Recenti Prog Med
· 2026 May · PMID 42095384
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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 ti...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.
Recenti Prog Med
· 2026 May · PMID 42095383
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Publisher ↗
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 d...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.
Recenti Prog Med
· 2026 May · PMID 42095382
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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...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.
Recenti Prog Med
· 2026 May · PMID 42095381
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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:...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.
This retrospective single-center study describes the use and content of Advance Care Planning (ACP) forms in a sample of 50 anonymized medical records of patients enrolled in a home-based primary palliative care program....This retrospective single-center study describes the use and content of Advance Care Planning (ACP) forms in a sample of 50 anonymized medical records of patients enrolled in a home-based primary palliative care program. ACP was documented in 62% of cases, with frequent reporting of hospitalization preferences (90.3%) and appointment of a healthcare proxy (90.3%), whereas treatment decisions and palliative sedation were less frequently addressed (45.2% and 16.1%, respectively). ACP discussions always involved the patient and the general practitioner (100%), with frequent participation of family members (87%) and palliative care nurses (61%), and only marginal involvement of other healthcare professionals (16%). These findings suggest that ACP is already integrated into clinical practice in this home-based primary palliative care setting; however, additional support may be needed to address more complex shared clinical decisions. Further, larger multicentric studies are needed to better understand the barriers and facilitators to ACP implementation in clinical practice.
The CAR-T therapies are characterized by high clinical, organizational, and economic complexity, requiring the adoption of dedicated governance models capable of ensuring equitable access, appropriateness, and sustainabi...The CAR-T therapies are characterized by high clinical, organizational, and economic complexity, requiring the adoption of dedicated governance models capable of ensuring equitable access, appropriateness, and sustainability. In this context, the Lazio Region has developed a regional network for the management of CAR-T therapies based on a multidisciplinary steering committee, a network of hospital centers, an informative platform, and a system for planning needs and assessing appropriateness. The system is based on the Real-World Data and a Horizon Scanning approach for the continuous updating of therapeutic indications. This experience represents an example of sustainable and replicable governance for the management of advanced therapies at the regional level.
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 g...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.
In this short essay, the authors address the potential duty of healthcare professionals to report to public authorities when a person with dementia admits to still driving their own vehicle. They do so in light of prelim...In this short essay, the authors address the potential duty of healthcare professionals to report to public authorities when a person with dementia admits to still driving their own vehicle. They do so in light of preliminary data from the fact-finding survey promoted by the Italian Association of Psychogeriatrics (AIP), which demonstrates that, on this issue, consensus is unclear and that professional practices are often adopted that are not always consistent with the broad regulatory framework. They then offer some practical advice, starting with the involvement of the person with dementia, an essential priority because, as all the evidence confirms, accountability and trust are essential prerequisites for the continuity and quality of 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 hum...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.
War hits the most vulnerable children hardest. In prolonged conflicts such as the one in the Gaza Strip, health and school infrastructure are destroyed, vaccinations and education are disrupted, while malnutrition and ch...War hits the most vulnerable children hardest. In prolonged conflicts such as the one in the Gaza Strip, health and school infrastructure are destroyed, vaccinations and education are disrupted, while malnutrition and child mortality rise sharply. Psychological trauma may last for decades. The open conflict involving the United States, Israel, and Iran - a war extending beyond national borders through direct attacks, bombardments, and indirect military actions - has already produced civilian casualties and regional instability with global economic and humanitarian consequences. In this context war emerges as one of the most powerful determinants of health. Its impact extends beyond the battlefield, influencing political and economic priorities even in distant societies and diverting resources away from health, education and social development. Outrage at these tragedies is therefore not merely an emotional response but a call to moral and civic responsibility.
The retrospective observational study by Assimakis et al. on Advance Care Planning (ACP) implemented in primary (or general) home palliative care found that 62% of medical records closed due to completion of the care pat...The retrospective observational study by Assimakis et al. on Advance Care Planning (ACP) implemented in primary (or general) home palliative care found that 62% of medical records closed due to completion of the care pathway contained a ACP in which the patient's wishes were documented in 83.9% of cases and that of the family members in 90.3%. The PCC was formulated by the General Practitioner (GP) with the patient in all cases except in cases of dementia or delirium, in which it was carried out with a family member previously appointed as a proxy by the patient. In 61% of cases, the community care nurse (district nurse) also contributed to the PCC. Advance will concerned possible hospitalization (90.3%), while indications on treatments (45.2%) and palliative sedation (16.1%) were less frequently documented. The study demonstrates that PCC can be implemented in daily care practices, even in general practice and in the community care, provided there is sufficient awareness and training on the topic. The latter are greatly facilitated by the presence of the Local Palliative Care Network.
Historically a model of excellence and international cooperation, the Cuban healthcare system is now in a state of documented collapse. With a density of 8.4 doctors per thousand inhabitants, the island is facing an unpr...Historically a model of excellence and international cooperation, the Cuban healthcare system is now in a state of documented collapse. With a density of 8.4 doctors per thousand inhabitants, the island is facing an unprecedented crisis: survival rates for childhood cancers have fallen from 80% to 65%, and nearly 100,000 people are on surgical waiting lists due to shortages of medicines, oxygen and anaesthetics. The structural causes lie in the tightening of the embargo, the effects of the pandemic and the recent cut-off of Venezuelan energy supplies, which is forcing hospitals to endure power cuts of up to twenty hours a day. The crisis also threatens public biotechnology innovation, a pillar of regional health sovereignty. The appeal urges the global medical community to break the silence, calling for the immediate suspension of sanctions on essential goods, the establishment of humanitarian corridors and the recognition of restrictions on care as a violation of fundamental human rights.