ChatGPT and dermatology.

Since the development of the artificial intelligence (AI), several applications have been proposed. Among these, the intersection of AI and medicine has sparked a wave of innovation, revolutionizing various aspects of healthcare delivery, diagnosis, and treatment. A review of the current literature was performed to evaluate the possible applications of ChatGPT (OpenAI, San Francisco, CA, USA) in the dermatological field. A total of 20 manuscripts were collected in the present review, reporting several potential applications of ChatGPT in dermatology, ranging from clinical practice to patients' support. The convergence of ChatGPT and dermatology represents a compelling synergy that transcends traditional boundaries of healthcare delivery. As AI continues to evolve and permeate every facet of medicine, ChatGPT stands at the forefront of innovation, empowering patients and clinicians alike with its conversational prowess and knowledge dissemination capabilities.

Nocturnal blood pressure patterns and cardiovascular outcomes in patients with masked hypertension.

Masked hypertension (MHT) is characterized by normal clinic and above normal 24-hour ambulatory blood pressure (BP) levels. We evaluated clinical characteristics and CV outcomes of different nocturnal patterns of MHT. We analyzed data derived from a large cohort of adult individuals, who consecutively underwent home, clinic, and ambulatory BP monitoring at our Hypertension Unit between January 2007 and December 2016. MHT was defined as clinic BP <140/90 mm Hg and 24-hour BP ≥ 130/80 mm Hg, and stratified into three groups according to dipping status: (a) dippers, (b) nondippers, and (c) reverse dippers. From an overall sample of 6695 individuals, we selected 2628 (46.2%) adult untreated individuals, among whom 153 (5.0%) had MHT. In this group, 67 (43.8%) were nondippers, 65 (42.5%) dippers, and 21 (13.7%) reverse dippers. No significant differences were found among groups regarding demographics, clinical characteristics, and prevalence of risk factors, excluding older age in reverse dippers compared to other groups (P < 0.001). Systolic BP levels were significantly higher in reverse dippers than in other groups at both 24-hour (135.6 ± 8.5 vs 130.4 ± 6.0 vs 128.2 ± 6.8 mm Hg, respectively; P < 0.001) and nighttime periods (138.2 ± 9.1 vs 125.0 ± 6.3 vs 114.5 ± 7.7 mm Hg; P < 0.001). Reverse dipping was associated with a significantly higher risk of stroke, even after correction for age, gender, BMI, dyslipidemia, and diabetes (OR 18.660; 95% IC [1.056-33.813]; P = 0.046). MHT with reverse dipping status was associated with higher burden of BP and relatively high risk of stroke compared to both dipping and nondipping profiles, although a limited number of CV outcomes have been recorded during the follow-up.

Clustering in light nuclei and their effects on fusion and pre-equilibrium processes / Agrupamiento de núcleos ligeros y sus efectos en la fusión y procesos de pre-equilibrio

Summary The study of heavy ion nuclear reactionis an important tool to observe and disentangle different and competing mechanisms, which may arise in the different energy regimes. In particular, at relatively low bombarding energy, it is quite interesting the comparison between pre-equilibrium and thermal emission of light charged particles from hot nuclear systems [1-6]. Indeed, the nuclear structure of the interacting partners can be strongly correlated to the dynamics, especially at energies close to the Coulomb barrier, and this effect emerges when some nucleons or clusters of nucleons are either emitted or captured. In particular, a major attention has been devoted, in the last years, to the possible observation of cluster structure effects in the competing nuclear reaction mechanisms, especially when fast processes are involved. At this purpose, the four reactions 16O+30Si at 111 MeV, 16O+30Si at 128 MeV, 18O+28Si at 126 MeV, 19F+27Al at 133 MeV have been measured to study the onset of pre-equilibrium in an energy range where, for central collisions, complete fusion is expected to be the predominant mode. Experimental data were collected using the GARFIELD + RCo array [7], fully equipped with digital electronics at the LegnaroNational Laboratories. The comparison between experimental data and different model predictions have been performed: in particular, both dynamical models based either on Stochastic Mean Field (TWINGO) or Anti-symmetrized Molecular Dynamics and fully statistical models (GEMINI++) have been considered. Simulated events are filtered through a software replica of the apparatus, to take into account all possible distortions of the experimental distributions due to the finite size of the apparatus.

