Search Results (270)

Background and Objectives: Pediatric chest pain is usually benign, but identifying children who require admission or have a cardiac diagnosis remains challenging. We aimed to identify factors associated with these outcomes, with a focus on recurrent presentation and the combined value of C-reactive protein (CRP) and predefined red-flag findings. Materials and Methods: This retrospective cohort included children aged 0–18 years presenting with chest pain to a tertiary pediatric emergency department between January 2021 and January 2026; visits with insufficient documentation were excluded. Red-flag findings were predefined as effort-related chest pain, syncope, palpitations, dyspnea, fever, or a family history of sudden cardiac death. Independent predictors were assessed using multivariable Firth logistic regression, and cluster-robust standard errors were used in a sensitivity analysis to account for recurrent visits. Results: Of 1703 visits (1435 patients), 452 (26.5%) were recurrent presentations. Admission occurred in 64 visits (3.8%), and 91 (5.3%) had a cardiac diagnosis. Red-flag findings (OR, 5.15), abnormal ECG (OR, 4.00), CRP > 5 mg/L (OR, 3.71), male sex (OR, 2.13), and recurrent presentation (OR, 2.51) were independently associated with admission (all p ≤ 0.009). Recurrent presentation was not associated with a cardiac or psychogenic diagnosis. Admission and cardiac diagnosis rates increased from 1.4%/2.2% in children with neither elevated CRP nor red-flag findings to 22.2%/24.8% in those with both. Routine ECG, troponin, and chest radiography had low diagnostic yields (2.1–6.0%), whereas echocardiography performed selectively yielded abnormal findings in 79.7%. Conclusions: Red-flag findings, abnormal ECG, elevated CRP, and recurrence were associated with admission, whereas recurrence was not associated with diagnosis. Combining CRP with red flags may improve risk stratification, though prospective validation is needed. Full article

Background/Objectives: Lumbar magnetic resonance imaging (MRI) is widely overused in low back pain. We assessed the appropriateness of lumbar MRI requests against three international guidelines and two independent large language model (LLM)-based artificial intelligence (AI) assessments, related appropriateness to diagnostic yield, and derived a simple decision rule to identify imaging likely to change management. Methods: In this single-centre retrospective study, 147 consecutive adults undergoing lumbar MRI for low back pain were analysed. Each request was classified using pre-imaging clinical variables according to operationalised ACR, NICE and ACP criteria and by two blinded LLM assessments (Claude, Anthropic; ChatGPT, OpenAI). The reference outcome was a management-changing MRI (subsequent surgery or interventional procedure); a four-item decision rule was derived by exhaustive search over clinical criteria optimising the Youden index. Results: Depending on the instrument, 57.8–72.1% of requests were inappropriate (ACR 66.0%; NICE 72.1%; ACP 66.0%; AI 57.8–64.6%). Agreement between instruments was substantial to near-perfect (κ 0.69–0.94; inter-AI κ 0.77). Red flags or neurological warning features were present in only 5.4%. MRI changed management in 33.3% overall—58.1–80.5% of appropriate versus 15.1–16.8% of inappropriate requests. A rule of four criteria—red flag or neurological warning feature, neurogenic claudication, purely radicular pain, or pre-imaging consideration of surgery/intervention—predicted management-changing MRI with 84% sensitivity and 81% specificity (Youden 0.64, versus 0.50–0.59 for the guidelines) and would have reduced imaging volume by 59.2%. Conclusions: Roughly two-thirds of lumbar MRI requests were guideline-inappropriate and rarely altered management. In this exploratory derivation cohort, a simple four-item rule showed promising predictive performance, but its apparent numerical advantage over existing guideline logic was not statistically confirmed and requires independent prospective validation; two blinded LLM assessments showed substantial agreement with guideline judgements, supporting further evaluation of LLM-based pre-order screening in independently validated settings. Full article

