The way people consume food has shifted, creating new standards for product production and marketing. The variations in plant-based and animal-derived food consumption are an important research area in disciplines like food science and consumer behaviour. This study seeks to explore how consumers react, both implicitly and explicitly, to a traditional meat product that has turned into a plant-based one. The purpose is to uncover differences in acceptance of plant-based versions of traditionally meat-based products using psychophysiological measures via electrodermal activity, and cognitive evaluation via questionnaires. Through an experimental blind/informed experimental protocol, a total of 57 participants took part of a within-subject design study, including a plant-based dry-cured fermented sausage in unknown and informed condition. Results showed differences in emotional responses, purchase intentions, product acceptance, and sensory assessment, influenced by factors such as age or meat consumption habits, and diet. Meat perception decreased among omnivores when informed of the product's plant-based composition. These findings offer important implications for consumer behaviour and marketing strategies, as the product's naming may affect its acceptance.
Despite its widespread usage in agriculture, the environmental fate of 3,4-dimethylpyrazole (DMP), the active part of the nitrification inhibitor DMPP, is relatively little investigated, especially with regards to the risk of leaching. We therefore used a combination of batch, column and lab studies to determine the fate of DMP and its degradation product 3-methylpyrazole-4-carboxylic acid (3-MPA) on sandy soils at conditions representative for a temperate climate such as that found in Northern Europe. DMP was degraded fastest in non-sterilized topsoil and slowest in sterilized subsoil. Manure increased degradation rates, but the degradation leveled off over time, leaving at least 5% after 5-12 months in both lab and field experiments. At environmentally realistic concentrations, DMP showed a relatively high sorption to topsoil, which increased by aging. Sorption cannot, however, be expected to retard the leaching of DMP much once it has reached the subsoil where degradation was also slow. The leaching potential was confirmed by the detection of low concentrations of DMP in column leachates and in pore water just above the groundwater table in the field, nonetheless, most of the non-degraded DMP remained in the upper 10 cm. The degradation product 3-MPA was quickly formed after application of DMPP, but leached in very low amounts, probably due to degradation in the topsoil. All in all, leaching of DMP and its transformation product 3-MPA seems to be low in sandy arable soil with plug flow conditions, while additional studies in other soil types are needed to evaluate if DMP can leach in soils where for example preferential flow conditions are more prevailing.
BACKGROUND Migration of foreign bodies to the right ventricle is a very rare condition, but may lead to a life-threatening state in the patient. Moreover, the presentation of symptoms in such cases may be deceiving. CASE REPORT We report the case of a 41-year-old man with a long-standing history of intravenous drug abuse who was admitted with chest and epigastric pain accompanied by hematemesis. Computed tomography demonstrated a pericardial effusion and a thin metallic foreign body embedded in the right ventricular wall. Further history revealed needle breakage during intravenous injection 2 weeks prior to admission. Transthoracic echocardiography showed signs of cardiac tamponade. Due to elevated inflammatory markers, empiric antibiotic therapy was initiated, and the patient was referred for urgent cardiothoracic surgery. Surgical exploration revealed purulent pericardial tamponade and a 20-mm needle fragment embedded in the right ventricular wall, which was successfully removed. Microbiological cultures confirmed methicillin-sensitive Staphylococcus aureus infection. Postoperative recovery was uneventful, and inflammatory markers initially normalized under targeted antibiotic therapy. CONCLUSIONS The presented case illustrates a rare and unexpected complication of intravenous drug abuse. It highlights a rare dual-mechanism pathophysiology: purulent pericardial effusion occurring in the presence of an intramyocardial needle. To date, only a few similar cases have been reported in the literature. No specific symptoms allow for early diagnosis, and completing a proper anamnesis seems to be the most valuable action in such situations.
