[Big hype about ChapGPT in medicine : Is it something for rhythmologists? What must be taken into consideration?] / Großer Hype um ChatGPT in der Medizin : Ist es etwas für den Rhythmologen? Was muss man bedenken?

ChatGPT, a chatbot based on a large language model, is currently attracting much attention. Modern machine learning (ML) architectures enable the program to answer almost any question, to summarize, translate, and even generate its own texts, all in a text-based dialogue with the user. Underlying technologies, summarized under the acronym NLP (natural language processing), go back to the 1960s. In almost all areas including medicine, ChatGPT is raising enormous hopes. It can easily pass medical exams and may be useful in patient care, diagnostic and therapeutic assistance, and medical research. The enthusiasm for this new technology shown even by medical professionals is surprising. Although the system knows much, it does not know everything; not everything it outputs is accurate either. Every output has to be carefully checked by the user for correctness, which is often not easily done since references to sources are lacking. Issues regarding data protection and ethics also arise. Today's language models are not free of bias and systematic distortion. These shortcomings have led to calls for stronger regulation of the use of ChatGPT and an increasing number of similar language models. However, this new technology represents an enormous progress in knowledge processing and dissemination. Numerous scenarios in which ChatGPT can provide assistance are conceivable, including in rhythmology. In the future, it will be crucial to render the models error-free and transparent and to clearly define the rules for their use. Responsible use requires systematic training to improve the digital competence of users, including physicians who use such programs.

[Splenic dysfunction in sickle cell disease: An update]. / Dysfonction splénique au cours de la drépanocytose : mise au point.

The spleen filters blood cells and contributes to the immune defense. The red pulp clears the blood from altered red blood cells via its unique microcirculatory network ; while the white pulp is a secondary lymphoid organ, directly connected to the bloodstream, whose specificity is the defense against encapsulated bacteria through the production of "natural" IgM in the marginal zone. Various health conditions can cause acquired impairment of the splenic function (or hyposplenism) directly and/or through therapeutic splenectomy. Hypo/asplenia is complicated by an increased susceptibility to encapsulated germ infections, but an increased risk of thrombosis and pulmonary hypertension has also been reported after surgical splenectomy. Homozygous sickle cell disease is the most common disease associated with functional asplenia. The latter appears early in childhood likely through repeated ischemic alterations caused by the sickling of red blood cells. In addition, specific complications such as hypersplenism and acute splenic sequestration can occur and may be life-threatening. We provide here an update on the role and physiology of the spleen, which will allow a better understanding of the pathophysiology of spleen damage and its consequences in sickle cell disease.

Fraction A: a new immunotherapeutic approach for ragweed pollinosis.

Fraction A, a concentrate derived from short ragweed extract by (NH4)2SO4 precipitation, contains all major allergens including antigen E. Therapeutic efficacy and safety of this alum-adsorbed product was evaluated in a multicenter double-blind clinical trial by comparing it to placebo in 131 randomly matched ragweed hay fever patients who were not treated for at least 1 year. Therapeutic response to fraction A injections was more significant than placebo (p less than 0.05) by investigators' evaluation, by average daily symptom score (1.097 vs. 1.378, p less than 0.05) during the peak ragweed season, or by average proportion of days in which medication was required (0.411 vs. 0.584, p = 0.01). Fraction A patients exhibited a significantly higher (p less than 0.0005) increase in hemagglutinating titer after treatment than placebo controls. Radioallergosorbent binding, evaluated in a subgroup of 31 patients before and after the ragweed season, was unchanged or decreased in 12 of 15 patients treated with fraction A. In contrast, 9 of 16 placebo-treated patients showed an increase in this index. Systemic effects were noted after 42 (1.5%) of 2.641 injections, while local reactions occurred at the rate of 2.3%. It is concluded that a single course of preseasonal immunotherapy wih alum-adsorbed fraction A is effective and relatively safe.