Search Results (13,025)

Damping-off caused by Fusarium spp. limits tomato seedling establishment, while chemical control is constrained by resistance development and environmental risks. As a result, biological alternatives and nanomaterials have attracted increasing interest. This study aimed to quantify the in vitro inhibition and in vivo control of Fusarium spp. associated with tomato damping-off using the marine strains KN1 and KN2 of Stenotrophomonas rhizophila and copper oxide nanoparticles (CuO-NPs). Nine fungal isolates were recovered from symptomatic plants; the most virulent isolate (3DR23HA) caused 60% disease incidence and was identified as Fusarium oxysporum. In dual-culture assays, both bacterial strains inhibited mycelial growth, with percentage inhibition of radial growth (PIRG) values exceeding 65% in several isolates, whereas KN1 showed greater inhibition of conidial germination. CuO-NPs exhibited a concentration-dependent response, reaching near-complete suppression at 0.75–1.0 mg mL⁻¹. In seedlings, the inoculated control showed 100% incidence and a disease severity index (DSI) of 85%, whereas KN1, KN1 + CuO-NPs at 0.75 mg mL⁻¹, and KN2 + CuO-NPs at 0.75 mg mL⁻¹ achieved a DSI of 0 and 100% control efficiency, while also improving growth and biomass. Overall, S. rhizophila, particularly strain KN1, and CuO-NPs at 0.75 mg mL⁻¹ represent a promising strategy for the integrated management of tomato damping-off in nurseries. Full article

Background: Treatment options for vulvar lichen sclerosus (VLS) remain limited; therefore, therapies that improve quality of life and reduce neoplastic risk are needed. Photodynamic therapy (PDT) is a potential option. This study aimed to evaluate quality of life and sexual function in patients treated according to the protocol used at our institution. Methods: Forty patients with refractory VLS underwent PDT using a 10% 5-aminolevulinic acid nanoemulsion (Ameluz^®) applied to lesions under an occlusive aluminum foil dressing. Patients received 1–6 sessions of 10 min illumination (LED: 37 J/cm², ~77 mW/cm²) at 4–6-week intervals. The Dermatology Life Quality Index (DLQI) and Female Sexual Function Index (FSFI) were used for assessment. Results: Thirty-seven participants answered DLQI, while 20 declared themselves to be sexually active and were included in the analysis. Greater number of PDT sessions was associated with a lower DLQI score (τ = −0.583; adjusted p < 0.001). The number of PDT sessions and the total FSFI score (p = 0.014), as well as desire (p = 0.016), arousal (p = 0.020), orgasm (p = 0.020), and satisfaction (p = 0.016) domains were significantly correlated. Age correlated positively with DLQI scores (p = 0.016), indicating greater disease burden in older patients. Longer disease duration was also associated with poorer quality of life (p = 0.020). Conclusions: PDT can be considered an effective treatment for patients with VLS refractory to standard topical corticosteroid and calcineurin inhibitor therapies when delivered using a refined, patient-centered protocol. This optimized approach used in our institution is based on short irradiation time and precise light delivery, providing a favorable balance between therapeutic efficacy, patient comfort, and treatment feasibility. Our findings also suggest that the cumulative number of PDT sessions is a key factor for clinical response. Further studies should address long-term outcomes. Full article

