Minerva medica最新文献

{"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":"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":"234-248"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","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":"Treatment of autoimmune hemolytic anemia: novel and investigational approaches.","authors":"Sigbjørn Berentsen","doi":"10.23736/S0026-4806.25.09617-X","DOIUrl":"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":"249-264"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","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":"Correlation between endorectal ultrasonography, magnetic resonance imaging and final histological examination in patients undergoing surgery for rectal cancer: a monocentric study on the first 50 cases.","authors":"Alex B Bellocchia, Stefania Soncini, Luca Bonatti, Federico Festa, Luca Cestino, Paolo Arese, Giulia Carbonaro, Giorgia Gavello, Marta Breda, Beatrice Degan, Antonella Evangelista, Salomè Pfannkuche, Dayana Benny, Francesco Quaglino","doi":"10.23736/S0026-4806.25.09542-4","DOIUrl":"10.23736/S0026-4806.25.09542-4","url":null,"abstract":"<p><strong>Background: </strong>Endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) are key diagnostic tools for rectal cancer staging. ERUS is preferred for early-stage cancer, while MRI is the standard for advanced stages. However, their effectiveness in patients undergoing neoadjuvant therapy (NAT) remains debated. This study compares ERUS and MRI in rectal cancer evaluation, correlating results with final histopathological findings and analyzing a subgroup of patients who received NAT.</p><p><strong>Methods: </strong>A retrospective study (February 2020 to February 2024) included oncology patients with rectal cancer treated electively at our Center, who had undergone both ERUS and MRI staging.</p><p><strong>Results: </strong>Out of 172 surgical patients, 50 met inclusion criteria (42% male, average age 71.9). Surgical procedures included 36 anterior rectal resections and 14 abdominoperineal resections, with a laparoscopic approach in 84% of cases. Additionally, 74% underwent NAT. ERUS showed high sensitivity and specificity for early-stage (T1 and T2) and lymph node detection, while MRI was optimal for T3 and T4 staging. Correlation with histological findings was strong for ERUS and less so for MRI. In NAT patients, results were consistent, but MRI showed better accuracy for lymph node involvement.</p><p><strong>Conclusions: </strong>ERUS and MRI are essential for rectal cancer diagnostics. ERUS is superior for early stages and lymph node evaluation, whereas MRI excels in advanced stages (T3 and T4). In NAT patients, ERUS remains favourable, but MRI's sensitivity and specificity improve for lymph node assessment.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"171-178"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039274","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":"Correction to: The administration of S. salivarius K12 to children may reduce the rate of SARS-CoV-2 infection.","authors":"Francesco Di Pierro, Maria Colombo","doi":"10.23736/S0026-4806.25.09743-5","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09743-5","url":null,"abstract":"<p><p>This article was published in Volume 112, issue 4 of publishing year 2021, with a mistake in the text and in Table I. The corrections to the text and the correct Table I are the ones included in this erratum. Page 514, second full paragraph, line 30 should read as follows: \"According to Table I, a nasal swab (rapid test) for detection of SARS-CoV-2 specific antigen was performed in 33 countries and in 46 children, respectively, in the treated and in the control groups.\"</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":"116 3","pages":"284"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287683","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":"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":"223-233"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","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":"Perioperative management of antihypertensive agents.","authors":"Jason F Shiffermiller, Zahid Iqbal, Michael P Smith","doi":"10.23736/S0026-4806.25.09618-1","DOIUrl":"10.23736/S0026-4806.25.09618-1","url":null,"abstract":"<p><p>A large proportion, possibly over half, of patients presenting for preoperative evaluation will be taking antihypertensive agents. The multiple classes of agents and their use in different combinations can make management decisions challenging. Poor blood pressure control and lack of evidence or conflicting evidence for certain agents can further complicate management. Appropriate antihypertensive management is important because it can have an effect on meaningful perioperative outcomes, including mortality. In this review, we discuss the factors that should be considered when making preoperative hypertension management decisions and we summarize the available evidence for the most common classes of antihypertensive agents, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and diuretics. In addition to preoperative management, the review includes information on perioperative and postoperative blood pressure management considerations. Where possible, we provide recommendations based on the available evidence and the guidance published by expert bodis. However, due to the variety of factors that may influence management, clinical decisions for individual patients must be made on a case-by-case basis.