Environmental-monitoring systems often bundle sensing, communication, storage, visualization, and control into one application, making later changes difficult. We designed a service-oriented platform that separates these functions through defined interfaces. It combines a Raspberry Pi gateway, a dedicated motor-control microcontroller, five environmental sensor modules, Node-RED middleware, a database, and a web interface. Deterministic code alone evaluates threshold and composite rules and controls safety-relevant alerts; an optional large language model (LLM) turns pre-computed statistics and rule outcomes into narrative reports. We examined data acquisition and rule processing during two short indoor campaigns. In the residential campaign, the SCD41 yielded 78 valid three-minute bins (234 min of recorded data) across four sessions between 09:18 and 17:12 local time; binned CO₂ concentrations ranged from 679 to 1471 parts per million (ppm). Using the initial campaign for development and the residential campaign as a temporal holdout, the persistence model produced a 15 min forecast mean absolute error of 58.3 ppm and a root mean square error of 78.8 ppm. A separate controlled experiment generated 270 reports from nine deterministic synthetic scenarios. Every reporter preserved all deterministic alert identifiers, while the fixed template and seven of the nine locally hosted LLMs achieved 100% numerical fidelity. Qwen 3.5 9B was the only LLM that returned all required measured content without automated claim-review flags and produced identical outputs across repetitions for every scenario. These results confirm integration and functional separation under the tested conditions, but they do not demonstrate week-scale reliability, longer-horizon forecasting accuracy, robotic mobility performance, or load scalability. Full article

This study aimed to evaluate the complementary potential of UAV-based and proximal multispectral sensing using the Plant-O-Meter (POM) sensor for the assessment of wheat grain yield and quality across different phenological stages and two growing seasons. The analysis was based on three vegetation indices, the Normalized Difference Vegetation Index (NDVI), Green Normalized Difference Vegetation Index (GNDVI), and Normalized Difference Red Edge Index (NDRE), and included two morphologically distinct genotype groups, awned and awnless. The study included nine awned and nine awnless genotypes. Vegetation indices showed pronounced seasonal dynamics, with higher values during intensive vegetative development and a decline during later growth stages. The strongest relationship with grain yield was observed for GNDVI-A during the heading to beginning of flowering stage (BBCH 51–61) in Season I (r = 0.85), whereas in Season II, the strongest relationship was observed for NDRE-A during the flag leaf stage (BBCH 37–39) (r = 0.80). Awned genotypes generally showed stronger VI–yield relationships, while associations with grain quality parameters varied among genotype groups and seasons. Linear mixed-effects models showed that both VI-related effects and genotype variability contributed to the variation in grain yield and quality. For yield, marginal R² was 0.43 in Season I and 0.50 in Season II, while conditional R² was 0.78 and 0.64, respectively. For protein and wet gluten content, model performance was more variable, with marginal R² values ranging from 0.30 to 0.39 for protein and from 0.31 to 0.33 for wet gluten. Genotype-level LOGO cross-validation further indicated variation in model performance when genotypes not included in model development were evaluated. Overall, the results indicate that relationships between multispectral vegetation indices and wheat grain yield and quality depend on sensing method, phenological stage, genotype characteristics, and growing season. The findings provide an exploratory basis for the application of multispectral sensing in wheat phenotyping and assessment of grain yield and quality, while further validation across broader genetic and environmental conditions is required. Full article

Teen dating violence (TDV) is a prevalent phenomenon, yet the role of cognitive–attitudinal factors such as the acceptance of relational “red flags” and the endorsement of romantic myths remains insufficiently explored. This study investigates how these factors are associated with adolescents’ evaluation of the seriousness of violence situations and blame attribution across diverse victim–perpetrator configurations. A convenience sample of 658 Italian adolescents (ages 12–19) completed self-report measures and evaluated experimental vignettes depicting verbal–emotional, relational–threatening, and physical violence across different- and same-sex relationship configurations. The results indicated that females reported greater acceptance of threatening/aggressive and jealous/possessive red flag behaviors, while males and younger students showed stronger endorsement of romantic myths. Although females rated violence as more serious than males, episodes involving male victims were consistently perceived as less serious regardless of couple type. In the best-fitting SEM for the physical violence vignette, greater acceptance of red flag behaviors was associated with lower perpetrator blame and perceived seriousness, while stronger endorsement of romantic myths was associated with greater victim blame and lower perpetrator blame and seriousness. These findings suggest that adolescents’ tolerance of warning signs and idealized romantic schemas may undermine violence recognition. Prevention efforts should prioritize challenging the normalization of control and male invulnerability through gender-sensitive approaches inclusive of diverse relationship configurations. Full article

