Panminerva medica最新文献

Obesity is a chronic disease associated with multiple health risks. Multimodal treatments including lifestyle interventions, pharmacotherapies and bariatric surgery should be the standard of care for obesity management. Bariatric surgery remains the most effective treatment yielding to sustainable weight loss (WL) of about 20-30%. Having understood better the role of the gut-brain axis on appetite, the field of obesity pharmacotherapy has been advancing rapidly. The recent approvals for glucagon-like peptide-1 (GLP-1) receptor agonist (RA) semaglutide 2.4 mg and the dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepatide as treatments for obesity have raised the bar for WL efficacy for the emerging obesity pharmacotherapies. Combining GLP-1 RA and other entero-pancreatic hormones including GIP, glucagon or amylin receptor agonists (RAs) as well as GIP receptor antagonists have shown promising data in early phases of clinical trials, with some progressing to phase III clinical trials. Notably, the combinations of GLP-1 RA, GIP and glucagon RA (retatrutide) have shown WL efficacy closing on to that observed in bariatric surgery. While entero-pancreatic hormone-based therapies have been the centre of attention for obesity pharmacotherapies, non- entero-pancreatic hormone treatments also hold promise. In this review, we present the future pharmacotherapies for weight management in people with obesity, focusing on entero-pancreatic hormone-based molecules.

Hepatitis D is considered the most severe form of viral hepatitis in humans, and chronic HDV hepatitis patients typically show a more rapid progression to cirrhosis and a higher mortality. While awareness of the disease has increased, it still remains underdiagnosed and of challenging treatment. Besides the physical toll that an HDV infection takes, the psychological impact needs to be considered when treating the infected patients. The aim of this work is to assess the psychological course of the disease from the patient's point of view and the clinicians tasked with the treatment of this specific class of patients. Two surveys covering emotional perspectives about the suspect of the disease, the diagnosis, the therapy, and the relationship between physicians and patients were administered to the clinicians and the patients. The patients reported their journey starting from sentiments of discouragement and fear upon diagnosis, the challenges associated with the disease's symptoms and the therapies, which evolved into a story of endurance, coexistence with the disease, and hope for future scientific advancements. The clinicians reported their challenges in caring for HDV-positive patients, which span from the sub-optimal referral rate, and the lack of therapeutic options to the occasional absence of patient compliance. Although, at the same time they describe elements of satisfaction that come from the efficacy of some treatments and the possibility of the development of novel drugs. In conclusion, the psychological toll that hepatitis D has on patients should be one of the factors driving communication with the physicians.

Introduction: Peripheral nerve injuries (PNIs) are challenging to manage due to complex anatomy and variable presentations. Artificial intelligence (AI) techniques are increasingly applied in medicine, and their role in PNI care is emerging. This systematic review aimed to summarize the current applications of AI in the diagnosis, prognosis, and treatment of PNIs.

Evidence acquisition: A comprehensive literature search of PubMed, Embase, and Web of Science was conducted (October 2024) for studies applying AI to human PNI diagnosis, prognostication, or treatment. After screening 1000 records, 42 studies met inclusion criteria. Data were extracted by two independent reviewers. Due to heterogeneity of outcomes, a narrative synthesis was performed complying with PRISMA guidelines.

Evidence synthesis: Included studies covered diverse AI applications: 20 on carpal tunnel syndrome, 10 on traumatic nerve injuries, 4 on brachial plexus injuries, 3 on nerve sheath tumors, 2 on regional anesthesia nerve blocks, and 1 each on peroneal nerve palsy, thermography-based diagnosis, and hand trauma. AI showed the greatest utility in diagnostics - for example, automating ultrasound and MRI image analysis with accuracy often comparable to experts. Notably, AI models accurately diagnosed carpal tunnel syndrome from ultrasound images and segmented nerves in medical images with high precision. Prognostic uses and intraoperative applications are promising but currently in early stages. Overall, AI tools demonstrated feasibility and improved speed or consistency in many PNI-related tasks, though most are still in validation phases.

Conclusions: AI is rapidly emerging as a valuable adjunct in PNI management. Diagnostic applications have progressed the most, while predictive modelling and surgical assistance remain nascent. The current evidence, although encouraging, is limited by small sample sizes, heterogeneity and lack of multicenter validation. With further development and proper integration, AI has the potential to enhance diagnostic precision, guide treatment decisions, and ultimately improve outcomes for patients with peripheral nerve injuries.

Interventional pulmonology has evolved over the past century from rudimentary endoscopic procedures to a highly specialized discipline encompassing a wide range of diagnostic and therapeutic techniques. This review outlines the historical milestones that have shaped the field, tracing the progressive development of flexible and rigid bronchoscopy, thoracic ultrasound, robotic systems, and advanced imaging modalities such as cone-beam CT. Each innovation has contributed to enhancing the accuracy, safety, and efficacy of interventions for various pulmonary diseases, including malignancies, interstitial lung disease, airway obstruction, and pleural disorders. The review also explores the role of pioneering figures whose vision and experimentation laid the foundation for modern practices. From Killian's first bronchoscopic foreign body removal to the latest robotic navigation systems, the trajectory of interventional pulmonology illustrates a dynamic interplay between technological advancement and clinical need.

