Minerva medica最新文献

{"title":"Supplementation with Pycnogenol® relieves symptoms of chronic inflammatory diseases with a significant vasculitis component: a pilot registry study.","authors":"Gianni Belcaro, Shu Hu, Maria R Cesarone, Valeria Scipione, Claudia Scipione, Mark Dugall, Umberto Cornelli, David Cox, Morio Hosoi, Beatrice Feragalli, Francesca Coppazuccari, Roberto Cotellese","doi":"10.23736/S0026-4806.24.09579-X","DOIUrl":"https://doi.org/10.23736/S0026-4806.24.09579-X","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the potential use of a food supplement, Pycnogenol^® (French maritime Pine Bark Extract) as an anti-inflammatory management during the remission phases of four conditions with a vasculitis component: systemic lupus erythematosus, Behçet's disease, Sjögren Syndrome and polyarteritis nodosa. Symptoms were minimal but persisting and the subjects did not use any chronic drug treatment.</p><p><strong>Methods: </strong>The aim of this pilot registry study was to evaluate the safety and the preventive effects of oral Pycnogenol^® on the residual symptoms of the inflammatory conditions and possible effects on the recurrence of symptoms in a 4-week, open, supplement registry study.</p><p><strong>Results: </strong>The registry study included 124 otherwise healthy subjects, suffering from one of the vasculitis conditions with 63 patients taking Pycnogenol^® 150 mg per day and 61 serving as controls. There were no dropouts. Symptom distribution was comparable in the control and in the supplement groups at baseline. No side effects of Pycnogenol^® supplementation were observed. The symptom scores that ranged from 0 to 10, decreased significantly in all the Pycnogenol^® groups after 4 weeks compared to controls (P<0.05). After 4 weeks ESR values decreased significantly in all Pycnogenol^® groups compared to controls (P<0.05). The proportion of subjects with high IL-6 (>5.9 pg/mL) decreased significantly after 4 weeks in the Pycnogenol^® group compared to controls. The proportion of subjects that needed to take nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to relieve signs and symptoms was significantly lower across all Pycnogenol^® subjects at 4 weeks compared to controls. Finally, plasma oxidative stress (high, >300 Carr Units, in all subjects at inclusion) was significantly reduced (P<0.05) in the supplemented subjects, with minimal improvements in the control groups.</p><p><strong>Conclusions: </strong>In conclusion, supplementation with Pycnogenol^® may offer advantages and management possibilities for patients with vasculitis diseases allowing to avoid more potentially dangerous drug treatments. Considering a prolonged course, it is possible that chronic management with Pycnogenol^® may prevent the recurrence of diseases with a vasculitis component to clinically significant levels.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart failure with preserved ejection fraction and atrial fibrillation.","authors":"Thibault Lenormand, Arnaud Bisson, Laurent Fauchier","doi":"10.23736/S0026-4806.25.09602-8","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09602-8","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are common diseases, inducing increased morbidity and mortality when associated. In this narrative review, we report available evidence in the literature regarding the pathophysiology behind this association, its impact on prognosis, and the therapeutic management of both entities. AF and HFpEF share several pathophysiological mechanisms, most notably inflammation, electrical and structural remodeling of the left atrium with fibrosis and involvement of epicardial adipose tissue, all concurring to left atrial myopathy. AF and HFpEF furthermore favor one another, showing their intricated pathophysiology. The presence of AF in HFpEF worsens patients' prognosis, as does the presence of HFpEF in AF patients. Data on the specific management of this subgroup of patients is scarce. SGLT2 inhibitors appear as the cornerstone of HFpEF treatment, with the same benefit in AF patients. AF management however is less clear, apart for the need for anticoagulation based on the CHA2DS2-VA score. Rate control therapy and rhythm control therapy are in balance for symptom control. Overall, holistic approaches offer the most promises in these comorbid patients. AF and HFpEF partner in comorbid patients and worsen general prognosis. Their management is complex, as is their pathophysiology, and holistic strategies may be the most appropriate way to provide efficient care in these patients.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial functional mitral regurgitation: cardiac remodeling and outcome after mini-thoracotomy mitral valve surgery.","authors":"Francesca Cortese, Marco F Costantino, Luisiana Stolfi, Gianpaolo D'Addeo, Filippo Prestipino, Antonella Matera, Riccardo D'Ascoli, Giampaolo Luzi","doi":"10.23736/S0026-4806.25.09469-8","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09469-8","url":null,"abstract":"<p><strong>Background: </strong>The atrial functional mitral regurgitation (AFMR) refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial (LA) disease, without left ventricular (LV) dilatation and dysfunction (at least initially) and intrinsic mitral valve (MV) disease.</p><p><strong>Methods: </strong>We conducted an observational analysis on 28 subjects, mean age and standard deviation 72.7±8.4 years, with AFMR who underwent mini-thoracotomy MV surgery (mitral annuloplasty and tricuspid ring annuloplasty when needed). No surgical treatment of atrial fibrillation (AF) has been performed.