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"265-279"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575056","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":"Supplementary management of chronic Lyme disease with Pycnogenol®.","authors":"Maria R Cesarone, Shu Hu, Gianni Belcaro, Umberto Cornelli, Beatrice Feragalli, Giovanni B Agus, Marcello Corsi, Claudia Scipione, Valeria Scipione, Ezio Bombardelli, Roberto Cotellese, Francesca Coppazuccari, Morio Hosoi, Pietromaria Bavera, Lars Rosenkvist","doi":"10.23736/S0026-4806.25.09703-4","DOIUrl":"10.23736/S0026-4806.25.09703-4","url":null,"abstract":"<p><strong>Background: </strong>The aim of this pilot supplement registry study was to investigate the efficacy of the anti-inflammatory supplement Pycnogenol^® in subjects with history of Lyme disease and persistent symptoms with no active bacteria present (Stage 2 and 3 of Lyme disease), on the reduction of inflammation and the relieve of the main symptoms. There is currently no specific treatment for this condition.</p><p><strong>Methods: </strong>The subjects were divided into two groups: one group received 150 mg/day of Pycnogenol^® alongside standard management, while the control group received only standard management. The observation period lasted for six months.</p><p><strong>Results: </strong>Forty subjects with history of Lyme Disease and persistent symptoms completed the study: 20 in the Pycnogenol^® group, 20 in the control group. No side effects from the supplementation were observed. The tolerability was optimal as no supplemented subject had to stop management and compliance was optimal with 97% of the Pycnogenol^® capsules correctly used. The two groups were comparable for sex, age distribution and for their main clinical findings and signs/symptoms at inclusion. During the study, corticosteroids at low dose were used on demand in 10% of subjects using Pycnogenol^® and significantly more, in 45% of the control patients (P<0.05). After 6 months, the number of patients experiencing symptoms was significantly lower in the Pycnogenol^® group compared to the control group across all symptoms (P<0.05). After 6 months, the intensity of all symptoms in the Pycnogenol^® group, was significantly lower, according to the scores in comparison with the control group (P<0.05). Plasma oxidative stress was significantly reduced in subjects of the Pycnogenol^® group (P<0.05) in comparison with controls. The improvement in plasma oxidative stress was seen in all subjects using Pycnogenol^®. Knee effusion on ultrasound was seen in 12 subjects of the supplement group at inclusion and in 3 Pycnogenol^® subjects at the end of the study in comparison with 12/20 subjects in the control group at inclusion and 8/20 at the end of the study. (P<0.05). Finally, ESR (Erythrocyte sedimentation rate, a global marker of inflammation) was significantly more reduced in the Pycnogenol^® group by the end of the study compared to controls (P<0.05).</p><p><strong>Conclusions: </strong>In conclusion, the present registry study showed that Pycnogenol^® intake for 6 months in patients with persistent symptoms of Lyme disease can help relieve the main symptoms by reducing inflammation and oxidative stress. Pycnogenol's anti-inflammatory and antioxidant double activity may help safely and effectively controlling the chronic inflammatory process.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"188-194"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082975","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":"Psoriasis and diabetes: a review of the pathophysiological and therapeutic interconnections.","authors":"David A De Luca, Cristian Papara, Tomasz Hawro, Diamant Thaçi","doi":"10.23736/S0026-4806.24.09570-3","DOIUrl":"10.23736/S0026-4806.24.09570-3","url":null,"abstract":"<p><strong>Introduction: </strong>Psoriasis is a chronic, immune-mediated skin disorder associated with systemic conditions like cardiovascular diseases, metabolic syndrome, and type 2 diabetes mellitus. Individuals with psoriasis show a higher risk of diabetes compared to the general population. This review aims to examine the relationship between the physiopathology and treatment of psoriasis and diabetes mellitus.</p><p><strong>Evidence acquisition: </strong>A systematic search was conducted across PubMed and Google Scholar up to July 2024. Observational studies and clinical trials involving all age groups and genders were included, focusing on the pathophysiology, inflammatory pathways, and therapeutic interventions for psoriasis and diabetes.</p><p><strong>Evidence synthesis: </strong>Evidence consistently showed an increased prevalence of type 2 diabetes among psoriasis patients. The IL-23/IL-17 axis plays a critical role in the inflammation driving both psoriasis and insulin resistance. This inflammation promotes metabolic syndrome components such as obesity. Conversely, insulin resistance and obesity amplify systemic inflammation, creating a vicious cycle in psoriasis patients. Integrated treatment approaches, combining targeted pharmacologic therapies with lifestyle modifications, demonstrated potential in managing both conditions effectively. Multidisciplinary care is vital to address the dermatological and metabolic aspects of these interconnected diseases.</p><p><strong>Conclusions: </strong>The shared inflammatory pathways between psoriasis and type 2 diabetes highlight the complex, bidirectional relationship between the two. Integrated therapeutic strategies that include lifestyle changes and targeted drug interventions show promise in improving outcomes for individuals affected by both conditions.