Background/Objectives: This study aimed to investigate the impact of allergic diseases (AD) or obstructive sleep apnea (OSA) risk, as a host factor, on the development of severe Mycoplasma pneumoniae Pneumonia (SMPP) in children by analyzing the clinical data of pediatric patients with Mycoplasma pneumoniae Pneumonia (MPP). Methods: This retrospective study enrolled children hospitalized with Mycoplasma pneumoniae pneumonia (MPP) at Shanghai Ninth People’s Hospital from November 2024 to November 2025. Patients were classified into severe (SMPP) and mild (MMPP) groups. Demographic, clinical, laboratory, and questionnaire data were collected and compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of SMPP and construct a nomogram. The model was validated for discrimination, calibration, and clinical utility using ROC curves, calibration plots, and decision curve analysis, with internal validation by bootstrap resampling. Results: Among the 150 enrolled children with MPP, 35 (23.3%) were classified as severe (SMPP) and 115 (76.7%) as mild (MMPP). Patients with SMPP exhibited significantly higher frequencies of allergic diseases, prolonged fever and steroid use, elevated inflammatory markers (CRP, LDH, D-dimer, ferritin, ALT), and higher PSQ and RQLQ scores (all p < 0.05). Disease severity was positively correlated with these clinical, laboratory, and questionnaire-based parameters. Multivariate logistic regression identified allergic diseases, PSQ score, LDH, and ferritin as independent predictors of SMPP. A nomogram incorporating these four factors demonstrated good predictive performance, with an internally validated C-index of 0.827, satisfactory calibration (Hosmer–Lemeshow p = 0.116), and clinical utility within a 0–25% threshold probability range on decision curve analysis. Conclusions: Children with MPP and comorbid AD or OSA risk are more likely to develop SMPP. Among children aged 6–12 years, RQLQ score is positively correlated with the severity of MPP. AD, PSQ score, LDH, and ferritin are independent risk factors for SMPP. Clinicians should be alert to the development of SMPP when children with MPP present with a history of AD, PSQ score >3.5, LDH >327.50 U/L, or ferritin >120.05 ng/mL. The visual nomogram model constructed by combining these risk factors demonstrates improved predictive performance for SMPP, with high predictive efficacy and accuracy. It has great clinical value and can be used for individualized risk assessment and early intervention. However, our proposed nomogram requires external validation prior to broader implementation. Full article

Background: The Middle East and North Africa (MENA) region faces a high cardiovascular disease (CVD) burden alongside endemic serum 25(OH)D (vitamin D) deficiency. This systematic review examines the relationship between vitamin D deficiency and CVD risk factors in MENA populations. Methods: PubMed, Cochrane Library, and Scopus were searched from inception to 18 October 2024, for observational studies in the MENA region examining vitamin D deficiency and cardiovascular risk factors in adults. Independent data extraction was conducted. Study quality was appraised using the Joanna Briggs Institute tool and the Newcastle–Ottawa Scale, with risk of bias visualized using Robvis. Weighted mean differences in cholesterol, body mass index (BMI), and HbA1c between those with and without vitamin D deficiency were computed with random-effects meta-analysis. The protocol was registered in PROSPERO (ID: CRD42025615188) and funded by the Royal College of Surgeons in Ireland—Medical University of Bahrain. Results: Seventeen studies from nine MENA countries were included, predominantly cross-sectional, involving community-based and disease-specific cohorts. Vitamin D deficiency was highly prevalent and consistently associated with higher adiposity and central obesity. Several studies reported significant links between deficiency and poor glycemic control, particularly in obese and prediabetic groups. Meta-analysis demonstrated significantly higher total cholesterol (MD = 0.32; 95% CI = 0.11 to 0.52, p < 0.001), BMI (MD = 1.81; 95% CI = 0.68 to 2.94, p < 0.001), and HbA1c levels (MD = 0.31; 95% CI = 0.06 to 0.57, p = 0.02) in vitamin D deficient individuals, with notable heterogeneity. Conclusions: Vitamin D deficiency is highly prevalent in the MENA region and consistently associated with adiposity-related risk factors. Despite heterogeneity, findings underscore the need for public health strategies and further research to clarify causal pathways and population-specific interventions. Full article