This study evaluated kinship identification using 19 short tandem repeats (STRs) from AGCU EX22 kit, 119 microhaplotypes (52 in Panel A + 67 in Panel B), and a theoretical 9622 genome-wide single nucleotide polymorphisms (SNPs) panel (The 9K). The system power was assessed accounting for linkage on the basis of 198 Chinese Southern Han (CHS) family samples and simulated data. STR + Panels A and B distinguished full-sibling (FS) from unrelated (un), with second-degree effectiveness above 0.96 when log10(LR) threshold was 4 and low false positive rate (<0.06%), but were insufficient for more distant kinship identification alone. The 9K panel was sufficient to separate third-degree from un but not for fourth-degree or more distant relatives. For discrimination among different kinships, STR + Panels A and B successfully distinguished all FS from half-siblings (HS), uncle/aunt-nephew/niece (UN), and grandparents-grandson/granddaughter (GS) in real data, with minimal overlaps (<0.2%). Discriminating second- and third-degree or within second-degree relatives seems very challenging, even for 9K panel. Including a carefully selected additional relative (AR) may improve discrimination between GS and UN/HS, such as AR (GS-un, which is GS for one person and un for the other) and AR (parent/child (PC)-UN). Similarly, an AR (PC-GS) may help distinguish UN from GS/HS, but there was slightly improved efficiency for HS.
Decompression sickness (DCS) is a low-incidence but potentially severe consequence of hyperbaric exposure. Probabilistic decompression models offer a framework to quantify this risk, yet their calibration is challenged by the scarcity of empirical outcome data. In this study, we propose a gradient-based optimization model to predict DCS probability, trained on 924 dive profiles from the US Navy Experimental Diving Unit XVal-He-9 tables, representing predefined DCS probabilities (2.3% and 4%), and optimized based on actual body tissues grouped in five compartments. The model achieved high predictive accuracy (MAE: 0.535%; RMSE: 0.694%) with consistent performance across training and test sets, indicating limited overfitting. Reduced accuracy was observed in intermediate depth ranges (100-130fsw or 30-39msw). Out-of-sample evaluation on 31 high-risk dives (three DCS cases) showed general agreement between predicted and observed incidence while suggesting a potential contribution of repetitive exposures not accounted for in the model. These results demonstrate that gradient-based optimization, trained based on existing probabilistic tables, seems to be capable of satisfactorily predicting decompression sickness risk for a given dive profile. Additionally, future studies can further adjust the loss function to account for individual or dive-related indicators, leading to a more individualized risk function.
Urinary diversion (UD) after radical cystectomy (RC) is a complex surgery that has effects on different patient aspects. The optimal UD method should be technically simple, functionally effective, and socially satisfying. The persistent controversy over the optimal method of UD is the rationale for conducting this study, given the characteristics of the population in our region. Simple UD methods include ureterocutaneous and ileal conduit (IC). To compare the surgical outcomes and to identify the factors influencing quality-of-life (QoL) after RC with cutaneous ureterostomy (CU) with separate stomata or IC. A prospective non-randomized study was performed on patients who underwent RC from October 2020 to March 2022. The demographic and clinical characteristics and QoL were compared in patients with IC and unilateral CU with separate stomata. The primary outcome was the difference in the QoL scores between patients with CU (group A) and those with IC (group B). QoL was assessed 6 months after surgery, using the validated Functional Assessment of Cancer Therapy-Bladder questionnaire. This study included 32 patients with a median age (range) of 61 (48-83) years and a median (range) body mass index of 23.95 (19.2-30.2) kg/m2. Wound infections (68.8%) and paralytic ileus (50%) were the commonest complications. The mortality rate was 18.8%, and the main cause was septicemia. The median time of the shunt procedure was significantly longer in group B (P < 0.001). Also, the postoperative anemia (P = 0.029), the days between appliance base changes (P < 0.001), and the rate of febrile urinary tract infections (P = 0.017) were higher in group A. However, the score of QoL (P = 0.025) and survival rate (P = 0.004) were significantly better in group B than in group A. The median QoL score for group A was 68 (52-90) while the median QoL score for group B was 80.50 (62-103) (P = 0.029). Serum creatinine level (P = 0.045), recurrent urinary tract infections (P = 0.025), and the number of re-interventions (P = 0.010) had a significant inverse association with QoL. However, the estimated glomerular filtration rate showed a significant proportional relation (P = 0.006). Unilateral CU with separate stomata may be associated with higher rates of postoperative anemia and urinary tract infections. However, IC seems to be associated with better QoL and febrile urinary tract infections. Increased serum creatinine level, recurrent infections, and re-interventions may influence the QoL score. Unilateral CU with separate stomata may still represent an option for patients undergoing RC.