Resumen El estudio de la reacción nuclear iónica pesada es una herramienta importante para observar y esclarecer los diferentes mecanismos que compiten entre sí, que pueden surgir en los diferentes regímenes energéticos. En particular, a una energía de bombardeo relativamente baja, es bastante interesante la comparación entre el preequilibrio y la emisión térmica de partículas ligeras cargadas por sistemas nucleares calientes [1-6]. De hecho, la estructura nuclear del grupo que interactúa puede estar fuertemente correlacionada con la dinámica, especialmente en energías cercanas a la barrera de Coulomb, y este efecto surge cuando se emiten o capturan algunos nucleones o grupos de nucleones. En particular, se ha dedicado una gran atención, en los últimos años, a la posible observación de los efectos de la estructura del agrupamiento en los mecanismos de reacción nuclear competitivos, especialmente cuando se trata de procesos rápidos. Para este propósito, las cuatro reacciones 16O + 30Si a 111 MeV, 16O + 30Si a 128 MeV, 18O + 28Si a 126 MeV, 19F + 27Al a 133 MeV se han medido para estudiar el inicio del preequilibrio en un rango de energía en el cual, para colisiones centrales, se espera que la fusión completa sea el modo predominante. Los datos experimentales se recogieron utilizando la matriz GARFIELD + RCo [7], totalmente equipada con electrónica digital en los Laboratorios Nacionales Legnaro. La comparación entre los datos experimentales y las diferentes predicciones de modelos se han llevado a cabo: en particular, se han considerado los modelos dinámicos basados en el Campo Medio Estocástico (TWINGO) o Dinámica Molecular Antisimétrica y modelos completamente estadísticos (GEMINI ++). Los eventos simulados se filtran a través de una réplica de software del aparato, para tener en cuenta todas las posibles distorsiones de las distribuciones experimentales debido al tamaño finito del aparato.

Prevalence and clinical outcomes of white-coat and masked hypertension: Analysis of a large ambulatory blood pressure database.

The aim of this study was to analyze prevalence and clinical outcomes of the following clinical conditions: normotension (NT; clinic BP < 140/90 mm Hg; 24-hour BP < 130/80 mm Hg), white-coat hypertension (WCHT; clinic BP ≥ 140 and/or ≥90 mm Hg; 24-hour BP < 130/80 mm Hg), masked hypertension (MHT; clinic BP < 140/90 mm Hg; 24-hour BP ≥ 130 and/or ≥80 mm Hg), and sustained hypertension (SHT; clinic BP ≥ 140 and/or ≥90 mm Hg; 24-hour BP ≥ 130 and/or ≥80 mm Hg) in a large cohort of adult untreated individuals. Systematic research throughout the medical database of Regione Lazio (Italy) was performed to estimate incidence of myocardial infarction (MI), stroke, and hospitalizations for HT and heart failure (HF). Among a total study sample of 2209 outpatients, 377 (17.1%) had NT, 351 (15.9%) had WCHT, 149 (6.7%) had MHT, and 1332 had (60.3%) SHT. During an average follow-up of 120.1 ± 73.9 months, WCHT was associated with increased risk of hospitalization for HT (OR 95% CI: 1.927 [1.233-3.013]; P = .04) and HF (OR 95% CI: 3.449 [1.321-9.007]; P = .011). MHT was associated with an increased risk of MI (OR 95% CI: 5.062 [2.218-11.550]; P < .001), hospitalization for HT (OR 95% CI: 2.553 [1.446-4.508]; P = .001), and for HF (OR 95% CI: 4.214 [1.449-12.249]; P = .008). These effects remained statistically significant event after corrections for confounding factors including age, BMI, gender, smoking, dyslipidaemia, diabetes, and presence of antihypertensive therapies.