Background: Osteoporosis is a chronic disease affecting individual, public and social health. Few data are available about the awareness of osteoporosis in Italy. The main purpose of our study is to evaluate the perception of osteoporosis in a selected sample of subjects of different age and sex.

Methods: This is a survey involving 299 adults (aged 18-75 years) designed to assess knowledge about osteoporosis and fracture risk conducted by a multidisciplinary research team of LUISS Guido Carli University.

Results: The knowledge of osteoporosis resulted almost high among the participants (97%) and most of them considered it a disease (86.1%). Most respondents (30.5%) did not know if they might be at risk of osteoporosis, especially the youngest (43.5%). A high percentage of participants (73.8%) considered a family history of osteoporosis the principal risk factor for bone loss, while only 8.9% thought that moderate to vigorous physical activity could favor bone loss. Many women (17.4%) did not consider menstrual irregularities a risk factor for osteoporosis. As for nutrients, 79.5% and 89.4% of subjects, respectively, thought that vitamin D and calcium might be useful to prevent bone loss. The majority of sample (74.8%) did not know the public and social impact of osteoporosis.

Conclusions: Although this survey involved a selected population and, thus, it cannot reflect the Italian general knowledge of osteoporosis, it might contribute to estimate the actual awareness of osteoporosis among people, regardless of their current bone health status, highlighting areas for further educational and research efforts.

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction. Ventricular arrhythmias may complicate acute SCAD presentation but the impact of ventricular arrhythmias on clinical outcomes is not well-established. This systematic review aimed to compare characteristics and outcomes of SCAD patients with or without concomitant ventricular arrhythmias.

Evidence acquisition: A systematic literature search was conducted using PubMed and Embase databases. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed using random-effects model.

Evidence synthesis: Four studies enrolling 2365 SCAD patients were included. The pooled prevalence of ventricular arrhythmias was 9.0% (95% CI: 6.0; 14.0, I²=87%) of patients with SCAD. Patients with ventricular arrhythmias were more likely to present with ST-segment elevation myocardial infarction (OR: 3.73, 95% CI: 2.50; 5.57, P<0.0001; I²=0%) and to undergo percutaneous coronary intervention (OR: 2.07, 95% CI: 1.29; 3.32, P=0.0025; I²=0%) than the entire SCAD cohort. They were more likely to have more in-hospital adverse events such as cardiac arrest (OR: 190.61, 95% CI: 4.39; 8275.52, P=0.0064; I²=85%), death (OR: 6.35, 95% CI: 3.04; 13.27, P< 0.0001; I²=0%), stroke (OR: 5.68, 95% CI: 2.00; 16.14, P=0.0011; I²=0%), cardiogenic shock (OR: 17.44, 95% CI: 1.50; 203.06, P=0.0225; I²=65%) and heart failure (OR: 6.98, 95% CI: 2.90; 16.81, P<0.0001; I²=57%) than the entire SCAD cohort. In addition, they experienced more adverse events in terms of all-cause death (OR: 5.76, 95% CI: 1.30; 25.51, P=0.021; I²=2%) and composite events (OR: 1.86, 95% CI: 1.07; 3.23, P=0.0267; I²=0%) at a mean follow-up of 4.26 years.

Conclusions: SCAD patients with concurrent ventricular arrhythmias were more likely to experience in-hospital clinical adverse events such as cardiac arrest, stroke, cardiogenic shock, heart failure, and death than the entire SCAD cohort as well as more death and composite adverse events during follow-up.

Non-communicable diseases (NCDs) like hypertension, type 2 diabetes, hyperlipidemia, and obesity, are a leading cause of mortality and have shown rising prevalence trends over the last few decades. Lifestyle interventions, particularly diet and physical activity, are an effective approach to addressing the underlying risk factors of these preventable NCDs, but their integration into the primary care practice remains underutilized. This review synthesizes evidence from systematic reviews and meta-analyses published between 2019 and 2024 to provide evidence-based recommendations for the integration of lifestyle interventions into primary care pathways. The included articles were noted for their risk of bias because of poor study design. While consideration must be given to the quality of evidence for these interventions because of the risk of bias, there is good evidence to support the use of several types of interventions including: diet modification (e.g. food replacement, calorie restriction, intermittent/periodic fasting); diet education and counselling; individual and group-based exercise interventions; interventions that aim to promote general physical activity in daily life; as well as combined dietary and physical activity interventions delivered individually, in groups, at a community level as well as through smartphone-supported applications. It is important for the health and care community to explore and implement alternative means of generating evidence, integrating lifestyle interventions into care pathways and increasing investment in the lifecycle of these interventions, which can promote health and prevent disease.