Italy is a major hub for migration routes. Disparities in health management across different geographic regions, particularly among individuals with type 2 diabetes mellitus (T2D), are well recognized, yet comprehensive data on the quality of T2D care in migrant populations remain limited. Quality indicators of T2D care were analyzed for foreign patients compared with European patients using the 2022 AMD Annals database. The Italian National Institute of Statistics classification defined geographic origins. Data on country of origin were available for 179,536 T2D patients, with 19.3% being foreign, mainly from North Africa, Central and Eastern Europe, Central and South Asia, Central and South America.Foreign T2D patients were generally younger, resulting in shorter disease duration. While annual screening rates for risk factors and major complications were as European subjects, critical gaps were noted in microalbuminuria and retinopathy assessments. Treatment intensity was lower for patients from North and West Africa and Central and South Asia, though the use of innovative therapies like GLP-1RAs and SGLT2i was comparable to European patients. The overall quality of care, measured by the Q-score, was lowest in West African patients (26.4 ± 9.1 vs. 29.1 ± 8.0), while 51.6% of those from Central and South Asia had satisfactory care quality (Q-score > 25). Study showed differences in age, disease duration, and treatment among patients from various geographic regions, while indicating equitable access to therapies and comparable overall quality of care. These findings may inform management strategies to improve T2D care for migrant populations.
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Numerous studies have investigated gout; however, a focused bibliometric evaluation of the most influential publications remains limited. This study identified and analyzed the top 100 most-cited articles on gout. The Web of Science Core Collection Science Citation Index Expanded database was searched using the term "gout." Articles published from January 1, 2000 to April 30, 2026 were screened. The top 100 most-cited articles were selected, and data on citation rank, publication year, journal, impact factor, country, institution, author, study type, research topic, and keywords were extracted. Bibliometric analyses were performed to characterize publication patterns and research trends. The most-cited article was published in 2006 and received 4359 citations. The top 100 articles were published in 34 journals, with Annals of the Rheumatic Diseases contributing the largest proportion. The United States was the leading contributing country. The University of Pennsylvania was the most productive institution, and Choi HK was the most prolific author. Observational studies were the most common study design. Keyword co-occurrence analysis identified 4 major research domains: epidemiology, pathophysiological mechanisms, pain management, and comorbidities. Frequently occurring keywords included hyperuricemia, gout, management, risk, arthritis, uric acid, prevalence, coronary heart disease, quality of life, and febuxostat. This bibliometric analysis summarizes the most influential publications in gout research from 2000 to 2026. Major research priorities have shifted from serum urate, diagnosis, and pharmacological treatment toward risk assessment, long-term outcomes, disease burden, and comprehensive management. Hyperuricemia and urate-lowering therapy remain central themes, while emerging topics such as gut microbiota suggest increasing interest in multidisciplinary and precision approaches to gout care.
'Publish or perish' is a grim reality for many academic surgeons and has led to authorship proliferation and internationalization of the cardiothoracic surgical literature. We sought to examine whether these trends are continuing today. We reviewed 17,267 articles from 2007-2022 in the archives of the three leading cardiothoracic journals (European Journal of Cardiothoracic Surgery, EJCTS; Journal of Thoracic and Cardiovascular Surgery, JTCVS; Annals of Thoracic Surgery, ATS). Data on the number of authors and geographic origin were collected. The mean number (± standard error) of authors per article increased with time for all journals: from 6.5 ± 0.1 in 2007 to 9.0 ± 0.2 in 2022 for the EJCTS (p < 0.001), from 7.4 ± 0.1 in 2007 to 8.2 ± 0.2 in 2022 for the JCTVS (p < 0.001), and from 6.9 ± 0.1 in 2007 to 9.0 ± 0.2 in 2022 for the ATS(p < 0.001). North American institutions increasingly dominate JTCVS/ATS, whilst European manuscripts decline in all journals. Only EJCTS showed increasing internationalization. Authorship proliferation continues in the three leading cardiothoracic surgical journals, reflecting the natural evolution of the demands of modern research and career progression.
BackgroundThe Ross procedure, introduced in 1967, transformed cardiac surgery. This study presents one of the first global bibliometric analyses, to the best of our knowledge, mapping research trends, collaborations, and authorship to identify future directions in this field.MethodsA global bibliometric analysis of Ross procedure publications (1967-2025) was performed using Scopus and PubMed. Data processed in R (bibliometrix, biblioshiny) explored productivity, collaborations, authorship, and thematic evolution. Future publication trends to 2050 were forecast using a linear extrapolation model with 95% confidence intervals.ResultsA total of 2370 Ross procedure publications were identified (1967-2025), showing an 8.1% average annual growth rate. Original articles dominated (65%), followed by reviews/meta-analyses (13.9%) and case reports (13.5%). Among 6228 authors (69.5% male), collaboration averaged 4.9 coauthors/document, with 12.6% international partnerships. The USA (32.3%), the Netherlands (19.3%), and Germany (14.5%) led in productivity. Top institutions were Erasmus University Medical Center (4.3%), Mount Sinai Health System (3.0%), and University Heart Center Lübeck (2.2%). Major journals included Annals of Thoracic Surgery (13.5%), Journal of Thoracic and Cardiovascular Surgery (12.2%), and European Journal of Cardio-Thoracic Surgery (7.6%). Faculty surgeons authored 66% of first-author papers. Main research themes involved allograft reintervention, durability, suture technique, failure, and postoperative complications. Linear regression predicted 164 annual publications by 2050.ConclusionsThis analysis reveals an exponentially increasing and sustained global interest in the Ross procedure, which continues to shape cardiac surgery worldwide. The findings highlight growing research output, robust international collaboration, and a focus on clinical innovation, ensuring ongoing advancements in surgical techniques, patient outcomes, and global cardiovascular surgical excellence.