</p><p><strong>Results: </strong>There was no in-hospital mortality. At one-year follow-up, we observe a reverse remodeling of the LV and LA, with a significant reduction of the end-diastolic volume of the LV (110 mL [95-148 mL] vs. 55 mL [48-59 mL], z: -0.7, P<0.001), of antero-posterior (A-P) diameter of left atrium (50 mm [38-60] vs. 46 mm [35-55], z: -3.3, P<0.01) and volume (83.5 mL [63.2-96.5 mL] vs. 63 mL [45.5-78.7 mL], z: -3.2, P<0.01), of the estimated systolic pulmonary artery pressure (PAP) (35 mmHg [30-43] vs. 25 [22-32.7], z: -3.9, P<0.001). Results were not altered by the presence or absence of AF. The overall 1-year survival rates were 100% and all the patients recovered to NYHA functional class I/II at the end of follow-up (z: -6, P<0.001).</p><p><strong>Conclusions: </strong>The results of our small study showed that mini-thoracotomy valve surgery for AFMR is safe and effective. It improves functional class (NYHA) and results in reverse-remodeling of LA, regardless of the presence or absence of AF. A reduction in left ventricular volumes was also observed, although baseline volumes were still within normal limits, as an expression of reduction in left ventricular overload. Mitral insufficiency should be the primary target of treatment, while AF appears to be an epiphenomenon rather than a causal element of AFMR.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing heart failure management: a comprehensive review of current and emerging therapies for heart failure with preserved ejection failure.","authors":"Siddharth P Agrawal, Ritu C Tated, Darshilkumar Maheta, Wilbert S Aronow","doi":"10.23736/S0026-4806.25.09656-9","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09656-9","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by diastolic dysfunction and high morbidity. It presents significant challenges in diagnosis and treatment due to its heterogeneous etiology and pathophysiology. This review evaluates the efficacy and clinical utility of current and emerging pharmacological therapies for HFpEF, emphasizing personalized approaches to improve patient outcomes. A comprehensive analysis of literature was conducted to assess the role of established treatments, such as diuretics, RAAS inhibitors, and beta-blockers, alongside emerging therapies, including sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and novel agents like mavacamten. SGLT2 inhibitors have demonstrated significant reductions in heart failure hospitalizations and symptom burden, while GLP-1 agonists show promise in managing HFpEF with obesity or metabolic syndrome. Mineralocorticoid receptor antagonists provide benefits in selecting patients, although broader therapeutic options remain limited. Other novel agents, such as nitrates and PDE-5 inhibitors, require further validation through clinical trials. HFpEF management demands a multifaceted approach combining lifestyle interventions, optimized pharmacotherapy, and emerging therapeutic strategies. Personalized treatment plans and continued research are vital for addressing the complexities of this syndrome and improving patient outcomes.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-kidney-metabolic syndrome and treatment advances: a narrative review.","authors":"Camilo Pena, Jackeline Flores, Kenneth Nugent","doi":"10.23736/S0026-4806.25.09607-7","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09607-7","url":null,"abstract":"<p><p>The American Heart Association has reformulated the chronic cardiorenal syndromes into the cardiovascular-kidney-metabolic syndrome. This formulation emphasizes the importance of adipose tissue as the key element in the development of chronic diseases, including diabetes, cardiac disease, and renal disease. The pathogenesis involves multidirectional pathways which have adverse effects on the vascular system, the heart, and the kidneys. Important outcomes in these patients include coronary disease, chronic heart failure, diabetes, and renal failure. The development of new drugs, including SGLT2 inhibitors, GLP-1 agonists, and mineralocorticoid receptor blockers have provided important advances in the treatment of these patients, and multiple randomized controlled trials have reported reductions in adverse cardiac and renal outcomes. This review summarizes the clinical trials with these drugs and provides a brief discussion of their pharmacology.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between dapagliflozin and risk of dementia and Parkinson's disease: a subgroup analysis of a meta-analysis of randomized controlled trials.","authors":"João V Fernandes, João V Ramos, Maurus M Holanda","doi":"10.23736/S0026-4806.25.09695-8","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09695-8","url":null,"abstract":"<p><strong>Introduction: </strong>Dementia and Parkinson's disease (PD) are prevalent neurodegenerative disorders with substantial global health impacts. Emerging evidence suggests that SGLT2 inhibitors, such as dapagliflozin, may offer neuroprotective benefits. This study aims to evaluate dapagliflozin's association with risks of dementia and PD through a sub-analysis of a meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Evidence acquisition: </strong>This sub-analysis adhered to PRISMA 2020 guidelines and included RCTs from a prior meta-analysis focusing on dapagliflozin. Studies comparing dapagliflozin to placebo with reported dementia or PD outcomes were selected. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and bias was evaluated with the Cochrane Risk of Bias 2 tool.