Recenti progressi in medicina最新文献

Collagenous gastritis is a rare pediatric disease characterized by chronic gastritis with superficial, irregular mucosal involvement, focal atrophy of the gastric glands, an inflammatory infiltrate predominantly composed of lymphocytes and plasma cells, and areas of epithelial erosion. Focal collagen deposition in the subepithelial region of the lamina propria is a hallmark feature. Gastric epithelial erosions can cause hematemesis and, more generally, occult gastrointestinal bleeding, leading to chronic iron-deficiency anemia. Currently, there are no established management guidelines, and data on long-term follow-up are lacking. We report a clinical case of collagenous gastritis, emphasizing its features and therapeutic approach.

Artificial Intelligence (AI) is increasingly promoted in healthcare as a driver of efficiency and sustainability. Yet this narrative may overlook systemic effects that risk widening inequalities and weakening the human dimension of care. This editorial interprets AI adoption through the lens of the Jevons Paradox: efficiency gains may expand demand and clinical workload, creating a "productivity trap" that ultimately reduces time for patient relationships. It also addresses the risk of technological dependency and erosion of professional autonomy. We propose a "Promethean" model of AI governance, grounded in anticipatory reflection, territorial equity, protection of care time, and sustainability. The aim is not to slow innovation, but to guide it toward a healthcare system that is more just, human, and accountable.

In patients with chronic respiratory failure and a stable oxygen requirement ≤4 L/min, switching from liquid oxygen to oxygen concentrators represents a potential strategy to optimize home oxygen therapy, although structured real-world experiences remain limited. This study describes the experience of the COMBO Project implemented by the Turin City Local Health Authority, aimed at the planned implementation of a therapeutic switch from liquid oxygen to oxygen concentrators and the assessment of its organizational and management outcomes. A retrospective descriptive-comparative observational study was conducted by comparing two periods (May-December 2023 and May-December 2024). A total of 129 patients eligible for the therapeutic switch were analyzed; for patients who completed the transition, a descriptive counterfactual scenario was developed to estimate the expected economic impact. The switch was successfully completed by 104 patients (80.6%). During the observation period, a 69% increase in the use of oxygen concentrators and a 3.9% reduction in liquid oxygen consumption were observed. Comparison with the counterfactual scenario showed an expected cost reduction of 2.56%. The main critical issues related to the transition process involved clinical, logistical, and prescribing aspects among patients who did not complete the switch. The COMBO Project experience demonstrates the feasibility of a structured therapeutic switch model in territorial healthcare settings; the value of the intervention lies primarily in process organization and in the coordinating role of the Territorial Pharmaceutical Service, while the observed economic impact should be interpreted as an expected benefit. The model appears potentially replicable in similar healthcare contexts.

Gastric cancer (GC) and esophagogastric junction cancer (EGJC) impose a severe global burden, with traditional treatments plagued by poor efficacy, high toxicity, and chemoresistance. Claudin 18.2 (CLDN18.2), a highly tissue-specific target, is abnormally overexpressed in GC/EGJC with limited overlap with HER2 positivity or PD-L1 CPS ≥5, making it ideal for precision therapy. Zolbetuximab, a CLDN18.2-targeted ADC, exerts anti-tumor effects via "targeted binding-endocytosis-MMAE release", reducing systemic toxicity versus traditional chemotherapy. Pivotal trials (MONO, FAST, SPOTLIGHT/GLOW, ILUSTRO) confirmed its monotherapy efficacy and superior PFS/OS when combined with chemotherapy (EOX, mFOLFOX6, CAPOX) in CLDN18.2-positive (≥70% staining), HER2-negative advanced GC/EGJC patients, with manageable safety. SPOTLIGHT/GLOW laid the foundation for its first-line approval. Post-approval, it may expand to other CLDN18.2-positive tumors and neoadjuvant/adjuvant therapy, with combination regimen optimization. However, MMAE's long-term cumulative toxicity, uncertain safety in special populations, and rare severe adverse reactions require real-world validation. This review systematically summarizes zolbetuximab's research progress, providing a reference for clinical application and future studies.

Background: Antimicrobial resistance (AMR) is a major global public health challenge, particularly in Italy, where surveillance data show high resistance rates for several pathogen-antibiotic combinations. This study aimed to evaluate trends in systemic antibiotic consumption in hospital settings within a Local Health Authority in Emilia-Romagna using PNCAR indicators.

Materials and methods: A retrospective analysis of systemic antibiotic consumption (Anatomical Therapeutic Chemical Classification System - ATC, class J01) was conducted at the Piacenza Local Health Authority between 2021 and 2024, using the WHO AWaRe classification. Data were expressed as DDD and DDD per 100 bed-days across seven hospital departments. The European Surveillance of Antimicrobial Consumption (ESAC) indicator for broad-spectrum antibiotics was calculated. An economic analysis of antibiotic expenditure per inpatient day was also performed and compared with regional and national benchmarks.