Background/Objectives: Early-onset colorectal cancer (EOCRC), diagnosed before age 50 years, is increasing in many populations and usually arises outside routine screening pathways. We synthesized clinical, demographic, familial, and genetic evidence relevant to risk-stratified early detection. Methods: Two core PubMed searches covering publications from 1 January 2010 through 1 June 2026 were supplemented by targeted PubMed searches and reference-list screening. The present review cited 82 journal publications and synthesized the findings qualitatively; no formal risk-of-bias assessment, certainty-of-evidence grading, or de novo quantitative pooling was performed. Results: EOCRC commonly involves the distal colon or rectum and presents with hematochezia, abdominal pain, altered bowel habits, or iron-deficiency anemia, with diagnostic intervals of several months. Screening colonoscopy in average-risk adults aged 45–49 years has a clinically relevant yield, although generally lower than in older adults, and direct evidence of reduced incidence or mortality remains limited. Risk rises with age before 50; sex and race or ethnicity provide limited, context-dependent discrimination. Family history is a consistent marker, although most cases lack documented familial aggregation. Pathogenic germline variants explain a minority, and polygenic risk scores are not established for routine practice. Conclusions: Early detection should combine timely investigation of warning signs, assessment of family history, equitable access to diagnostics, germline testing for patients with EOCRC, cascade testing, and prospective validation of population-specific models. Full article

Background/Objectives: Endometrial polyps are a prevalent pathological condition within the uterine cavity. While the majority of lesions are classified as benign, histopathological examinations indicate a potential for malignant transformation occurring in 0.5–5% of cases. The present study aimed to evaluate the prevalence of endometrial carcinoma and pre-malignant histopathological findings (glandular hyperplasia without atypia and atypical glandular hyperplasia) associated with endometrial polyps and to identify pertinent risk factors among Polish women undergoing hysteroscopic polypectomy under local anesthesia. Methods: A retrospective cohort study was conducted at the Outpatient Hysteroscopy Center of the Heliodor Swiecicki University Hospital of Gynecology and Obstetrics, affiliated with Poznan University of Medical Sciences. The study included patients treated using the GUBBINI mini-resectoscope under local anesthesia with the Hystero-Block system (Tontarra Medizintechnik GmbH, Wurmlingen, Germany) between December 2022 and July 2026. Statistical analysis of risk factors was performed using the Kruskal–Wallis H test and Fisher’s exact test. Odds ratios for potential risk factors were also calculated. Results: The study comprised 2588 patients. Endometrial carcinoma associated with endometrial polyps was identified in 16 women (0.62%). Additional histopathological findings included glandular hyperplasia in 360 patients (13.91%) and atypical hyperplasia in 35 patients (1.35%), with the remaining patients diagnosed with benign uterine polyps (84.12%). Patients with malignant and pre-malignant lesions were significantly older than those with benign polyps (p < 0.001). Regarding polyp size, patients diagnosed with glandular hyperplasia without atypia had significantly larger polyps than those with benign lesions (p < 0.001). Estimated postmenopausal status was associated with significantly higher odds of endometrial carcinoma (Odds Ratio [OR] = 6.56, 95% Confidence Interval [CI]: 2.12–20.30, p = 0.001) and atypical glandular hyperplasia (OR = 3.13, 95% CI: 1.41–6.96, p = 0.005) compared to benign polyps. Similarly, obesity increased the odds of glandular hyperplasia without atypia (OR = 1.32, 95% CI: 1.01–1.74, p = 0.045) and atypical glandular hyperplasia (OR = 3.33, 95% CI: 1.67–6.65, p < 0.001). Furthermore, hypertension was associated with higher odds of glandular hyperplasia without atypia compared to benign polyps (OR = 1.41, 95% CI: 1.02–1.97, p = 0.040). Other evaluated risk factors, including type II diabetes mellitus, infertility, abnormal uterine bleeding, breast cancer history, hypothyroidism and polyendocrine metabolic ovarian syndrome (PMOS), did not reach statistical significance (p > 0.05). This large cohort provides important data regarding the prevalence and risk factors of carcinoma associated with endometrial polyps and pre-malignant uterine lesions in Polish women. Conclusions: Endometrial carcinoma associated with endometrial polyps is a rare entity among Polish women undergoing outpatient hysteroscopy (0.62%). Nevertheless, the primary diagnostic value of this large-scale study lies in demonstrating that despite the low prevalence of malignancy in standard “see-and-treat” outpatient settings, systematic histopathological evaluation remains an absolute diagnostic mandate, as relying solely on visual or clinical parameters is insufficient to exclude malignancy. Furthermore, identified risk factors, such as age, polyp size, estimated postmenopausal status, obesity and hypertension, serve as critical diagnostic red flags, associated with increased odds of concurrent premalignant lesions or carcinoma. Full article