Impact of hypertension on global cardiovascular risk stratification: analysis of a large cohort of outpatient population in Italy.

BACKGROUND: Control of hypertension remains a major unmet need, worldwide. HYPOTHESIS: To test whether the presence of hypertension may improve global cardiovascular (CV) risk stratification and achievement of therapeutic targets for CV risk factors in adult outpatients in Italy. METHODS: Physicians were asked to submit data covering the first 10 consecutive adult outpatients. All data were centrally analyzed for global CV risk assessment and rates of control of major CV risk factors, mostly blood pressure (BP) levels, in different high-risk subgroups of hypertensive patients. RESULTS: Overall, 1078 physicians collected data of 9864 outpatients (46.7% females, age 66.1 ± 10.3 years) with valuable data on BP levels, among which 7147 (72.5%) had a diagnosis of hypertension and 2717 (27.5%) were normotensive subjects. Hypertensive patients were older and had a higher prevalence of major risk factors, including smoking, obesity, dyslipidemia, and family history of cardiovascular disease, as well as comorbidities, than did normotensive subjects (P < 0.001 for all comparisons). Despite worse control of BP (66.9% vs 36.2%, P < 0.001), high-density lipoprotein cholesterol (40.5% vs 37.4%, P < 0.005), triglycerides (72.1% vs 67.8%, P < 0.001), and fasting plasma glucose (71.2% vs 67.0%, P < 0.005), hypertension was associated with larger availability and frequency of diagnostic examinations and greater use of antihypertensive, glucose-lowering, and lipid-lowering drugs, as well as antiplatelet agents, compared with normotension (P < 0.001). CONCLUSIONS: Presence of hypertension significantly improved clinical data collection and CV risk stratification. Such an approach, however, was not paralleled by better control of major CV risk factors.

High blood pressure, ventricular tachycardia and transient left ventricular dysfunction: do not forget pheocromocytoma.

Pheochromocytoma is a neuroendocrine tumour of the adrenal gland that secretes an excessive amount of catecholamines, leading to a rapid rise and fall in blood pressure, headache, sweating and palpitations. The clinical scenario of pheochromocytoma, however, may be extremely variable and may include atypical cardiovascular manifestations, eventually leading to delays or mistakes in diagnosis. This issue is crucial since a missed diagnosis of pheochromocytoma may imply fatal consequences. This article reports a case of pheochromocytoma presenting with quite atypical cardiovascular manifestations such as transient left ventricular dysfunction and ventricular tachycardia. The pathophysiological determinants underlying uncommon clinical presentations of pheochromocytoma are also discussed. Received for publication 19 May 2011; accepted for publication 10 June 2011.

Angiotensin type 2 receptor in hypertensive cardiovascular disease.

PURPOSE OF REVIEW: The renin angiotensin system plays a key role in the development of hypertension-induced cardiovascular remodeling and cardiovascular damage. Angiotensin II (Ang II) exerts its effects by acting on two distinct subtypes of receptor, the angiotensin type 1 receptor (AT1R) and the angiotensin type 2 receptor (AT2R). Whereas AT1R mediates most of the recognized actions of Ang II, it appears that AT2R opposes, in part, the actions mediated by AT1R. As the AT2R is expressed in adult tissues in smaller numbers than AT1R, the actions and cell signaling of AT2R have been less well characterized than those of AT1R. RECENT FINDINGS: Current knowledge suggests that AT2R stimulation mediates vasodilation, antigrowth, proapoptotic and antiinflammatory effects. Hence, AT2R can modulate cardiovascular remodeling as well as the progression of atherosclerosis. A protective role of AT2R in the cardiovascular system has been also documented in humans, mainly during chronic AT1R inhibition. Furthermore, a new nonpeptide AT2R agonist has been developed, with potential future therapeutic applications in hypertensive conditions. SUMMARY: This article reviews the role of AT2R expression signaling and function in the pathogenesis of the functional and structural alterations induced by hypertension on the cardiovascular system.