To combat climate change, farmers want to develop sustainable agriculture that enhances food production while strengthening their capacity to cope with extreme weather events and pest and disease pressures. Promoting agroecological farming practices is a promising approach in enhancing sustainability and strengthening the climate-resilient farming systems. Recent research often overlooks to what extent the agroecological farming practices (AFP) provide a measurable advantage over non-AFP methods under increasing environmental challenges. In this regard, this study compares the extent of climate resilience between AFP mango-based farming systems and non-AFP mango-based farming systems in southern Ethiopia. AFP adopters applied ecological principles like intercropping, integrated pest management, agroforestry, canopy management, varietal diversity, and water and soil preservation to enhance biodiversity and soil health, and boost productivity and ecosystem services. The study employed a mixed-method design, drawing on the data from 395 selected households. The resilience of AFP and non-AFP farming systems was assessed by computing the 13 agroecosystem indicators of climate resilience using the Self-evaluation and Holistic Assessment of Climate Resilience of Farmers and Pastoralists (SHARP+) tool. Households in AFP mango-based farming system demonstrated greater diversification in agricultural production system compared to those in non-AFP mango farming system. The analysis of climate resilience indicators showed that the mango production systems under the AFP were more climate-robust than their conventional systems. Both the compound resilience score and the household resilience index showed that the mango farming systems under AFP substantially enhanced climate resilience. Hence, coordinated supports from the extension services, NGOs, and researchers are needed to scale up these benefits of AFP. Strengthening the AFP mango farming requires addressing the key barriers such as market access, input availability, and crop diversification strategies. This paper identifies important avenues for further AFP research in Sub-Saharan African countries. Full article

Background/Objectives: Non-variceal upper gastrointestinal bleeding (NVUGIB) remains a major clinical emergency, particularly among patients receiving antiplatelet or anticoagulant therapy, whose use has increased substantially in recent years. This study aimed to evaluate the clinical characteristics, endoscopic findings, risk stratification, and outcomes of NVUGIB in patients receiving antithrombotic therapy, and to compare the predictive performance of commonly used prognostic scores. Methods: This prospective cohort study included 89 patients receiving antithrombotic therapy who presented with NVUGIB at Beni-Suef University Hospitals between March 2023 and March 2025. Clinical presentation, laboratory findings, and endoscopic characteristics were recorded. Risk stratification was assessed using Glasgow–Blatchford (GBS), Rockall, Baylor, AIMS65, ABC, and PNED scores. The optimal cut-off values for prediction of rebleeding and mortality were determined using receiver operating characteristic (ROC) analysis and the Youden index. Area under the curve (AUC) values were reported with 95% confidence intervals. Results: Endoscopy revealed that peptic ulcers were the most common lesion (41/89, 46%), followed by erosive disease (27/89, 30%), with the stomach being the most frequently involved site (76.5%). Rebleeding occurred in 16 patients (18.0%), while mortality was observed in 2 patients (2.2%). The Glasgow–Blatchford score demonstrated the most consistent performance for predicting rebleeding, with an optimal cutoff value of 5.5 (derived using the Youden index), yielding 92.9% sensitivity and 78.8% specificity. For mortality prediction, AIMS65, ABC, and PNED scores showed very high AUC values, although these findings should be interpreted cautiously due to the small number of mortality events (n = 2). No statistically significant difference in rebleeding or mortality was observed between single and dual antithrombotic therapy, although patients receiving dual therapy required longer hospitalization and more transfusion units. Conclusions: In patients with antithrombotic-related GI bleeding, ulcers and erosions predominate, with minimal differences between single and dual therapy outcomes. Concomitant NSAID use trends toward higher mortality. Glasgow–Blatchford score offers optimal performance for both rebleeding and mortality prediction, with a cutoff of 5.5 providing excellent sensitivity (92.9%) and specificity (78.8%) for rebleeding risk assessment. Full article