Distinguishing infectious collections from underlying malignancies may represent a significant diagnostic challenge, particularly when tumors present with necrotic, cystic, perforated, or abscess-like components. Here, we introduce the descriptive concept of “cancer–abscess” as a practical imaging-oriented framework for recognizing underlying malignancies presenting as presumed infectious collections. The first case involves an appendiceal-region malignancy initially interpreted as a postoperative pericecal collection after appendectomy; the second concerns a locally advanced rectal carcinoma complicated by abscess formation and fistulization into the gluteal region. Ultrasound, computed tomography, and magnetic resonance imaging findings are reviewed to highlight recurrent diagnostic red flags, including persistent mass-like architecture, enhancing solid components, irregular soft-tissue proliferation, necrotic-colliquative areas associated with pathological enhancement, suspicious nodal or implant-like disease, and atypical extension patterns. Recognition of these features may support earlier suspicion of malignancy, guide further diagnostic work-up, and reduce delays in oncologic treatment. The “cancer–abscess” concept should be considered whenever presumed infectious collections show atypical or persistent imaging characteristics. Full article

Background/Objectives: Modern automated hematology analyzers combine quantitative cell counting with proprietary algorithms for automated morphological interpretation. While analytical validation traditionally focuses on measurement agreement, less attention has been paid to the evaluation of algorithm-assisted morphological interpretation. This study compared the analytical performance and automated morphological flagging of the Sysmex XN-9100 and Mindray BC-7800/BC-7900 platforms under routine laboratory conditions. Methods: A total of 183 peripheral blood samples collected between October 2025 and February 2026 were analyzed in parallel using both platforms. The study population included healthy individuals and patients with hematological and non-hematological disorders. Analytical agreement for complete blood count (CBC) and leukocyte differential parameters was assessed using Passing–Bablok regression and Bland–Altman analyses. Automated morphological flagging was evaluated in 157 samples using expert optical microscopy as the reference standard. McNemar’s test, Cohen’s kappa coefficient, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: Excellent agreement was observed for the principal CBC parameters, including white blood cell count, red blood cell count, hemoglobin, hematocrit, mean corpuscular volume, and platelet count (correlation coefficients: 0.981–1.000), with minimal proportional bias. Greater variability was found for monocytes, eosinophils, and basophils, particularly at low cell concentrations. Although analytical performance was highly comparable, the two platforms showed different morphological flagging profiles. Both analyzers achieved high negative predictive values (>90%), while differences in sensitivity and specificity across individual flag categories reflected distinct algorithm-assisted classification strategies. Agreement with expert microscopy ranged from fair to moderate for most pathological flags. Conclusions: The Mindray BC-7800/BC-7900 and Sysmex XN-9100 demonstrated excellent analytical agreement for routine CBC testing. However, comparable analytical performance did not necessarily correspond to identical automated morphological interpretation. These results indicate that evaluation of modern hematology analyzers should include both analytical performance and agreement between automated flags and expert microscopy. Full article

Background/Objectives: Autoimmune nodopathies are a distinct subgroup of immune-mediated peripheral neuropathies caused by antibodies targeting nodal and paranodal proteins, including contactin-1 (CNTN1). These disorders are frequently misclassified as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), despite fundamental differences in pathophysiology, clinical course, and treatment response. Growing evidence indicates that systemic manifestations, such as proteinuria, may represent relevant diagnostic red flags. We report a case of anti-CNTN1 autoimmune nodopathy with renal involvement and long-term follow-up after rituximab therapy. Methods: We describe the longitudinal clinical, electrophysiological, laboratory, and therapeutic features of a patient presenting with an acute/subacute sensory ataxic neuropathy evolving into a chronic immune-mediated disorder. Serial nerve conduction studies were performed during multiple hospital admissions and follow-up visits. Autoantibody testing for nodal/paranodal antigens was undertaken, and systemic biomarkers were monitored over time. Results: The patient initially exhibited a robust response to intravenous immunoglobulin (IVIg), consistent with an acute inflammatory neuropathy. Subsequent relapse was characterized by cranial nerve involvement, worsening sensory ataxia, peripheral edema, albuminocytologic dissociation on cerebrospinal fluid analysis, proteinuria, and an inverted albumin/gamma globulin ratio, redirecting the diagnostic hypothesis toward CIDP. The detection of anti-CNTN1 antibodies ultimately established the diagnosis of autoimmune nodopathy. Owing to poor durability of IVIg, rituximab was initiated, resulting in sustained clinical improvement and near-complete recovery of motor and sensory nerve conduction parameters at one-year follow-up (November 2025). Conclusions: This case emphasizes the diagnostic relevance of extraneurological biomarkers, including proteinuria and peripheral edema, in autoimmune nodopathies and supports early nodal/paranodal antibody testing in atypical demyelinating neuropathies. Prompt B-cell-directed therapy may enable functional recovery of nodal integrity and improve long-term outcomes. Further studies are needed to clarify potential immunological triggers, including anti-IL-23 therapies, in the pathogenesis of anti-CNTN1 autoimmune nodopathy. Full article

