-analysis aimed to compare intravenous rhPro-UK with alteplase in patients with AIS. A systematic literature search was conducted in PubMed, Embase, and Cochrane Central up to January 2025. Randomized controlled trials (RCTs) comparing intravenous rhPro-UK with alteplase were included. Outcomes of interest were functional recovery (modified Rankin Scale [mRS] 0-1 and 0-2 at 90 days), early neurological improvement (National Institutes of Health Stroke Scale [NIHSS] reduction within 24 hours), intracranial hemorrhage, all-cause mortality, and recurrent stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated under a random-effects model. Risk of bias was assessed with the Cochrane RoB 2 tool. Three RCTs involving 2295 patients were included (1209 treated with rhPro-UK; 1148 with alteplase). No statistically significant differences were observed between groups for intracranial hemorrhage (OR 1.04; 95% CI: 0.73-1.48), mRS 0-1 at 90 days (OR 0.91; 95% CI: 0.77-1.08), mRS 0-2 at 90 days (OR 0.95; 95% CI: 0.79-1.14), early NIHSS improvement (OR 0.94; 95% CI: 0.79-1.11), all-cause mortality (OR 1.16; 95% CI: 0.66-2.03), or recurrent stroke (OR 0.72; 95% CI: 0.31-1.66). Intravenous rhPro-UK demonstrated comparable efficacy and safety to alteplase in AIS, supporting its role as a potential alternative thrombolytic, particularly in regions with limited access to alteplase.
Tobacco use remains a major global health issue, causing over seven million deaths annually. In Italy, nearly one-quarter of the population are current smokers, with increasing use of electronic and heated tobacco products, particularly among adolescents. The expanding availability of high-nicotine vaping devices highlights the need to better understand smoking behaviors in young people. This study aimed to assess the prevalence and determinants of smoking habits in a high school in northern Italy. An anonymized online survey was administered to all students of a high school in Pavia between March and October 2025, collecting information on demographics, smoking behaviors, product use, age and context of initiation, and parental smoking. A total of 1179 valid questionnaires were analyzed. Overall, 41.2% of students had used at least one tobacco or nicotine product, with e-cigarette use exceeding traditional cigarette smoking. The mean age at first use was about 14 years. Most adolescents initiated smoking in social settings. Parental smoking was strongly associated with adolescent use of cigarettes (OR=1.69), e-cigarettes (OR=1.68), and cannabis (OR=1.43). Price increases and reduced peer smoking were the most frequently reported motivators for cessation. Adolescent nicotine use in this cohort was markedly higher than national and international estimates, with earlier initiation and narrowing gender differences compared with past data. Parental and peer influences remain key determinants. Early, school-based and family-oriented strategies are essential to reduce experimentation and promote long-term cessation.
Tumor-induced osteomalacia (TIO) is an ultrarare paraneoplastic syndrome caused by overproduction of fibroblast growth factor 23 (FGF23). There is low awareness of the disease so that TIO is underdiagnosed. In addition, symptoms reported by patients with TIO are usually nonspecific thus rendering the diagnosis difficult to be made. Biochemical hallmarks are represented by hypophosphatemia, increased or inappropriately normal levels of FGF23, low to low normal circulating 1,25(OH)<inf>2</inf>D and renal phosphate wasting. From the histological point of view, phosphaturic mesenchymal tumors are the entities responsible in majority of cases. Tumors causing TIO are generally of small size and grow slowly. There are a number of functional and anatomical imaging techniques utilized for tumor localization; 68Ga DOTA based technologies have the better sensitivity and specificity in respect to other techniques. Surgery is the treatment of choice; in a very few selected cases non pharmacological and pharmacological treatment are available.
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