[The declining power of the human touch in the digital world.].

Humans are social creatures, and touch is the most primitive form of relationship. In the context of the traditional medical examination, touch, palpation, is essential to diagnose or suspect pathology. But it is not only an issue of semeiotics.

[Data in medicine: from numbering to narration.].

Precision medicine aims to use big data to analyze all dimensions of the individual and "tailor" treatment to individual characteristics. Care precisely "tailored" to the individual must, moreover, also (especially?) include his or her narratives, his or her histories, biological but also biographical. Responding to the challenges of complexity therefore requires a recomposition of the fragmentation of knowledge, collaboration among professionals, and interdisciplinary coordination to ensure that the goals of number experts coincide with those of clinicians, so as to respond to the real needs of people and their care needs.

[Artificial intelligence applied to the electrocardiogram, or is there really a needle in a haystack?].

Artificial intelligence applied to the standard Ecg (Ai-Ecg) is able to enormously enhance the performance of a diagnostic test that has been in use for over 100 years. The tool can in fact identify diseases, cardiac and non-cardiac, hidden or foreseeable, often asymptomatic, previously undetectable. Here we describe some of the main applications in cardiology: sub-clinical atrial fibrillation and asymptomatic left ventricular dysfunction.

[Artificial intelligence and dermatology.].

The approach of artificial intelligence (AI) systems can especially support doctors who base their work on the interpretation of digital images. Despite undoubted favorable results, the validation of diagnostic algorithms in clinical practice has not yet been demonstrated. In the dermatological field, a study found the poor performance of AI systems in diagnosing skin lesions that better reflect clinical practice, that is characterized by the presence of "artifacts" such as crusts or ulcerations above the lesion, hair or pen marks, pigmentation.

[The power of the citizen in digital culture.].

Symptoms reported by the patient are generally considered to be of lesser scientific value than objective, measurable data. New digital technologies make it possible to record sensations that have always been expressed through the lens of subjectivity, such as mood, cognitive activity and neuroendocrine activity. The patient's access to biological and behavioral parameters and the possibility of acquiring them directly, independently and autonomously, allow people to actively participate in their own care process and in maintaining their state of health, capable of balancing and sometimes overturning the traditional top-down relationship with the doctor.

[Let's open the black box: eXplainable Artificial Intelligence (XAI).].

The so-called "opacity" of artificial intelligence (AI), the black box model, raises concerns about the increasing use in relevant and critical areas of our society such as health, assistance, autonomous driving, military technologies, the economy, finance, justice, insurance. The need to create models that make it possible to understand, trust and therefore govern the emerging generation of these systems is increasingly felt, while maintaining a high level of performance. This is why a new discipline is being developed, eXplainable AI (XAI), which can be defined as a set of tools and techniques used to make the operation of AI increasingly transparent and easy to understand.

[Neurotechnologies and neurorights: mental privacy.].

The therapeutic and rehabilitative use of neurotechnologies against disabling diseases for which common treatments are partially or completely ineffective is developing more and more rapidly. Projects for the installation of brain-computer interfaces capable of enhancing perceptions, saving memories, amplifying and canceling them selectively are now a reality. The mental domain, which has always been considered the private sphere par excellence, the last territory inaccessible even to the rampant intrusiveness of "datism", is in serious danger.

[Artificial intelligence: the inscrutability of algorithms.].

The use of artificial intelligence radically changes the role of the doctor and his/her relationship with the patient, which becomes in fact a three-way relationship: artificial intelligence-doctor-patient, in which the first component is able to heavily influence and sometimes oppress both the doctor and the patient. The black box model is an additional complicating factor because it does not allow the doctor to know the steps that led the machine to make the decision and this causes difficulties in sharing choices. It is considered useful to propose a methodological approach that can provide reasonable guarantees to both the patient and the doctor.

[Bidirectional relationship between atrial fibrillation and stroke.].

The temporal relationship between atrial fibrillation (AF) and stroke has always been considered one-way: the presence of arrhythmia favors the occurrence of stroke. Recent studies have questioned this association and raised the possibility that it may be bidirectional. Some ischemic events are actually due to stasis following AF episodes.

[Artificial intelligence systems and precision medicine: hopes and realities.].

Precision medicine (MP), using machine learning (ML) techniques of artificial intelligence (AI), analyzes the so-called "big data" to improve diagnostic skills and predictive response to therapy, in order to tailor the treatment on individual characteristics. Furthermore, the use of large databases is limited by their very nature, as data and not values, capable of threatening the validity and generalizability of the conclusions. Currently, for this reason, interventions on populations, subpopulations or groups are still fundamental, favoring, especially in the pharmacological field, the response of the "average patient", over the particular case.

[End-of-life predictive models: risk of prognostic persistence?].

Machine learning techniques, applied in the palliative field, are able to define an increasingly accurate prognosis in patients with advanced neoplasms and to identify patients at greater risk of functional decline or short-term mortality. The improvement of predictive abilities can allow an enhancement of prognostic abilities and also a more accurate detection of the most complex needs of patients. Moreover, data, even scientific data, are not values, any intervention based on them must be endowed with meaning.