Prehabilitation transforms the preoperative waiting period into an opportunity for patients to actively improve their health before surgery. With surgical populations ageing and presenting with increasing frailty, patient prioritised outcomes, such as postoperative complications and disability, affect >20% of patients undergoing major surgery, resulting in substantial healthcare costs. This review combines the current evidence for prehabilitation components, including exercise, and respiratory, nutritional, cognitive, and psychosocial interventions. Although respiratory prehabilitation showed high certainty evidence for reducing postoperative pulmonary complications after major surgery, other components showed promising but lower certainty benefits. Multimodal prehabilitation, especially when exercise and nutrition are combined, seems to be most effective for improving clinical and patient centred outcomes. Significant knowledge gaps remain, however, about optimal programme design, delivery models, target populations, and strategies to maximise adherence. Patient perspectives emphasise the importance of individualised coaching or support from healthcare professionals, or both, home based accessibility, and collaborative care. Future research should include a focus on pragmatic multicentre trials with robust cost effectiveness analyses to support implementation in the health system of effective, scalable prehabilitation programmes that can meaningfully improve outcomes for surgical patients. Opportunities to enhance the effectiveness and reach of prehabilitation include exploiting existing and emerging technologies, as well as optimising participant support to maximise adherence.
Peripherally inserted central catheters (PICCs) are widely used in oncology but are associated with higher rates of catheter-related thrombosis compared to other central venous access devices. Tunnelled non-cuffed centrally inserted central catheters (tnc-CICC) may offer a safer alternative in patient at high risk of thrombosis. This retrospective cohort study evaluated 193 tnc-CICCs placed in 182 cancer patients at a tertiary oncology unit between January 2021 and December 2022. Primary outcomes is catheter-related thrombosis; secondary outcomes are procedural duration and complication rates. Data were analysed using non-parametric statistical methods. The overall thrombosis rate was 1% (0.18 per 1,000 catheter days), significantly lower than reported PICC-associated thrombosis rates. No major intraoperative complications occurred. The overall complication rate was 19.7%, with catheter malfunction (9.3%), migration (5.2%) and bloodstream infections (4.1%) being the most common. Median procedural time was 34 min, with no significant difference based on operator experience. Off label use of PICCs as tnc-CICCs seems safe and effective. It provides an alternative to PICCs in oncology patients at high risk of thrombosis, even when placed by operators with low experience levels. These findings support the inclusion of tnc-CICCs in vascular access algorithms for cancer patient at high risk of thrombosis and suggest feasibility for nurse-led insertion programs.
Deregulation of transcriptional factors is a severe genetic event during carcinogenetic process. Among them, C-Fos proto-oncogene (gene locus: 14q24.3) encodes for a nuclear phosphoprotein that is involved in critical intracellular functions. Our aim was to explore the impact of C-Fos different expression patterns on a series of laryngeal squamous cell carcinoma (LSCC) cases. A set of fifty-five (n=55) LSCC tissues were analyzed by implementing a combination of anti-C-Fos-based immunohistochemistry and digital image analysis assays, respectively. Overexpression of the molecule (high staining intensity levels) was confirmed in 34/55 (61.8%) of the selected cases, whereas the remaining 21/55 (38.2%) were characterized by low expression rates. C-Fos deregulation was marginally correlated with the stage of the examined malignancies (p=0.048), demonstrating a progressively increased protein overexpression. No further statistical correlations were established referring to gender, anatomic location, grade or tobacco and alcohol consumption, respectively. C-Fos oncogene overactivation is a frequent event in subgroups of LSCC patients. C-Fos overexpression seems to lead to an aggressive phenotype increased metastatic potential (advanced stage). Identifying specific C-Fos genetic signatures that lead to its overactivation should be a significant step for an optimal oncological approach by targeting the gene.