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"195-222"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443131","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":"Endoscopic ultrasound with bronchoscope fine-needle biopsy in the diagnosis of suspected malignant pulmonary lesions with crown-cut needle: a retrospective study.","authors":"Filippo Lanfranchi, Gioele Castelli, Giacomo Giulianelli, Laura Mancino, Gabriele Foltran, Michele Rizzo, Federico Fracasso, Alberto Pavan, Lorenzo Nicolè, Licia Laurino, Lucio Michieletto","doi":"10.23736/S0026-4806.25.09633-8","DOIUrl":"10.23736/S0026-4806.25.09633-8","url":null,"abstract":"<p><strong>Background: </strong>The role of Transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) in the diagnosis of malignant pulmonary lesions adjacent to the esophagus is a well-known procedure with high diagnostic yield. Moreover, it is indicated for lung cancer staging. Franseen needle tip is a crown-cut needle that allow to obtain tissue cores and provide huge amount of tissue for pathologist's evaluation, moving from fine needle aspiration (FNA) to fine needle biopsy (FNB). Few data about EUS-B-FNB and Franseen needle tip are available in Literature.</p><p><strong>Methods: </strong>Between May 2022 and June 2024, 33 patients with lymphadenopathy who underwent EUS-B with Franseen needle tip were consecutively enrolled. Chest CT scan was performed prior procedure. Lymphnodes' dimension at imaging and EUS-B were recorded. EUS-B-TBNB was performed with 22G or 25G needle size. Diagnostic yield and specimen adequacy (SA) for predictive markers were evaluated.</p><p><strong>Results: </strong>22G needle was used in 18 patients and 25G in 15, and no statistically significant differences were observed between sex and age in the two groups. Overall Diagnostic Yield was 91% (30/33), with no statistically significant differences between 22G and 25G needle group (89% and 93%, respectively). SA for predictive markers was achieved in 20 of 23 patients (87%) with cancer diagnosis, with no significant differences between 22G and 25G group (P=0.59). No adverse events were observed.</p><p><strong>Conclusions: </strong>EUS-B-FNB is a safe and an effective diagnostic method that should be performed in every bronchoscopy suite. Franseen needle tip provides high quality samples for pathologists, avoiding procedure repetition and/or more invasive procedures.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"179-187"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082962","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":"Definitions for hypertensive response to exercise: a systematic review.","authors":"Gloria Petrasch, Hadassa Brito DA Silva, Valeria Heller, Nina Schmidt, Gioia Bebi, Laura Spormann, Céline Ghidoni, Elisa Alba Schmidt, Greta Hametner, Jan Riess, Jan Vontobel, Mark Haykowsky, David Niederseer","doi":"10.23736/S0026-4806.25.09678-8","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09678-8","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension (HT) is a leading modifiable risk factor for cardiovascular disease, but resting blood pressure (BP) measurements often miss hypertensive episodes during daily activities, affecting 10-15% of adults. A hypertensive response to exercise (HRE), characterized by abnormally high systolic BP (SBP) increases, is associated with future arterial HT and cardiovascular events, even in normotensive individuals and athletes. Despite its clinical significance, definitions of HRE vary widely, leading to inconsistent incidence estimates. The aim of this study was to collect available values of HRE and investigate definitions for HRE.</p><p><strong>Evidence acquisition: </strong>This systematic review followed PRISMA guidelines, conducting a comprehensive search of MEDLINE and Embase from 1974 to 2024. The search included studies on normotensive adults and athletes with or without HRE, focusing on BP cutoffs across exercise modalities and intensities. Eligible study designs included original research studies of any design, while reviews, case reports, and meta-analyses were excluded. Data extraction and synthesis involved multiple reviewers to ensure accuracy, with results presented in narrative and tabular formats.</p><p><strong>Evidence synthesis: </strong>A total of 25 studies with 15,391 participants (weighted mean age 50 years, 28.3% female, 5.4% athletes) were analyzed, encompassing various study designs, including cross-sectional, case-control, cohort, and longitudinal studies. Exercise test protocols included treadmill (14 studies), bicycle ergometry (seven), shuttle/runs (three), and hand-grip strength (one), with most studies utilizing peak exercise intensities and automated BP measurements. Cut-offs for HRE varied, with most studies using SBP thresholds of ≥210 mmHg for men and ≥190 mmHg for women, though some studies proposed higher thresholds or included diastolic BP criteria. Definitions and methodologies for HRE were heterogeneous, reflecting variability across studies. Age, sex, fitness level, and test protocols significantly influence BP response, yet these factors are mostly omitted in the definition of HRE, with older adults and postmenopausal women showing exaggerated responses. Athletes exhibit higher peak SBP during exercise due to increased peak exercise cardiac output and augmented muscular strength enabling the athletes to push peak SBP higher, but thresholds applied are often the same as for non-athletes, underscoring the need for fitness-specific cut-offs. Variations in test protocols, measurement methods, and reliance on legacy cut-offs, which have been reproduced over decades further complicate consensus on standardized thresholds.</p><p><strong>Conclusions: </strong>Standardized, phenotype-specific criteria are essential to improve diagnostic accuracy and guide clinical recommendations in HRE.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188739","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}