Background: Disseminated coccidioidomycosis (DCM) often requires prolonged antifungal therapy (AFT). Real-world data on AFT duration in DCM are limited. We evaluated time to AFT discontinuation among patients with DCM in the United States clinical practice. Methods: This retrospective, longitudinal study used STATinMED data (2016–2024). Patients had ≥1 International Classification of Diseases, Tenth Revision (ICD-10) code for DCM (B38.3, B38.4, B38.7, B38.81) during January 2017–December 2023, ≥1 claim for a triazole or amphotericin B within 21 days of the DCM diagnosis (index date), and continuous medical/pharmacy coverage during the 6-month baseline period. Discontinuation was defined as a ≥21-day gap without AFT. Antifungal agent/formulation switches were not considered discontinuations unless accompanied by a qualifying gap. The Kaplan–Meier methods were used to estimate time to discontinuation. Results: We identified 991 patients with DCM. Median age was 52 years (IQR 36, 65); 60.0% were men. Most resided in California (42.8%) or Arizona (33.6%). Initial AFT consisted predominantly of triazoles (96.8%), primarily fluconazole (83.2%). Discontinuation occurred in 27.6%, 40.0%, 54.2%, and 68.0% of patients by 3, 6, 12, and 36 months. Median AFT duration was 9.9 months. Conclusions: In a large US claims cohort, there was substantial variability in AFT duration in routine practice. Many patients had AFT durations under the lower limit of guideline recommendations for DCM, suggesting potential under-treatment, though appropriate clinical justifications may have existed. Full article

Aims: This study aimed to examine the association between three-year changes in body mass index (BMI) and the risk of new-onset or progressive diabetic kidney disease (DKD) among people with type 2 diabetes and a normal BMI at baseline. Methods: A total of 416 people with type 2 diabetes (T2DM) and a normal BMI were enrolled from the Chongqing Diabetes Registry (CDR, NCT03692884) cohort and were followed for incident DKD until 2025. The change in BMI at the three-year follow-up was classified as follows: stable BMI (<5% change), decreased BMI (≥5% reduction), and increased BMI (≥5% gain). Cox proportional hazards models were used to analyze the association between BMI change categories and DKD risk. Results: During a mean follow-up of 3.4 years, people with an increased BMI exhibited a significantly higher risk of DKD onset or progression compared with people with a stable BMI [HR = 1.67, 95%CI: 1.15–2.43, p = 0.007]. Each 1% increase in BMI was significantly associated with an increased risk of DKD onset or progression [HR = 1.05, 95%CI: 1.02–1.07, p < 0.001]. This association remained significant after multivariable adjustment. Time-dependent receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) of this indicator reached 0.683–0.729 for the prediction of new-onset or progressive DKD risk over 3–5 years. In subgroup analyses, decreased BMI was associated with a lower risk of DKD among people aged <60 years [HR = 0.21; 95% CI: 0.04–0.96; p = 0.044]. Conclusions: A ≥5% increase in BMI in three years may be a risk factor for new-onset or progressive DKD among people with T2DM and normal BMI. Conversely, a ≥5% decrease in BMI may be associated with renal protection in non-elderly individuals within the population. Full article

The integration of rooted plant flour into traditional noodle matrices, such as rice noodles and qingke noodles, represents a novel approach to enhancing the nutritional and sensory profiles of staple foods. This study investigates the volatile flavor components and functional compounds derived from rooted plant flours, including Gongmi “tribute rice”, qingke “highland barley” flour, kudzu vine flour, Gastrodia elata blume flour, dried ginger flour, and fishwort root flour, when incorporated into rice and qingke noodles. The novelty of this research lies in its comprehensive analysis of how these flours influence not only the nutritional and textural properties but also the volatile organic compounds (VOCs) that define sensory acceptance and health benefits. Using advanced gas chromatography mass spectrometry (GC-MS), we identified key VOCs, such as esters, aldehydes, and terpenes, which contribute to unique flavor profiles like umami, sweetness, and earthy notes in fortified noodles. Additionally, the study highlights the best functional compounds for health, including polyphenols, resistant starch, and polysaccharides, which demonstrate significant antioxidants, anti-inflammatory, and cholesterol-lowering properties. For instance, highland barley enriched flour exhibited high levels of phenolic compounds and carotenoids, which correlated with improved antioxidant activity and a reduced glycemic index. Similarly, Gongmi flour contributed elevated levels of γ-aminobutyric acid (GABA) and rutin, enhancing the rice noodles’ potential to manage metabolic diseases and support cardiovascular health. Molecular docking analyses predicted strong interactions between key volatile compounds (e.g., 3-dihydro-1, 3-trimethyl-33-phenyl-1H-indene) and metabolic targets like ACE and SGLT1, suggesting mechanisms for their cardioprotective and anti-diabetic effects. This research provides a groundbreaking framework for developing next generation functional foods by leveraging rooted plant flours to bridge the gap between sensory appeal and health efficacy, offering strategic insights for personalized nutrition and sustainable food production. Full article