'The present King of France', Russell maintained in On Denoting, seems to force us into either of the following positions. Either we follow Meinong but then infringe the law of contradiction, or posit senses beyond references, but we seem never able to genuinely talk about them. Hence, Russell urged, it is worth considering 'a somewhat incredible interpretation' of definite descriptions. This is his famous theory of descriptions, now not considered to be incredible anymore. In this paper we will investigate whether and, if so, how some of On Denoting's core claims can be applied not to the present King of France, but to propositions. We will see that following Russell on his considerations concerning the present King of France but not on parallel considerations concerning propositions and phrases that seem to refer to propositions is an unstable position, which Russell himself in On Denoting, and most of us today, seem to occupy. We will then discuss how to reach a more stable position. According to the account we will end up presenting, while there is some thing we believe when we believe truly, there is no thing we believe when we believe falsely. The account might look like a non-starter and goes against what Russell himself claimed. But, we will argue, we can find in On Denoting and in its theory of descriptions the resources to render such an account at least a bit less incredible.
Cuticular waxes undeniably form the primary barrier restricting uncontrolled water loss from leaves, yet the functional consequences of environmentally induced wax modifications for residual (cuticular) transpiration remain a matter of debate. This review summarises current knowledge on how major abiotic stimuli influence foliar cuticular wax amount and composition and critically re-evaluates their effect on transpirational properties of leaves. By focusing on a strictly curated set of studies integrating gas chromatography for chemical wax analysis and permeance-based residual (cuticular) transpiration measurements, we demonstrate that light quantity seems to represent the most dominant driver of wax deposition and that naturally increased wax amounts do not inherently translate into an enhanced water barrier, with the latter aspect challenging the recurrently postulated 'more cuticular wax must equal lower rates of residual (cuticular) transpiration' narrative. Instead, bridging modern research with long-standing transport models indicates that the qualitative composition and spatial arrangement of cuticular wax might constitute the more decisive factors orchestrating cuticular water barrier properties. While the available data are still insufficient to identify clear causal relationships between compound classes, chain length distributions and structural heterogeneity affecting water permeability, they might point to further complexities, such as unintended off-target effects as a consequence of genetic engineering.
Prader-Willi Syndrome (PWS) is a rare, complex, genetic neurodevelopmental disorder that induces a hypothalamic dysfunction with a global developmental delay and specific trajectories. Behavioral and psychiatric disorders are recurrent in PWS, emerging during childhood and varying considerably in their manifestations. This study aimed to gain a better understanding of the relationship between emotion, cognitive and behavioral regulation abilities in children with PWS, and explore the impact on daily life. Twenty-five children with PWS aged between 9 and 15 took part in the study, along with an equal number of age-matched control children. A series of assessments was proposed to children and their parents to measure cognitive and executive competencies, affective and behavioral problems, and family impact. The children with PWS were clearly distinguished from the control group, displaying marked deficits in cognitive skills, including executive ones, and affective problems. Inter-task correlation analyses showed that many variables were significantly interrelated in the PWS group, in contrast with the control group. Inter-individual variation was strong and cluster analyses revealed that three subgroups emerged; one marked by cognitive and executive deficits, a second by a high level of affective problems, while a third displayed relatively preserved cognitive, executive and emotional skills. The three clusters did not differ in the family impact. The variability of behavioral problems observed in children with PWS seems to be underpinned by cognitive and emotional regulatory mechanisms. This original approach is discussed in light of the literature.
