Recenti progressi in medicina最新文献

The aim of this work is to provide an updated overview of the use of sotorasib in advanced NSCLC harboring KRAS G12C mutations, summarizing both clinical trial and real-world evidence supporting its use in pretreated patients. The analysis focuses on efficacy, safety, and management of key toxicities, with particular attention to hepatic adverse events. Specific emphasis is also placed on intracranial activity and the use of sotorasib in special subgroups, including frail patients and those with comorbidities, providing a practical framework for daily clinical practice. The objective is to offer evidence-based guidance to facilitate treatment personalization and improve clinical outcomes in this complex patient population.

On professional social media, "I'm thrilled to share that our paper has just been published…" has become a ritualized form of self-promotion. This manuscript examines how such practices intersect with narcissism, algorithms, altmetrics and inequalities (notably gender), shifting attention from methodological quality to the researcher's visibility. It argues for a more reflexive use of social media in science, focusing on questions, methods, limits and implications for patients and policy, rather than on academic ego and visibility metrics.

Parenteral nutrition (PN), developed since the 1960s with the pioneering work of Dudrick, today represents a safe therapeutic option both as exclusive support and as an integration to enteral nutrition (EN). In critically ill patients, the risk of malnutrition is high due to profound metabolic alterations and nutritional therapy must be modulated according to the stage of the disease, avoiding both overfeeding and underfeeding. We present the case of a polytraumatized adolescent admitted to intensive care following a serious motorcycle accident. After an initial stabilization phase, early EN was initiated, increasing to 75% of the estimated caloric requirement. The onset of intolerance (vomiting and gastric stagnation - RG) associated with alterations in cholestasis and hepatic cytolysis indices necessitated reducing EN and considering alternative strategies. In the absence of improvement, supplemental parenteral nutrition (SPN) was initiated, with a high-protein mixture, prudent lipid modulation, and daily micronutrient supplementation. EN was maintained at a low dose for trophic purposes. With progressive clinical recovery, the reduction of RG, intestinal canalization, and EN were increased until reaching the caloric requirement, allowing the suspension of SPN and the subsequent transition to oral feeding. This case highlights how, in intensive care, EN and PN should not be considered hierarchical alternatives but rather complementary tools, to be modulated in a personalized and multidisciplinary manner. Targeted management ensures adequate nutritional intake, prevents complications, and improves clinical outcomes in critically ill patients.

Riassunto. Gli inibitori dei checkpoint (ICI) sono anticorpi monoclonali utilizzati come farmaci anti-neoplastici, indicati nel trattamento del carcinoma polmonare a piccole cellule (SCLC) in stadio avanzato. La perdita della tolleranza immunitaria dovuta a tali ICI è associata a disturbi immunomediati quali sindromi neurologiche paraneoplastiche. Data la rarità di questi casi (1% dei pazienti), gli specialisti e i laboratori devono essere pronti a riconoscere e caratterizzare queste eventi clinici. Presentiamo qui il raro caso di un paziente con SCLC avanzato trattato con inibitori del checkpoint che sviluppa un'encefalite come espressione di un evento paraneoplastico. La letteratura evidenzia come la rilevazione di un pannello esteso di autoanticorpi sia ormai diventata necessaria ai fini di una corretta diagnosi. Ma quali tipi di test di laboratorio sono davvero efficaci per l'individuazione di tali anticorpi e quindi per la corretta diagnosi? In questo caso clinico proponiamo l'uso combinato di test tissutali, immunoblot con antigeni ricombinanti e test cellulari. Questa strategia ci ha consentito l'individuazione di anticorpi anti-CRMP5, nel siero e nel liquido cefalo rachidiano del paziente considerati ad alto rischio. Il lavoro infine propone una flow chart diagnostica per la definizione delle specificità anticorpali.

Introduction and objectives: Clinical research is a strategic priority for the Italian healthcare system, with significant benefits for patients, economy and public health. The Clinical Advancement & Research Excellence (CARE) project identified the main obstacles that limit the full expression of the potential of clinical trials in Italy and proposed concrete solutions.

Methods: Starting with an online survey and following a simplified Delphi method, a multidisciplinary panel of experts identified the main barriers to clinical research in Italy and proposed a set of programmatic instances designed to improve the present situation. The final instances were formulated also based on the review by external stakeholders.

Results: The following programmatic instances were developed: 1) support the compliance with trial contract signing times; 2) create a national standard for Clinical Trial Sites (CTS) and a dedicated portal; 3) define the role of General Practitioners; 4) promote campaigns to raise awareness on the importance of clinical research.

Conclusions: The instances presented offer concrete insights to optimize the effectiveness and efficiency of clinical trials in Italy, ensuring international competitiveness and allowing patients to benefit from innovative therapies.

This article surveys how parts of the international medical-scientific and broader academic community have reacted to the current Israel-Palestine war. Journals such as BMJ, BMJ Global Health and The Lancet called for a ceasefire and documented the destruction of Gaza's health system; JAMA and NEJM used a more institutional tone, while Nature and Science reported on the collapse of research in Gaza. Professional bodies including the WMA, APHA, BMA and, more recently, the IAGS issued explicit statements. In Italy, orders and societies have responded unevenly. Regarding long-term outcomes of the war, the piece highlights evidence linking severe trauma, malnutrition and environmental exposures to possible epigenetic and intergenerational effects, and argues for symbolic and political pathways toward reconciliation and peace.