Medication-related osteonecrosis of the jaw (MRONJ) represents a major clinical challenge for oral and maxillofacial surgery departments as well as dental practices. With increasing life expectancy and the more frequent use of medications associated with osteonecrosis, the incidence of MRONJ continues to rise. To date, there are no uniform treatment standards with scientifically proven effectiveness for this condition. To evaluate the impact of platelet-rich fibrin (PRF) on the outcomes of MRONJ treatment and to identify factors that may influence the effectiveness of PRF therapy, we conducted a comparative prospective study including 22 patients divided into two groups: patients treated with PRF and patients treated without PRF. PRF was prepared according to the PRF Duo Quattro Process protocol for PRF (Nice, France). The study was registered at ClinicalTrials.gov (NCT07464678). The following parameters were assessed: age, smoking status, gender, lesion location, body mass index (BMI), C-reactive protein (CRP) concentration, pain intensity, presence or absence of fistulas, soft tissue healing and radiological findings. Patients were evaluated preoperatively and postoperatively at 14 days, 6 weeks, and 6 months. The study demonstrated a reduction in pain after surgery among patients treated with PRF. In addition, the use of PRF resulted in improved healing outcomes in patients with elevated CRP. Higher BMI was associated with poorer therapeutic response to PRF. Improvements in soft tissue healing and disease stage were observed in the PRF group; however, these differences did not reach statistical significance. All findings should be interpreted with caution due to the limited sample size. There is still no standardized treatment for MRONJ. The use of platelet-rich fibrin as an inexpensive and safe adjunctive therapy may provide clinical benefits for patients, particularly through a significant reduction in pain. Further large-scale, multicenter studies are required to confirm these findings. Full article

Ten substituted quinobenzothiazinium salts were tested for their ability to inhibit acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). All the compounds inhibited AChE in the IC₅₀ range of 0.03–0.658 µM, with 5,8,10-trimethyl-12H-quinolino[3,4-b][¹,⁴]benzothiazin-5-ium chloride (3d) being the most potent inhibitor, with an IC₅₀ value significantly better than that of the clinically used rivastigmine and galantamine and comparable to that of tacrine and donepezil. The IC₅₀ values for BChE inhibition ranged from 0.34 to 4.25 µM; 5,9-dimethyl-12H-quinolino[3,4-b][¹,⁴]benzothiazin-5-ium chloride (3b) exhibited the strongest BChE inhibitory activity and in general, all the investigated compounds were more potent inhibitors than rivastigmine and galantamine. Based on the calculated selectivity index values, they are rather preferential inhibitors of AChE. Cytotoxicity tests performed on normal human dermal fibroblasts (HFF-1) did not demonstrate any significant cytotoxicity under the tested conditions. The distance-oriented structure distribution for the studied molecules was related with the activity data using principal component analysis and hierarchical clustering analysis. (SAR)-based evaluation is reported to predict activity cliffs using a similarity–activity landscape index for the AChE inhibitory response values. Moreover, direct protein-mediated in silico methods were utilized to identify factors that may be relevant for quantitative (Q)SAR modeling. In practice, target-oriented molecular docking was used to organize the spatial distribution of the ligand property space for the anti-AChE system. In general, this series of alkylated quinobenzothiazinium salts with potent inhibitory activity against cholinesterases fulfills Lipinski’s rule of five based on in silico predictions and is also expected to have high absorption in the human gastrointestinal tract. All active derivatives are also expected to penetrate the blood–brain barrier, making them promising compounds for further research and possible use in Alzheimer’s disease therapy. Full article