Red blood cell (RBC) exchanges (RCE) are particularly efficient to treat and prevent complications in patients with sickle cell anemia (SCA). However, the low weight of young children is a barrier to their use. Spectra Optia is a therapeutic apheresis platform that enables automatic priming to prevent hemodynamic complications in low-weight children. The easiest method is to use albumin for priming, which is allowed by the software. We conducted a retrospective monocenter analysis of the feasibility, safety, and efficacy of albumin priming during RCE (RCE/Alb-primed) in 19 children weighing 12 to 23 kg for a total of 153 sessions. They were treated either on an emergency basis (8 children, 8 sessions), before surgery (2 children, 4 sessions) or as part of a RCE program (9 children, 141 sessions). Indications of RCE/Alb-primed sessions included: (i) an extracorporeal volume of the kit equal to 15% of the child's total blood volume, (ii) a weight of less than 20 kg, or (iii) a weight between 20 and 25 kg with a hematocrit (Hct) of 20% or less. We monitored Grade 2 adverse events (AEs) during the sessions, in extenso decreased blood pressure, increased heart rate and fatigue. Post-apheresis hematocrit and the fraction of cell remaining (FCR) values after RCE were compared to the expected ones. A low incidence of complications was observed in the 153 RCE/Alb-primed sessions with only 1 episodes of transient Grade 2 AEs. Post-apheresis Hct and FCR reached expected values with the RCE/Alb-primed method. In conclusion, RCE/Alb-primed seems to be safe and efficient in young SCA children and should be proposed systematically for curative RCE or prophylactic programs.
All organisms need protection against infection. Bacteria are often primarily seen as infectious agents, but they also need protection against bacterial viruses, so-called bacteriophages. To this end, bacteria have developed very complex defense systems, including apoptosis-like mechanisms, restriction enzymes, and even adaptive-type mechanisms involving immunological memory of immune responses through a system called CRISPR-Cas. An earlier dominating view was that adaptive immunity in eukaryotes only exists in jawed vertebrates, as their immune system includes the classical and highly variable immunoglobulins (Igs) and T-cell receptors (TCR). However, other types of variable molecules, which may be involved in immunity, have also been identified in insects, snails, lancelets, plants, sea urchins, and jawless fishes. Interestingly, fishes without jaws, such as the hagfish and lamprey, have a very complex adaptive immunity built on lymphocyte-like cells and variable lymphocyte receptors (VLRs). Notably, the variability of these VLRs has been estimated to be in the same range as Igs and T-cell receptors. This illustrates that very diverse strategies have been used to create an adaptive immune system in different organisms, indicating potent convergent evolution. Vertebrate immunity includes both adaptive and non-adaptive components, which work closely together to form a very powerful immune system for defense against infections. In contrast to adaptive immunity, the majority of the non-adaptive innate defense mechanisms, such as pattern recognition receptors, antimicrobial peptides (AMPs), iron-binding proteins, the complement system, and lysozymes, can be traced back to early eukaryotes. Immunity of invertebrates seems to rely almost entirely on innate defense mechanisms, while the presence of complex adaptive mechanisms in invertebrates, such as the VLRs of jawless fishes and Igs and TCR of jawed vertebrates, is questionable. This review summarizes old and recent findings of importance for our understanding of how immunity became an integrated part of all living organisms, from bacteria to humans, and the very different strategies that different organisms use in the protection against infection.
Excessive use of antibiotics promotes antibiotic resistance. Deferred prescribing (prescriptions dispensed according to clinical progress) is a strategy to reduce this overconsumption. Recognized in some countries, this practice is poorly documented and not recommended in France. To determine the rate of deferred outpatient prescriptions, their dispensing rate, and their characteristics. This observational study was conducted over 1 year in 20 pharmacies and focused on prescriptions with a handwritten note indicating deferred dispensing. The data collected included patient age and sex, prescriber specialty, drug class, dispensing delay, and population density. Feedback from pharmacists was also collected. Of 174 deferred prescriptions (0.021% of prescriptions), 38% were dispensed immediately, 20% were dispensed later, and 42% were not dispensed. The majority were prescribed by general practitioners (84%). Dispensing was significantly more immediate in urban areas (P = 0.02). Feedback analysis showed that pharmacists had a positive perception of deferred prescribing, seeing it as a tool for empowerment, antibiotic reduction, and collaboration. However, its implementation was limited by logistical constraints and patients' perception of the prescription as a right to dispensing. Effectiveness of deferred prescribing in reducing antibiotic consumption appears to be limited, especially in urban areas. Deferred prescription has little effect on antibiotic consumption. It seems more important to learn not to prescribe antibiotics when infections are viral. Delaying the prescription may help, but communication between pharmacists, doctors, and patients needs to be strengthened. Harmonization of practices and patient education need to be improved in this context of cascading uncertainties.