Oligodendroglioma-like morphology, classically recognized by round nuclei, optically clear cytoplasm, and perinuclear halos, is one of the most familiar patterns in neuropathology but also one of the most diagnostically misleading. Although historically associated with oligodendroglioma, this phenotype is now recognized across a wide spectrum of neoplastic and non-neoplastic central nervous system lesions, including adult-type diffuse gliomas, ependymal tumors, pediatric-type low-grade gliomas, glioneuronal and neurocytic tumors, metastatic clear-cell neoplasms, demyelinating disease, and subacute infarcts. The 2021 WHO Classification of CNS Tumors has consolidated a diagnostic framework in which histology remains indispensable, but no longer sufficient, for tumor classification. In this setting, oligodendroglioma-like morphology should be interpreted as a morphological clue that prompts a differential diagnosis and guides ancillary testing rather than as a definitive diagnostic category. This review provides a practical integrated approach to CNS tumors and tumor-like lesions with oligodendroglioma-like or clear-cell morphology. We summarize the major diagnostic mimics of oligodendroglioma, highlighting first-line immunohistochemical panels, and proposing a tiered molecular workflow to identify the conditions in which genome-wide DNA methylation profiling becomes essential. Particular emphasis is placed on clinico-pathological correlation and on red flags that should prompt reconsideration of a conventional oligodendroglioma diagnosis. Full article

Background/Objectives: Thrombocytopenia increases bleeding tendency and may complicate perioperative management in total knee arthroplasty (TKA), yet data on both in-hospital burden and post-discharge adverse events are limited. This study evaluated the association between preoperative platelet count and outcomes after primary TKA. Methods: In total, 3474 primary TKAs performed for osteoarthritis at a single institution (2008–2023) were retrospectively reviewed. Patients were classified as Normal, Mild, Moderate, or Severe by preoperative platelet count; the Severe group (N = 6) was excluded from comparative analyses and reported descriptively. Inverse probability of treatment weighting (IPTW) balanced baseline covariates. In-hospital outcomes were red blood cell (RBC) transfusion, intensive care unit (ICU) admission, and length of stay; follow-up outcomes were 30-day readmission, 1-year periprosthetic joint infection (PJI), and 1-year mortality. Results: After IPTW, the RBC transfusion rate rose with lower platelet count (Normal, 14.0%; Mild, 27.0%; Moderate, 32.5%; p < 0.001), and transfusion volume peaked in the Moderate group. ICU admission was more frequent (Moderate, 6.0%; Normal, 0.7%; Mild, 0.4%; p = 0.002), and length of stay increased with severity (p = 0.008). Readmission, 1-year PJI, and mortality were comparable across groups. In multivariable analysis, moderate thrombocytopenia was independently associated with RBC transfusion (adjusted odds ratio [aOR], 3.26; 95% confidence interval [CI], 1.51–6.59; p < 0.001) and ICU admission (aOR, 5.46; 95% CI, 1.37–17.41; p = 0.008), but not PJI or mortality. Conclusions: Preoperative thrombocytopenia—particularly in the mild-to-moderate range evaluated in this study—increased perioperative burden after TKA, with higher RBC transfusion and ICU utilization, but was not associated with a significant increase in major postoperative adverse events during 1-year follow-up. Even if not causally responsible, a low preoperative platelet count is a routinely available marker that may flag patients requiring closer perioperative attention. As the associated burden appears largely limited to the hospitalization period, such attentive in-hospital management may allow these patients to achieve favorable outcomes. Full article