Introduction: Cardiovascular disease (CVD) is a leading cause of non-cancer death among cancer survivors, attributable to cardiotoxic therapies and cardiovascular risk factors. General population risk prediction tools, including ASCVD (Atherosclerotic cardiovascular disease), Framingham’s Score, and PREVENT (Predicting Risk of Cardiovascular Disease EVENTS), lack cancer-specific variables. We evaluated whether these models, even after statistical optimization, could predict cardiovascular mortality in cancer survivors. Methods: Using the National Health and Nutrition Examination Survey (NHANES) 2001–2018, linked with National Death Index (NDI) mortality data, we conducted a retrospective analysis of 634 and 429 cancer survivors, respectively, across model-specific cohorts free of baseline cardiovascular disease. Discrimination was assessed for ASCVD, Framingham Score, and PREVENT using standardized thresholds of 7.5% and 20%, as well as Youden-optimized cutoffs. Area under the curve (AUC) comparisons were performed using the DeLong non-parametric method. Results: Standard thresholds showed suboptimal discrimination across all models (AUCs: ASCVD 0.56, Framingham 0.53, PREVENT 0.64). In contrast, Youden-optimized AUCs (ASCVD: 0.68; PREVENT: 0.71; all p < 0.001, DeLong test). Optimization increased the “low-risk” group’s mortality rate from 2.8% to 4.1% (RR = 1.47), suggesting improved statistical fit came at the cost of overestimating the risk. Optimized thresholds outperformed conventional cutoffs, underscoring the necessity for recalibrated, cohort-specific risk stratification in cancer survivors. Conclusions: Standard risk scores have inadequate discrimination for cardiovascular mortality prediction in cancer survivors. Threshold recalibration improves statistical metrics but does not resolve the structural failure of these models to account for cardiotoxic exposure. Development of cardio-oncology-specific risk models incorporating oncologic exposures is therefore warranted. Full article

Background/Objectives: Ascending aortic aneurysm is a heterogeneous disease, with many cases of acute Stanford type A aortic dissection (ATAAD) presenting with aortic diameters below currently recommended surgical thresholds. Demographic factors such as age and sex, along with indexed aortic size groups, have been proposed to improve risk stratification. Methods: We included 65 adult patients who underwent surgical intervention for ATAAD. Morphometric measurements were obtained from computed tomography angiography (CTA) using centerline reconstruction. Maximum ascending aortic diameter and length were measured. Indexed parameters included the aortic size index (ASI), aortic height index (AHI), aortic length index (ALI) and cross-sectional aortic area indexed to height (CSA/H). Estimated pre-dissection dimensions were derived by reducing diameter by 18% and length by 2.7%. The cohort was stratified by age-, sex-, and ASI-defined groups. Results: Women were older than men (mean age 67 [SD 11] vs. 58 [SD 13] years, p = 0.01). Aortic diameter and length did not differ significantly by age or sex. At presentation, an ascending aortic diameter < 5.0 cm was observed in 37.1% of patients aged < 65 years and 26.7% of those aged ≥ 65 years. When stratified by sex, 25.0% of women and 35.6% of men presented with an ascending aortic diameter < 5.0 cm. Indexed parameters (ALI, AHI and ASI) were higher in older patients and women despite their smaller body size. In estimated pre-dissection analyses, less than 10% of the patients had diameters ≥ 5.5 cm, whereas most had estimated diameters < 5.0 cm. Conclusions: A substantial proportion of patients with ATAAD present with aortic dimensions below the current surgical thresholds. These findings underscore the limitations of diameter-based criteria and support the potential value of indexed geometric parameters in improving risk assessment in ATAAD patients. Full article