we aimed to provide data collected in women who were active on social media platforms about menopause-associated symptoms and their impact, as well as resources, preferences and needs, with a specific focus on non-hormonal strategies. a cross-sectional observational study conducted via an anonymous online survey involving patient associations (namely vulvodynia, endometriosis, premature menopause, and natural menopause) in Italy. selected items of a comprehensive questionnaire co-developed by a multidisciplinary team of experts in gynaecology, psychology, and representatives from patient advocacy groups. a sample of 473 Italian postmenopausal women (median age: 56 yrs; range 31-76 yrs), including 231 (48.8%) subjects with chronic conditions (48 with a past history of vulvodynia, 21 of endometriosis, and 15 of oncological diseases) completed the survey. There was a good understanding of the typical menopausal symptoms (90.3% hot flushes, 83.7% vaginal dryness). Weight gain was very commonly attributed to menopause (86.9%) as the most challenging symptom (59.4%). A negative view of menopause was reported by 30.6%, with an impact on relationships (26.4%), social life, and work (9.5% for both). The majority (96.8%) identified lifestyle changes as an effective non-pharmacological intervention for managing menopausal symptoms. Additionally, 26.2% reported that the use of nutraceuticals under medical advice could be effective. Psychological support was positively experienced by 19% and considered beneficial by 56.8%, in spite of direct experience. Providing evidence-based education on menopause is mandatory to foster individualised care. Primary prevention with lifestyle modification and some non-pharmacological interventions seems well-received.
Public health research and practice are shifting towards integrative consideration of physical activity (PA), sedentary behaviour (SB), and sleep, as interdependent components of daily time use. However, no previous reviews have synthesised evidence on economic costs associated with these movement behaviours. The aim of this systematic review was to synthesise evidence on economic costs of insufficient PA, excessive SB, and inadequate sleep duration. Literature searches were conducted in Open Dissertations, PsycINFO, PubMed/MEDLINE, Scopus, SPORTDiscus, and Web of Science. Publications that provided estimates of total, direct, or indirect monetary cost of any of the three behaviours in the general adult population were included. Out of 21,418 screened references, 40 papers met the inclusion criteria (77.5% from high-income countries; 77.5% on economic costs of PA only; 90% reporting estimates based on self-reported movement-behaviour data). In Canada (the only country for which estimates of economic costs of all three movement behaviours were available) the combined total annual cost of insufficient PA, excessive SB, and inadequate sleep duration was 9.2 billion USD or 0.41% of the gross domestic product. In studies using the population attributable fraction (PAF) based approach, the total annual national costs of insufficient PA and excessive SB ranged from 1.94 to 9.78 billion USD and 1.82 to 1.97 billion USD, respectively. In the only study that used the PAF-based approach to estimate the cost of inadequate sleep duration, the total national cost in Canada was 0.44 billion USD per year. Globally, billions USD per year are cumulatively spent on adverse consequences of unhealthy movement behaviours. However, the exact cost could not be estimated, because evidence was available only for a limited number of mostly high-income countries. In the included studies, the cost of insufficient PA was approximately 2-4 times higher than the cost of excessive SB and 16 times higher than the cost of inadequate sleep duration; hence it seems that public health initiatives should focus primarily on promoting PA. More research is needed, particularly in low- and middle-income countries, using device-based movement-behaviour data, and exploring costs of excessive SB, inadequate sleep duration, and not meeting the overall 24-hour movement guidelines.
