Evaluation of ChatGPT as a Counselling Tool for Italian-Speaking MASLD Patients: Assessment of Accuracy, Completeness and Comprehensibility.

BACKGROUND: Artificial intelligence (AI)-based chatbots have shown promise in providing counseling to patients with metabolic dysfunction-associated steatotic liver disease (MASLD). While ChatGPT3.5 has demonstrated the ability to comprehensively answer MASLD-related questions in English, its accuracy remains suboptimal. Whether language influences these results is unclear. This study aims to assess ChatGPT's performance as a counseling tool for Italian MASLD patients. METHODS: Thirteen Italian experts rated the accuracy, completeness and comprehensibility of ChatGPT3.5 in answering 15 MASLD-related questions in Italian using a six-point accuracy, three-point completeness and three-point comprehensibility Likert's scale. RESULTS: Mean scores for accuracy, completeness and comprehensibility were 4.57 ± 0.42, 2.14 ± 0.31 and 2.91 ± 0.07, respectively. The physical activity domain achieved the highest mean scores for accuracy and completeness, whereas the specialist referral domain achieved the lowest. Overall, Fleiss's coefficient of concordance for accuracy, completeness and comprehensibility across all 15 questions was 0.016, 0.075 and -0.010, respectively. Age and academic role of the evaluators did not influence the scores. The results were not significantly different from our previous study focusing on English. CONCLUSION: Language does not appear to affect ChatGPT's ability to provide comprehensible and complete counseling to MASLD patients, but accuracy remains suboptimal in certain domains.

The autoimmune landscape of Porto-sinusoidal vascular disorder: What the rheumatologist needs to know.

Porto-sinusoidal vascular disorder (PSVD) encompasses a group of vascular disorders characterized by lesions of the portal venules and sinusoids with clinical manifestations ranging from non-specific abnormalities in serum liver enzymes to clinically overt portal hypertension and related complications. Several reports have documented cases of PSVD in patients with systemic autoimmune conditions, such as systemic lupus erythematosus, systemic sclerosis, and rheumatoid arthritis. It is of note that these diseases share specific pathophysiological features with PSVD, including endothelial dysfunction, vascular inflammation, and molecular signatures. This narrative review aims to summarize the current knowledge on the association between PSVD and systemic autoimmune diseases, emphasizing the importance of promptly recognizing this condition in the rheumatological practice, and highlighting the key aspects where further research is necessary from both pathogenic and clinical perspectives.

The Use of a New Dedicated Electrocautery Lumen-Apposing Metal Stent for Gallbladder Drainage in Patients with Acute Cholecystitis.

Aims: Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our study aims to evaluate the technical and clinical success, safety, and feasibility of endoscopic ultrasonography-guided gallbladder drainage using a new dedicated LAMS. Methods: This is a retrospective multicenter study that included all consecutive patients not suitable for surgery who were referred to a tertiary center for EUS-GBD using a new dedicated electrocautery LAMS for acute cholecystitis at eight different centers. Results: Our study included 54 patients with a mean age of 76.48 years (standard deviation: 12.6 years). Out of the 54 endoscopic gallbladder drainages performed, 24 (44.4%) were cholecysto-gastrostomy, and 30 (55.4%) were cholecysto-duodenostomy. The technical success of LAMS placement was 100%, and clinical success was achieved in 23 out of 30 patients (76.67%). Adverse events were observed in two patients (5.6%). Patients were discharged after a median of 5 days post-stenting. Conclusions: EUS-GBD represents a valuable option for high-surgical-risk patients with acute cholecystitis. This new dedicated LAMS has demonstrated a high rate of technical and clinical success, along with a high level of safety.

Hepatitis C Virus Infection in the Elderly in the Era of Direct-Acting Antivirals: Evidence from Clinical Trials and Real Life.

The introduction of direct-acting antiviral agents (DAAs) into clinical practice has revolutionized the therapeutic approach to patients with chronic hepatitis C virus (HCV) infection. According to the most recent guidelines, the first line of treatment for HCV infection involves the use of one of three pan-genotypic DAA combinations, sofosbuvir/velpatasvir (SOF/VEL), glecaprevir/pibrentasvir (GLE/PIB), and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). These drugs have been shown to be effective and safe in numerous clinical trials and real-world studies, but special populations have been neglected. Among the special populations to be treated are elderly patients, whose numbers are increasing in clinical practice. The management of these patients can be challenging, in particular due to multiple comorbidities, polypharmacotherapy, and potential drug-drug interactions. This narrative review aims to summarize the current scientific evidence on the efficacy and safety of DAAs in the elderly population, both in clinical trials and in real-life settings. Although there is still a paucity of real-world data and no clinical trials have yet been conducted in the population aged ≥ 75 years old, some considerations about the efficacy and safety of DAAs in the elderly can be made based on the results of these studies. The pan-genotypic associations of DAAs appear to be as efficacious and safe in the elderly population as in the general population; this is both in terms of similar sustained virologic response (SVR) rates and similar frequencies of adverse events (AEs). However, further studies specifically involving this patient population would be necessary to confirm this evidence.

Advances towards circular economy policies in the EU: The new Ecodesign regulation of enterprise servers.

The concept of a circular economy has been widely accepted by governments and industries. In Europe, the European Commission adopted the Circular Economy package in 2015. The Ecodesign Directive has been identified as one of the most suitable legislative tools for achieving some of the objectives in the package because it has the potential to translate the circular economy principles into specific product material efficiency requirements. This paper applies the Ecodesign policy process to "enterprise servers" to illustrate how circular economy strategies can be implemented by European product policies. Indeed, the paper introduces a potential novel approach to "operationalize" circular economy principles in product policies. The evolution of the material efficiency requirements for a more circular economy is described up to their final formulation, which is the one in the published Ecodesign regulation. This legal act includes requirements on design for disassembly, firmware availability, data deletion, and presence of critical raw materials. The process for enterprise servers has been successful as the early discussions between stakeholders, policymakers and experts, supported by appropriate metrics along an iterative debate, comes to the publications of material efficiency requirements in a regulation. This study represents a 'first-of-a-kind' experience, and sets precedents for the development of similar requirements for other product groups.

Accounting for the environmental benefits of remanufactured products: Method and application.

Although the importance of reusing products has been stated frequently, both in legislation and by academics, the scientific literature does not provide comprehensive and systematic methods of assessing the reuse of a generic product from an environmental point of view. Moreover, the definitions of reuse provided in the literature and legislation are not always consistent. This article introduces an original classification of different types of reuse, including some suggested definitions. It then focuses on remanufacturing, a type of reuse in which a used product (or its components) is returned to at least its original performance level. The article describes the development of a method for assessing, from a life-cycle perspective, the potential environmental benefits of remanufacturing energy-related products. The method includes several novel aspects: it helps to analyse possible trade-offs between potential environmental impacts and energy efficiency; it allows the independent modelling of some parameters that influence product reuse; and it can be applied even at the early stages of the design process, when some specifications may not yet have been defined. The environmental impacts of a product's life-cycle stages are used as input parameters for the assessment. The method is then applied to an enterprise server, a case-study product for which remanufacturing is a current market practice. A sensitivity analysis is included to check how uncertainties could affect the overall results. The results of the case study show that remanufactured servers, even those that are less energy efficient, can have lower environmental impacts than new ones. For example, reusing some components (e.g. hard disk drives and memory cards) is environmentally beneficial even if the remanufactured server consumes up to 7% more energy than a newly manufactured server. The case study also demonstrates how the method proposed could be used in the context of product policy discussions.