Background/Objectives: When the squamocolumnar junction is not fully visible (type 3 transformation zone), colposcopy-directed biopsy may under-sample endocervical disease. Endocervical curettage (ECC) is recommended in selected settings, but its incremental diagnostic yield in this setting, and whether this yield is concentrated in women with HPV16/18, remains clinically debated. Methods: We performed a retrospective cohort study of women referred to colposcopy because of HPV16/18 positivity regardless of cytology, persistent non-16/18 high-risk HPV positivity, and non-16/18 high-risk HPV positivity with abnormal cytology. Persistent non-16/18 high-risk HPV positivity was defined as repeated positivity on two tests performed at least 6 months apart. Eligible women had type 3 transformation zone documented and underwent paired ectocervical biopsy plus ECC at the same visit; biopsy was obtained in all women, including targeted sampling of the most abnormal ectocervical area when no discrete lesion was evident. Women were stratified by HPV genotype into HPV16/18 and non-16/18 high-risk HPV groups. The primary outcome was index high-grade cervical lesion, defined histologically as CIN2, CIN3, or carcinoma in situ; invasive cervical cancer was excluded. The added diagnostic yield of ECC was defined as ECC-only CIN2+, that is, CIN2+ detected on ECC when biopsy was <CIN2. Results: The cohort included 690 women (HPV16/18: 310; non-16/18 high-risk HPV: 380). Baseline cytology was negative for intraepithelial lesion or malignancy in 116 individuals (16.8%), ASC-US in 155 (22.5%), LSIL in 205 (29.7%), and ASC-H/HSIL in 214 (31.0%). On index composite histology, 122/690 (17.7%) had CIN2, 198/690 (28.7%) had CIN3, and 11/690 (1.6%) had carcinoma in situ. ECC identified CIN2+ not detected by biopsy in 19/690 (2.8%) cases, representing 19/331 (5.7%) of all CIN2+ diagnoses. ECC-only CIN2+ was more frequent in HPV16/18 than non-16/18 high-risk HPV (4.5% vs. 1.3%, p = 0.017). In multivariable analysis, HPV16/18 was associated with increased odds of ECC-only CIN2+ (aOR 3.22, 95% CI 1.10–9.44). No invasive cervical cancers were included in the analytic cohort. Conclusions: In type 3 transformation zone colposcopy, ECC adds a modest incremental yield for CIN2+ detection, with higher yield in HPV16/18-positive women. These findings support a risk-weighted approach to ECC rather than universal routine sampling. Full article

Introduction: Hypertrophic cardiomyopathy (HCM) is a common myocardial disease worldwide and is associated with heart failure symptoms and sudden cardiac death. In a subset of patients, it may produce dynamic left ventricular outflow tract obstruction (LVOTO) and systolic anterior motion (SAM)-related mitral valve dysfunction through drag forces and altered mitral–septal geometry. In contrast, subaortic stenosis caused by a subaortic membrane is an uncommon congenital lesion that may lead to fixed subvalvular LVOTO in adulthood. The coexistence of these entities is rare and can substantially complicate diagnosis and management. Case presentation: A 51-year-old woman with HCM, paroxysmal atrial fibrillation, and heart failure presented with acute decompensation and cardiogenic shock. After initial hemodynamic stabilization and cardioversion for atrial fibrillation with rapid ventricular response, multimodality imaging with transthoracic and transesophageal echocardiography, coronary computed tomography angiography, and cardiac magnetic resonance demonstrated dual LVOTO, with a dynamic component related to HCM/SAM physiology and a fixed component caused by an elongated subaortic membrane, accompanied by severe SAM-related mitral regurgitation. Echocardiography showed a resting peak LVOT gradient of 49 mmHg, increasing to 85 mmHg with the Valsalva maneuver. After exclusion of obstructive coronary artery disease and evaluation for selected phenocopies, the patient underwent septal myectomy, subaortic membrane resection, and adjunctive mitral valve plication. Early postoperative echocardiography showed reduction in the maximum provoked LVOT gradient to 38 mmHg and improvement of mitral regurgitation from severe to mild. At 3-month follow-up, she remained in sinus rhythm, improved to New York Heart Association functional class II, and had no documented readmissions for heart failure. Conclusions: Combined fixed and dynamic LVOTO due to concomitant subaortic membrane and HCM is exceedingly rare. Accurate diagnosis requires a high index of suspicion and a multimodality imaging strategy to define the obstructive mechanisms and support mechanism-based surgical management and avoid incomplete treatment when a coexisting fixed lesion is present. Full article