Results: The hospital antibiotic consumption (ATC J01) showed an overall decline, decreasing from 113.3 DDD/100 bed-days in 2022 to 97.5 in 2024. AWaRe analysis revealed a marked reduction in Access antibiotics and a concomitant increase in Watch agents, while Reserve use remained stable. Amoxicillin-clavulanic acid and ceftriaxone were the most frequently prescribed antibiotics. The ESAC indicator remained stable at approximately 54%.

Conclusions: Contextualizing antibiotic consumption data within local epidemiology allows a more accurate interpretation of prescribing patterns and supports the development of tailored stewardship interventions. Integrating local monitoring with national surveillance systems could strengthen the evaluation of PNCAR targets.

We base this commentary on a direct experience: ten months after the initiation of peer review for one of our manuscripts submitted to a first-quartile journal, the process remains ongoing. This situation prompted us to reflect more broadly on a growing systemic problem in scientific publishing: reviewer fatigue and the increasing difficulty editors face in identifying qualified, willing reviewers. While peer review remains the cornerstone of scientific quality assurance, we believe its sustainability is increasingly threatened by an inherently imbalanced system that strongly incentivizes manuscript submission while offering little formal recognition for reviewing activity. In our view, reviewer fatigue is a multifactorial phenomenon. A key driver is the unpaid nature of peer review, which is typically performed during personal time in the context of rising clinical and administrative workloads, particularly in anesthesiology. This burden is compounded by the proliferation of scientific journals and the exponential growth in manuscript submissions, a trend further accelerated by the widespread adoption of artificial intelligence tools that lower barriers to manuscript production. Increasing subspecialization further narrows the pool of eligible reviewers, concentrating the reviewing burden on a limited number of already overextended experts. We also consider insufficient editorial triage an important and often underappreciated contributor. When manuscripts with fundamental methodological or conceptual flaws are routinely sent for external review, reviewer motivation declines and editorial timelines are unnecessarily prolonged. Additional factors - including limited training in peer review, lack of feedback, and absence of academic recognition - further erode the perceived value of reviewing. We discuss several potential strategies, including formal recognition systems, targeted use of AI for preliminary manuscript screening, and stricter desk rejection policies. In conclusion, we view reviewer fatigue as a systemic threat to the integrity and efficiency of peer review that demands urgent, balanced, and concrete action by the scholarly community.

The current practice of informed consent is often reduced to a bureaucratic and defensive formality, far removed from its original purpose. For the Slow Medicine movement, consent must instead reflect three core values: it must be uncluttered, that is, personalised and not overloaded; respectful of the patient's autonomy and pace; and fair, capable of bridging cultural and linguistic inequalities to ensure equitable understanding. Overcoming this 'bureaucratic burden' is essential to transforming a signed form into a genuine relationship of trust and active participation in care.

Phthalates are compounds widely used in everyday consumer products. They represent a ubiquitous source of exposure due to their ability to migrate from materials, leading to widespread environmental contamination and human exposure. Substantial evidence has demonstrated adverse effects on the endocrine, reproductive, and developmental systems, with particular vulnerability during fetal life and early childhood. Prenatal exposure has been associated with unfavorable perinatal outcomes as well as metabolic and neuroendocrine alterations. Although regulatory policies of the European Union have reduced exposure levels, critical issues persist due to the continued presence of phthalates in long-lasting consumer articles. Therefore, strengthened regulatory integration, biomonitoring, and prevention strategies are required to ensure enhanced protection of public health.

Introduction: Environmental diseases include a wide spectrum of pathologies whose development is influenced by physical, chemical and biological factors external to the individual. Recent WHO estimates show that 24% of global deaths are due to environmental factors as air pollution, climate change, toxic chemicals and poor hygiene. The Province of Alessandria, Piedmont, Italy, has been subjected to contamination due to industrial plants where hazardous materials have been used. To investigate the level of awareness of the population about environmental pathologies, the Research and Innovation Department of the Azienda Ospedaliero-Universitaria of Alessandria and ASL AL distributed a survey to secondary school students and citizens of Alessandria and Casale Monferrato, in two phases between 2022 and 2023.

Materials and methods: The sample comprises 230 participants equally divided by gender and with different levels of education. The survey explores knowledge of environmental causes of diseases and their impact on mortality and possible preventive measures.

Results: The majority of the sample associate environmental diseases with human pathologies (89.1%), with a higher awareness among students (91% compared to 86.6% of citizens). The main causes identified are air pollution (70.4%) and toxic substances in the air and water (64.8%). 84.8% identify cancer and 69.6% COPD as associated diseases. 56.4% estimate an impact of environmental factors between 10 and 15% on global mortality. The main preventive measures include the use of cleaner fuels (83.9%), improved hygiene measures (70%) and the promotion of sustainable mobility (70%).

Conclusions: This survey reveals a fair degree of awareness of environmental diseases, but also an underestimation of associated mortality. Therefore, it is necessary to improve education and communication on environmental risks through targeted campaigns and educational interventions. Future studies should broaden the sample and analyze percentage differences between subgroups to optimize educational and preventive actions.