[From anamnesis to digital narration.].

The classic anamnesis, oriented to the disease, tends to consider the patient as the object of the privileged attention of medical science. Especially in the context of general medicine, characterized by a patient-oriented approach, illness histories are used instead, which are more pertinent to a context characterized by subjectivity and objectivity, both biological and biographical paths. Digital technologies, which have so radically changed the doctor-patient relationship, can help to describe in a more exhaustive way the not strictly clinical needs of patients and doctors and provide the possibility of building a new way of interaction and sharing of the objectives of care.

[You're anemic, the electrocardiogram says so.].

A recent, retrospective, multicenter korean study is the first to highlight the possible application of electrocardiograms (ECGs) for the diagnosis of systemic conditions, in particular anaemia. To confirm this predictive ability, however, methodologically more valid studies are needed, on populations at greater risk and with less serious levels of anaemia. As always, in the context of human-machine interaction, the integration between technology and the clinical experience of health professionals is also necessary, the soft skills that make them superior to algorithms.

[The virtualist].

The CoViD-19 pandemic has changed the concept of clinic and doctor-patient relationship. Due to the risk of mutual contagion, patients in many cases were managed without direct physical contact. This resulted in a forced acceleration towards e-health and remote consultation.

[Risk communication: a social construction.].

The technological developments of artificial intelligence have created predictive models capable of improving prognostic accuracy compared to traditional methods. However, there are many uncertainties about their effective applicability in clinical reality, due to the lack of rigorous methodological studies. These new perspectives can offer the starting point for a reflection on risk communication, taking for example a very frequent situation in daily practice, cardiovascular risk, describing ancient but still current concepts.

[Digital contact tracing: the network of integrated bodies.].

The Italian government, noted the seriousness of the pandemic in progress, is considering resorting to digital contact tracing, i.e. the use of citizens' mobile devices for the mapping and tracing of subjects who come into contact with infected people.

[Precision nutrition: handle with care.].

Diet is a fundamental risk determinant for the majority of chronic diseases in the western world. Precision nutrition aims to tailor nutritional interventions, through the availability of new technologies in the "omic" area. This knowledge has enormous potential, but there are currently no validated results in the clinical setting.

[Beyond empowerment: the emancipated patient or the datoma?].

Digital culture gives the patient an ever greater role in managing their own health, which should be a normal place and time of sharing, based on general principles of democracy. The risk is that life itself becomes pertinent to medicine, as it is objectified in medical terms through increasingly advanced and intrusive digital technologies, and that these end up transforming people into datasets, "datomi". Therefore, strategies and tools must be developed for a "true" participation in the culture of health/disease, which does not mean the exploitation of people transformed into data profiling or direct management by citizens, but a concrete exercise in listening and sharing values, meaning, interests and objectives.

[From habeas corpus to habeas data.].

Health data, increasingly accessible and transparent, are attractive preys for the creation of value in the digital market. The concept of personal and anonymous data has by now disappeared in a sort of "far web" of filing and obsessive profiling, out of control, in which the violation of privacy seems systematic. The protection of confidentiality requires above all a cultural response, capable of aligning the current contexts, produced by the ever more advanced computational intelligences, with the recovery and promotion of people's rights.

[Atrial fibrillation and the sentinel watch.].

The Apple Watch 4 is a wearable device whose advertising launch made a lot of noise, not only for technological advances in general, but above all because the latest version is able to record an electrocardiogram. The device signals to the wearer the possible presence of atrial fibrillation, an arrhythmia that is often difficult to identify. There is also the possibility that the increased engagement of citizens causes excessive confidence in self-monitoring and in "do-it-yourself" diagnoses.

[The robotic assistance system.].

The aging of the population is a reality common to the entire Western world, while the time available and human resources are limited. According to many experts, the new robotic technologies could help meet the care needs of the elderly, at home and in hospitals and nursing homes. In particular, care robotics could foster their autonomy and provide support to operators in the sector.

[The doctor-patient relationship in the digital world: a Babylon?].

Babylon Health provides a quick, on-demand service for patients without important health problems, technologically competent, who can contact a doctor at convenient times for episodic and well-defined needs. The majority of the assisted, the elderly, the complex sick, the digital illiterates, those who need home assistance tend instead to be excluded. It is legitimate to find alternative solutions to health systems that are collapsing, but technology cannot replace the doctor-patient relationship.

[The syndemic model in medicine. From the reconstruction of social and health contexts, to the return of citizenship rights.].

The syndemic model in medicine aims to deepen the interaction between different pathologies and the social situations in which they are determined, considering not only the biomedical definition of typical comorbid conditions, but also the interaction between genetic and environmental factors, and lifestyle. Applying a syndemic approach can be relevant and innovative because it offers the opportunity to identify the barriers and circumstances that cause or exacerbate pathological conditions. The unresolved problem is how to translate successfully this approach into professional practice.

[Human and artificial intelligence: comparison and clash of cultures].

. Human and artificial intelligence: comparison and clash of cultures. Machine learning has become ubiquitous and indispensible for solving complex problems in most sciences.