Despite calls to publish negative studies in prominent medical journals, greater submission and acceptance of positive results remains an issue. We aimed to quantify the degree to which high-impact general medical journals publish negative study results. We searched MEDLINE/PubMed for all randomized controlled trials published in five high-impact general medicine journals: Annals of Internal Medicine, the British Medical Journal (BMJ), the Journal of the American Medical Association (JAMA), the Lancet, and the New England Journal of Medicine (NEJM). Our search spanned a 10-year period from 2014 to 2023, which included data from before and after the emergence of the COVID-19 global pandemic. We performed single-author data extraction via abstract review to determine study positivity, defined as statistical significance for the primary outcome, flagging abstracts for secondary review if positivity was not clear. Two authors reviewed all flagged abstracts. We calculated the proportion of negative studies (i.e., not meeting statistical significance for the primary outcome) overall, by journal, and by publication year. We used logistic regression to model the odds of a study reporting a negative result by journal and year. Our search yielded 3722 individual citations, with screening resulting in 3600 randomized controlled trials for review, with 31% of studies reporting negative results. The proportion of negative studies varied, ranging from 22% in the Lancet to 51% in BMJ and JAMA. The proportion of negative studies remained consistent over time. High-impact general medical journals vary widely in the percentage of negative studies that they publish but did not change over time, even during and after a global pandemic. Further study is needed to determine factors influencing this phenomenon and what can be done to minimize publication bias.
In 1988, plastic surgeon Lee Dellon in Annals of Plastic Surgery hypothesized that there was "A Cause for Optimism in Diabetic Neuropathy". He noted that entrapment neuropathy is common in diabetic peripheral neuropathy (DPN) and explained that multiple sites of local nerve entrapment can also produce the classically described clinical picture of progressive and irreversible 'length dependent axonopathy'. This observation has justified for him the use of nerve decompression (ND) surgery for beneficial treatment of DPN pain, diabetic foot ulcer (DFU), ulcer recurrences and their subsequent complications. Subsequent observational and controlled reports have consistently demonstrated post-operative benefit for these problems, but ND has not yet been widely adopted. The lack of an etiologic explanation of the physiology changes which would allow surgery to modify the metabolic disturbances of diabetes has likely been involved in such hesitance. Recent explanations that glycolysis is altered in diabetes through intensified polyol metabolism which produces swollen nerves, local peripheral entrapments and compression neuropathy now provide plausible associations of hyperglycemia with epidermal hypoxia and nutrition deficit. Recognition that nerve enlargements can create secondary fibro-osseous compressions explains the well-known association of diabetes and compression syndromes. Peripheral nerve entrapments damage small c-fibers and produce sympathetic autonomic as well as sensorimotor dysfunction. This explains the diminished skin microcirculation, epidermal hypoxia and nutrition deficit seen in diabetes, DPN, DFU and Charcot neuroarthropathy. Laboratory and clinical evidence has demonstrated that ND in diabetes rejuvenates at least two sympathetically commanded skin microcirculation processes and explains how surgery is producing beneficial results. This article recapitulates the literature which clarifies the processes by which ND surgery can modify painful DPN, DFU occurrence, ulcer healing, DFU recurrence risk, amputations after DFU healing, and bilateral pain relief after unilateral surgery.
Improvement in progression-free survival (PFS) is increasingly used by health authorities for cancer drug approvals. We analyzed 106 randomized controlled trials (RCTs) with positive PFS outcomes published in JAMA Oncology, Lancet Oncology, Journal of Clinical Oncology, and Annals of Oncology during 2020 - 2023. RCTs were categorized as 'targeted' (n = 83) or 'conventional' (n = 23) by their interrogated treatment variables. Two measures of PFS effect sizes were analyzed: hazard ratio (HR) and PFS increment. Among the RCTs of targeted therapies, the 25th-percentile value (Q1) of HR increased significantly (slope = 0.05 per year; P = .02) during the study period whilst Q1 of PFS increment decreased significantly (slope = -9.1 percentage points per year; P = .03). Similar trends were not observed among the RCTs of conventional therapies. Our analyses suggest a potential bias in accepting RCTs of targeted therapies despite decreased PFS effect sizes.
Otitis media is a complex disease. The pathogenesis of both acute and chronic otitis media results from a complex interplay of anatomical, microbiological, and immunological factors. Identified risk factors include patient-related aspects such as nutrition, allergies, ethnicity, and genetic predisposition, as well as environmental factors such as socioeconomic status, tobacco use, attendance at daycare centers and recurrent respiratory infections. During the COVID-19 pandemic, strict measures led to a significant decline in the incidence of acute otitis media. However, infections with variants such as Omicron showed an increased rate of secretory otitis media. In the post-COVID phase, complication rates due to middle ear infections rose again, with prevalence returning to pre-lockdown levels. Preventive measures focus on ensuring adequate Eustachian tube function, treating allergies, and consistently administering pneumococcal vaccinations. In contrast, surgical treatment remains the gold standard for chronic middle ear infections and cholesteatoma. However, radical removal can be associated with high morbidity rates, underscoring the need for innovative approaches. These include optical coherence tomography (OCT) and minimally invasive laser surgery. Furthermore, new insights into the role of the immune system in the pathogenesis of both acute and chronic otitis media could open up new therapeutic possibilities for the future. This article discusses the current state of knowledge on the pathophysiological mechanisms, classification, diagnosis, and treatment of otitis media, as well as new treatment models and their implications.