La salute “intelligente”: eHealth, consenso informato e principio di non-discriminazione

L’intelligenza artificiale medica, branca avanguardistica della sanità digitale, promette di diventare, nel prossimo futuro, un valido sostegno per il professionista sanitario, ma pone (almeno) un duplice ordine di problemi di natura costituzionale, strettamente connessi: da un lato, spinge a interrogarsi sulla configurabilità di un obbligo in capo al medico di informare il paziente dell’uso di tali tecnologie nel processo diagnostico e terapeutico, quale espressione del principio del consenso informato, anche alla luce dei diversi rischi di bias che interessano la macchina; dall’altro, impone una riflessione sull’impatto proprio di questi bias sul godimento del diritto alla salute. Sommario: 1. Introduzione. L’impatto dell’eHealth sul diritto costituzionale alla salute: la prospettiva di analisi. – 2. Le radici costituzionali del consenso informato come proiezione dell’autodeterminazione terapeutica. – 3. L’intelligenza artificiale a supporto della diagnosi: quale impatto sul consenso informato? – 3.1. Il contenuto dell’obbligo informativo in capo al medico in contesti clinici tradizionali. – 3.2. Sull’esistenza di un obbligo di informare il paziente dell’utilizzo di intelligenza artificiale per la diagnosi e la proposta di terapia. – 4. Applicazioni medico-sanitarie dell’intelligenza artificiale e (rischi di) discriminazione. – 5. (Segue.) Oltre la “neutralità” degli strumenti digitali.“Intelligent” health: eHealth, informed consent and principle of non-discrimination. Medical AI, one of the emerging areas encompassed by eHealth, promises to offer valuable support to healthcare professionals in the near future, but it poses (at least) two sets of closely related constitutional problems: on the one hand, the issue of informed consent must be addressed, determining whether a legal obligation exists to disclose AI/ML usage for diagnostic or therapeutic purposes, especially in light of the very real risks of algorithmic bias; on the other hand, further reflection on the potential impact of precisely these biases on (the enjoyment of) the right to health is certainly required

Geometry of Information Integration

Information geometry is used to quantify the amount of information integration within multiple terminals of a causal dynamical system. Integrated information quantifies how much information is lost when a system is split into parts and information transmission between the parts is removed. Multiple measures have been proposed as a measure of integrated information. Here, we analyze four of the previously proposed measures and elucidate their relations from a viewpoint of information geometry. Two of them use dually flat manifolds and the other two use curved manifolds to define a split model. We show that there are hierarchical structures among the measures. We provide explicit expressions of these measures

IL-17 and its role in inflammatory, autoimmune, and oncological skin diseases. State of art

Recent data support the theory of the involvement of IL-17 in the pathogenesis of several chronic inflammatory skin diseases (psoriasis, atopic dermatitis, acne, hidradenitis suppurativa) and autoimmune skin diseases (alopecia areata, vitiligo, bullous diseases). Even if the role of IL-17 in inflammatory and autoimmune diseases has been reported extensively, its role in tumor is still controversial. Some reports show that Th17 cells eradicate tumors, while others reveal that they promote the initiation and early growth of tumors. Herein, we review the role of IL-17 in the involvement of some common dermatologic diseases: psoriasis, atopic dermatitis, hidradenitis suppurativa, acne, vitiligo, melanoma, and nonmelanoma skin cancers

Therapeutic options for the treatment of actinic keratosis with scalp and face localization

Actinic keratosis (AK) is a common skin disease related to ultraviolet chronic exposure, that is now considered a squamous cell carcinoma in situ. Primary skin cancer prevention strategies should be recommended for high risk patients. There is a wide spectrum of treatment options available for AKs, and several variables should be taken into account regarding the best therapeutic choice for each patient. The purpose of this article is to review the current treatment strategies for AKs localized on the face and scalp, with a focus on the practical point of view that could be useful for choosing the best therapeutic option. The two main therapeutic approaches will be distinguished first: lesion-directed and field-directed. Afterwards, the treatment based on clinical type and patient comorbidity will be discusse

Prevalence and natural history of potential coeliac disease in adult patients.

OBJECTIVE: Potential celiac disease (PCD) is a form of CD characterized by positive endomysial/tissue transglutaminase antibodies and a preserved duodenal mucosa despite a gluten-containing diet (GCD); it can evolve into flat, active CD. This evolution is, however, not certain. Our aim was to retrospectively study the prevalence and the natural history of adult patients with PCD. METHODS: The clinical notes of all 47 patients with PCD attending our clinic between September 1999 and October 2011 were retrospectively reevaluated. To study their clinical features, patients with active CD, randomly selected and matched for sex and date of birth, served as controls. Symptoms, associated diseases, familiarity, and laboratory data at diagnosis were compared. RESULTS: Prevalence of PCD among all celiac patients directly diagnosed in our center was 42/187, (1/4.4, 18.3%, 95% confidence interval (CI) 13.3-23.4%). Age at diagnosis, laboratory data, prevalence of symptoms, associated diseases, and familiarity for CD did not differ between patients with PCD and those with active CD. Some patients with PCD maintained a normal duodenal mucosa for many years and their symptoms spontaneously improved despite maintaining a GCD. CONCLUSIONS: PCD is not a rare form of CD. Having found no difference at all in age at diagnosis and clinical features between PCD and active CD could suggest that PCD is not a prodrome of CD but is a separate entity that can only subsequently evolve into active CD

Dynamical complexity in the C.elegans neural network

We model the neuronal circuit of the C.elegans soil worm in terms of a Hindmarsh-Rose system of ordinary differential equa- tions, dividing its circuit into six communities which are determined via the Walktrap and Louvain methods. Using the numerical solution of these equations, we analyze important measures of dynamical com- plexity, namely synchronicity, the largest Lyapunov exponent, and the ?AR auto-regressive integrated information theory measure. We show that ?AR provides a useful measure of the information contained in the C.elegans brain dynamic network. Our analysis reveals that the C.elegans brain dynamic network generates more information than the sum of its constituent parts, and that attains higher levels of integrated information for couplings for which either all its communities are highly synchronized, or there is a mixed state of highly synchronized and de- synchronized communities