Navigational obstacles pose compound collision and pollution risks, yet conventional quantitative assessment models relying on data-driven “best-estimate” approaches suffer from “alarm masking”, whereby critical risk signals are diluted through averaging. This study develops a conservative hybrid risk assessment framework that preserves critical risk signals while systematically incorporating qualitative factors beyond the reach of quantitative data. The fuzzy inference rules of an existing integrated model were redesigned into a priority-stratified hybrid hierarchical–parallel fuzzy inference system (HHP-FIS); a qualitative evaluation matrix of four categories and 32 items was constructed through a two-stage expert procedure (a Delphi panel of eight officials and an analytic hierarchy process (AHP) survey of 59 experts with 34 valid responses); and a Red Flag Protocol was introduced as a fail-safe veto mechanism. The framework was verified through eighteen paired random-input simulations across two grid systems and a case study of a 68.9-ton drifting fishing vessel near Seongsan Port, Jeju Island. The model upwardly reclassified underestimated low-frequency, high-consequence scenarios, raised the case-study risk from Low (44.6 and 47.7) to Moderate (59.1 and 74.8), with an action level consistent with expert judgment, and was robust to rule-weight perturbations, providing a decision-support tool for obstacle-removal prioritization and marine pollution prevention. Full article

Background and Objectives: Angular and rotational lower limb alignment concerns are a frequent reason for paediatric consultations. In most children, these findings reflect physiological developmental patterns that resolve spontaneously, but unilateral, progressive, or symptomatic cases may indicate pathology and require specialist assessment. Materials and Methods: This narrative review summarizes clinically relevant developmental norms, key elements of history and physical examination, common differential diagnoses, and practical indications for imaging and referral, with the objective of offering a structured clinical guidance framework for primary care and paediatric practitioners. Results: Physiological coronal plane lower limb alignment typically progresses from infant genu varum to neutral alignment by around 2 years, followed by transient genu valgum between 3 and 6 years, and stabilizes by approximately 7–8 years. Rotational alignment changes predictably with growth and most commonly presents as in-toeing due to femoral anteversion, internal tibial torsion, or metatarsus adductus. Out-toeing is less often physiological and should prompt careful evaluation for underlying disorders, including slipped capital femoral epiphysis. Clinical assessment should prioritize gait observation, foot progression angle, hip rotation, and thigh–foot angle, while imaging should be reserved for atypical presentations, asymmetry, progression, pain, or suspected systemic or neuromuscular disease. Conclusions: Most paediatric lower limb alignment “abnormalities” represent normal variants and require reassurance and observation. Recognizing age-appropriate patterns and red flags enables paediatricians to limit unnecessary interventions while ensuring timely referral and treatment for pathological conditions. Full article

Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of cardiac dysfunction in adults, resulting from extracellular deposition of misfolded transthyretin fibrils and progressive myocardial impairment. Clinical expression and diagnostic yield differ substantially between sexes, contributing to systematic underdiagnosis in women, who often present with subtler myocardial remodeling, heart failure with preserved ejection fraction (HFpEF)–dominant phenotypes, and nonspecific systemic manifestations that fall below conventional diagnostic thresholds, particularly in early disease stages. Female patients, particularly those with ATTRwt, tend to present at older ages and more frequently show HFpEF-dominant phenotypes and nonspecific extracardiac manifestations. Carpal tunnel syndrome (CTS) is an important extracardiac red flag for ATTR-CM, but its interpretation in women requires caution because of the high background prevalence of idiopathic CTS in the general population. Evidence also suggests sex-related differences in diastolic function, right ventricular involvement, and overall progression. Despite these biological and phenotypic distinctions, women are markedly underrepresented in trials of disease-modifying therapies, limiting conclusions about sex-specific treatment effects and leaving uncertainty about whether current pharmacologic interventions provide comparable benefit. Hormonal influences, genetic background, and age-related mechanisms, comorbidities, and diagnostic pathways may contribute to the distinctive female phenotype, but underlying mechanisms remain insufficiently defined. This narrative review examines sex-associated differences in ATTR-CA, focusing on mechanisms of underdiagnosis, principal clinical and imaging features, and implications for therapeutic response, with the goal of improving diagnostic accuracy, guiding individualized management, and ultimately enhancing outcomes for women and all affected patients worldwide in clinical practice. Full article