</p><p><strong>Evidence synthesis: </strong>Four RCTs met the inclusion criteria. For dementia, the pooled OR was 2.826 (95% CI: 0.264-30.229; I²=0%). For Alzheimer's-type dementia, the OR was 2.308 (95% CI: 0.232-22.928; I²=0%), while for PD, the OR was 0.533 (95% CI: 0.072-3.944; I²=0%). None of the results were statistically significant, and heterogeneity across studies was negligible.</p><p><strong>Conclusions: </strong>This sub-analysis found no significant association between dapagliflozin and reduced risks of dementia or PD. While these results align with previous meta-analyses, further long-term RCTs are necessary to clarify dapagliflozin's neuroprotective potential and broader therapeutic applications.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The treatment of adenomyosis-induced ovarian hyperstimulation syndrome with leuprolide.","authors":"Cong Ye, Bo Zhong, Hui Xu, Tong Jia, Hongling Guo","doi":"10.23736/S0026-4806.25.09186-4","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09186-4","url":null,"abstract":"","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in oncolytic and immunotherapy of measles virus.","authors":"Yongping He, Xue Zhou, Ye Liu, Zhixu He","doi":"10.23736/S0026-4806.25.09447-9","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09447-9","url":null,"abstract":"","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of autoimmune hemolytic anemia: novel and investigational approaches.","authors":"Sigbjørn Berentsen","doi":"10.23736/S0026-4806.25.09617-X","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09617-X","url":null,"abstract":"<p><strong>Introduction: </strong>Autoimmune hemolytic anemia (AIHA) is a heterogeneous group of diseases. While corticosteroids remain first-line therapy for the warm-antibody types (wAIHA), they are ineffective in cold agglutinin disease (CAD). During the last couple of decades, several new established or investigational treatment options have appeared. These advances have resulted in improvements of therapy, but also raised new challenges.</p><p><strong>Evidence acquisition: </strong>This review aims at providing an update on AIHA treatment with focus on novel and investigational approaches. PubMed was searched for original research articles and reviews from 2000 through 2024. Selected case reports, published congress presentations, book chapters, and older articles were included when considered relevant.</p><p><strong>Evidence synthesis: </strong>Pathogenetic features and diagnostic workup in AIHA are briefly outlined, and existing therapies for the respective subtypes are reviewed. The evidence for new documented therapies is described, including erythropoietin, fostamatinib, and bortezomib-based combinations in wAIHA; and complement-directed therapies in CAD. Investigational and experimental therapies are also addressed, including inhibitors of the neonatal Fc receptor, cytokine inhibitors, complement blockers, Bruton tyrosine kinase inhibitors, and plasma cell-directed approaches in wAIHA; and Bruton tyrosine kinase inhibitors, plasma-cell directed therapies, novel complement inhibitors, cytokine antagonists, and novel monoclonal antibodies in CAD.</p><p><strong>Conclusions: </strong>Exact diagnostic workup is critical for selection of optimal therapy in AIHA. While therapy is becoming increasingly evidence-based, several unmet needs remain. The ideal therapy has not been found for wAIHA or CAD, and evidence-based options are largely lacking for the still rarer subtypes. Patients with AIHA should be considered for clinical trials.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The outcome difference of monotherapy versus combination therapy among patients with pneumonia: a systematic review.","authors":"Pande A Permatananda, Pande A Pandit","doi":"10.23736/S0026-4806.24.09446-1","DOIUrl":"https://doi.org/10.23736/S0026-4806.24.09446-1","url":null,"abstract":"<p><strong>Introduction: </strong>Pneumonia is a severe public health problem on a global scale. Pneumonia continues to be the leading infectious disease-related cause of mortality worldwide. Selecting appropriate antimicrobial treatment is a significant challenge including multi-drug resistant bacteria. The use of monotherapy and combination therapy of antibiotics in pneumonia is still controversial. Considering the wide range of patient characteristics and illness severity in pneumonia, it is important to investigate the variables that affect mortality in different treatment plans. Therefore, this study aimed to systematically review the available evidence regarding comparing monotherapy and combination regimens in pneumonia patients.</p><p><strong>Evidence acquisition: </strong>A systematic search across various electronic databases like PubMed, Google Scholar, Proquest, and Cochrane was conducted to identify articles published from 2014 to 2024. Review papers, incomplete articles, and duplicates were excluded.</p><p><strong>Evidence synthesis: </strong>Initially, 179 articles were retrieved from the database search. After a systematic elimination process, sox pertinent articles were identified. These articles involved a total of 11,513 patients across 11 studies. All studies were conducted at single centers, comprising three retrospective cohort studies, one prospective cohort study, one randomized controlled trial, and one cross-sectional study.</p><p><strong>Conclusions: </strong>Monotherapy and combination therapy have comparable outcomes in mortality rate and hospital length of stay. However, combination therapy is linked with a lower mortality rate in immunocompromised and APACHE ≥15 patients.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}