Search Results (5,300)

Background/Objectives: Liver metastases in breast cancer patients are associated with poor prognosis and limited therapeutic options. Selective Internal Radiation Therapy (SIRT), also known as transarterial radioembolization (TARE), has emerged as a loco-regional treatment modality, particularly in cases refractory to systemic therapies. Objective: To systematically review and synthesize evidence from existing systematic reviews and meta-analyses on the efficacy and safety of SIRT in breast cancer patients with liver metastases. Methods: A comprehensive literature search was conducted in PubMed using predefined keywords related to SIRT and breast cancer, restricted to systematic reviews and meta-analyses. Inclusion criteria were reviews evaluating SIRT in breast cancer patients with hepatic metastases, reporting on efficacy (e.g., objective response rate, disease control rate, overall survival) and/or safety outcomes. The quality of included reviews was assessed using AMSTAR 2. Results: Seven systematic reviews and meta-analyses were included. Reported objective response rates (ORRs) ranged from 36% to 61%, and disease control rates (DCRs) from 78 to 96%. Toxicity profiles were generally favorable, with limited grade 3–4 adverse events. Some heterogeneity was noted in patient selection, types of microspheres used (glass vs. resin), and outcome definitions. Conclusions: SIRT appears to be a promising option for breast cancer patients with liver metastases, particularly in the setting of treatment resistance. However, heterogeneity among available studies and the lack of prospective randomized trials limit definitive conclusions. Further high-quality studies are warranted. Full article

Background and Objectives: This study aimed to assess the prognostic value of several inflammation-based hematological indices in patients with ischemic and hemorrhagic stroke and to evaluate whether their prognostic significance differs between stroke types. The analyzed indices included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI). Materials and Methods: This retrospective cohort study analyzed the medical records of stroke patients admitted to two hospitals in Shymkent, Kazakhstan. Hematological parameters were calculated from routine complete blood counts obtained on the third day of hospitalization. Nonparametric tests, univariable and multivariable logistic regression, and receiver operating characteristic (ROC) analysis were used to evaluate associations between inflammatory indices and in-hospital mortality. Results: A total of 199 patients who met the inclusion criteria were classified into three groups according to in-hospital outcome at discharge: (1) patients discharged alive (favorable outcome), (2) patients who died during hospitalization due to ischemic stroke (unfavorable ischemic stroke), and (3) patients who died during hospitalization due to hemorrhagic stroke (unfavorable hemorrhagic stroke). NLR, SIRI, AISI, and SII values were significantly higher in both unfavorable outcome groups compared with the favorable outcome group (p < 0.001, effect size r > 0.6). No statistically significant differences were observed between unfavorable ischemic and hemorrhagic stroke outcomes. In logistic regression analysis, NLR (OR = 1.65) and SIRI (OR = 2.36) showed the strongest associations with in-hospital mortality. ROC analysis demonstrated good predictive performance, with AUC values of 0.885 for NLR and 0.867 for SIRI. Conclusions: The inflammatory indices evaluated in this study were associated with stroke outcomes regardless of stroke subtype. Among them, SIRI and NLR showed the highest prognostic value. These indices may serve as accessible markers of disease severity but should not be considered independent clinical decision-making tools. Full article

Background and Purpose: This study retrospectively evaluates the outcomes of head and neck adenoid cystic carcinomas (ACCs) treated with particle therapy, including carbon ion radiotherapy (CIRT) alone or combined with photon therapy, at a single institution. Methods and Materials: Patients with ACC who underwent CIRT alone or a combination of CIRT and photon therapy at the Marburg Ion Therapy Center between February 2017 and December 2023 were included. Radiation therapy was administered postoperatively in surgically resectable patients and as definitive treatment in unresectable patients. Newly diagnosed patients received CIRT as a boost in combination with photon intensity-modulated radiation therapy (IMRT), while those with recurrent disease received CIRT alone. Prognostic factors were analyzed using Kaplan–Meier analysis and proportional hazards regression for multiple regression. Late toxicities (grade 3 or higher) were recorded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4. Results: A total of 73 patients were included, with a median age of 57 years (range: 16–86 years) and a median follow-up of 20 months (range: 3–70 months). The cohort included 28 males (38%) and 45 females (62%). The median CIRT dose was 24 Gy (relative biological effectiveness (RBE)) (range: 15–60 Gy) in a median of 8 fractions (range: 5–20), and the median photon dose was 50 Gy (range: 45–54 Gy) in 25 fractions (range: 15–30). Locoregional recurrence-free survival rates at 1 and 3 years were 89.6% and 75.4%, respectively, while distant metastasis-free survival rates were 82.1% and 61.4%, respectively. LC was significantly influenced by T stage, with patients with T4 tumors showing worse outcomes. Treatment was generally well tolerated, with acute side effects including mucositis and skin erythema. Severe chronic toxicities were rare, with only 1% of patients experiencing grade 3 dysphagia and grade 3 xerostomia. Conclusions: CIRT, particularly when combined with photon therapy, demonstrates favorable local control and promising efficacy in head and neck ACC, though distant metastasis remains the primary pattern of failure. Tumor stage is a significant negative prognostic factor for local control and overall survival. Full article