A male infant presented at three months of age with generalized ataxia, hypotonia, aspiration of liquids and recurrent generalized seizures. He was treated with levetiracetam and phenobarbital. Methods: Extensive testing, including whole genome sequencing was done. He had two known pathogenic variants in the HMBS gene: p.R167Q [maternal] and p.T35M [paternal]. Plasma and urine exhibited high concentrations of 5-aminolevulinic acid, porphobilinogen, and uroporphyrin 1. Activity of hydroxymethylbilane synthase in red blood cells of the child was markedly reduced [18 nmol uroporphyrin/ g hemoglobin /h; reference range: 60-335]; it was ∼50% of normal in parents. The findings supported the diagnosis of biallelic severe HMBS deficiency with severe disease phenotype. A 5-day course of intravenous heme led to no observable clinical improvement. Orthotopic liver transplantation at the age of 15 months led to only mild transient improvement. Developmental delays and seizures persisted. MRI scans of the brain showed progressive white matter volume loss, cystic changes, and multifocal supratentorial signal abnormalities. He died at 88 months of age. Findings at autopsy of the brain showed patchy gliosis and leukodystrophy. We also review 11 previously reported cases. No effective disease-modifying therapy currently exists for biallelic HMBS deficiency. Substantial neurological injury is present by the time of diagnosis and seems irreversible.
Change isn't something new to Medicine. Since the beginning of times, Medicine has been forced to, progressively, adapt according to scientific, biological and technological discoveries as well to the social and ethical transformations. Nowadays, the evolution of Medicine points out to the gradual introduction of new supporting tools in healthcare, such as Artificial Intelligence (AI), which can be very challenging. The challenges are not the ones relate to the introduction of AI or other technological tools, per si, since that seems inevitable, but how their introduction may impact some cornerstones of Medicine Law, such as physician-patient relationship, consent and even physicians' civil liability. Summing up, we are dealing with newer challenges of even older issues. In this article, we aim to review the doctor-patient relationship, duty of information and consent and medical civil liability in the light of the introduction of AI supporting tools in healthcare.
2025 European guidelines recommended transition from cytology to HPV-based cervical cancer screening. We compared both strategies in a pilot in Poland. Eligible, consenting women aged 30-59 years underwent centralized 1:1 randomization to HPV-testing or cytology (HPV or cytology arm, respectively) in 30-39, 40-49, and 50-59 years age strata in 27 clinics. Arm assignment was unblinded. HPV positive samples underwent liquid-based cytology (LBC) triage. If normal, another LBC was performed in six months. Abnormal LBC triggered colposcopy. If both LBCs were normal, p16/Ki-67 immunocytochemistry and FAM19A4/miR124-2 methylation tests were performed. Either positive triggered referral to colposcopy. In the cytology arm, abnormal results triggered another cytology after six months or colposcopy, according to routine protocols. Cervical intraepithelial neoplasia grade 2 or worse (CIN2+) detection rate in the population intended to treat was the main outcome. NCT04111835-Clinicaltrials.gov. Between 28 October 2019 and 31 December 2022, 16,795 and 16,707 women underwent primary HPV or cytological testing, respectively. 702/16,795 (4.2%; 95% CI: 3.9%-4.5%) and 499/16,707 women (3.0%; 95% CI: 2.7%-3.3%), were referred for colposcopy in the HPV and cytology arm, respectively (RR = 1.40; 95% CI: 1.25-1.57). CIN2+ was detected in 137 women (0.82%; 95% CI: 0.69-0.96%) and in 71 women (0.42%; 95% CI: 0.34-0.54%; OR = 1.93; 95% CI: 1.34-2.77), while CIN grade 3 or worse (CIN3+) was detected in 69 women (0.41%; 95% CI: 0.32%-0.52%) and in 35 women (0.21%; 95% CI: 0.15%-0.29%; OR = 1.99; 95% CI: 1.16-3.42) in the HPV and cytology arm, respectively. In HPV positive women with two normal LBCs immunocytochemistry and methylation detected 4/9 (44.4%) and 7/9 (77.8%) CIN2+ cases, respectively. HPV-based screening may almost double CIN2+ detection compared to cytology. It however yields more positive screening results and colposcopies. Smooth transition from cytology to HPV-based screening requires proper triage strategies and additional colposcopy services. Methylation seems to detect more CIN2+ than immunocytochemistry in HPV positive women with two normal LBCs. Polish Ministry of Health.