Cesarean section (CS) rates have risen globally, and while an often lifesaving and necessary intervention, CS deliveries increase future maternal/neonatal risks and are costly to both patients and healthcare systems. The U.S. Department of Health and Human Services has set a national low-risk pregnancy CS (NTSV) target of 23.9% under the Healthy People 2030 initiative. This analysis compares NTSV rates of uninsured patients receiving prenatal care from a mobile clinic to the national target and also compares overall mobile health CS rates with national and state CS rates. Through reviewing 5 years of electronic medical records, we calculated an NTSV CS rate of 25.0% among our University of Arizona Mobile Health Program prenatal patients, an uninsured and medically vulnerable patient group. This rate is similar to both the most recent Arizona state average of 23.4% and the national target of 23.9%. The MHP total CS rate is 26% over our study period, which is less than the most recent National and Arizona rates of 32.3% and 29.0%. These findings suggest that access to free prenatal care through a mobile health delivery model may contribute to favorable obstetric outcomes among uninsured individuals and have implications for addressing maternal and neonatal health inequities among those who face multiple barriers to receiving adequate prenatal care. Full article

Background: IgG4-related hypertrophic pachymeningitis (IgG4-RHP) is an extremely rare central nervous system (CNS) autoimmune disorder, characterized by dural thickening, space-occupying effects, and neurological compression symptoms. It is frequently misdiagnosed as meningioma due to overlapping radiological features, leading to inappropriate management. This study aims to report a unique case of IgG4-RHP with skull destruction and subcutaneous mass formation, and summarize its diagnostic and therapeutic strategies through literature review. Methods: A 53-year-old male with a chronic subdural hematoma history was admitted for a progressive right frontal subcutaneous mass. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were performed, followed by staged surgeries (subcutaneous biopsy and craniotomy with subtotal resection). Histopathological examinations (Hematoxylin and Eosin staining, IgG/IgG4 immunostaining) and serum IgG4 detection were conducted. The patient received postoperative prednisone acetate (60 mg/d) and 3-month follow-up. A literature search was also performed to analyze 34 previously reported IgG4-RHP cases. Results: Histopathology showed dense lymphoplasmacytic infiltration, storiform fibrosis, ≈40 IgG4+ plasma cells per high-power field (HPF), and an IgG4+/IgG+ ratio of ≈30%. Serum IgG4 was significantly elevated to 1521 μg/mL (normal < 1350 μg/mL), with marked reduction in residual lesions on follow-up MRI. Literature review revealed a 73.5% male predominance, mean age of 48.6 years, headache as the most common symptom (58.8%), and a 38.5% misdiagnosis rate. Glucocorticoids alone or combined with immunosuppressants achieved favorable outcomes in 96.0% of treated cases. Conclusions: Histopathological examination combined with serum IgG4 detection is the gold standard for IgG4-RHP diagnosis. Surgical resection relieves mass-occupying effects, while glucocorticoids are first-line therapy. Long-term follow-up is necessary for recurrence monitoring, and rituximab is effective for refractory cases. Awareness of atypical manifestations like skull destruction can reduce misdiagnosis and improve outcomes. Full article

Accurate acquisition of low-observable targets with a minimal radar cross-section (RCS) poses a significant challenge for multi-source remote sensing systems, such as integrated radar–electro-optical (REO) platforms, particularly in complex electromagnetic environments characterized by strong noise interference and a high false-alarm rate. Conventional methods, which often treat data association and fusion from heterogeneous sensors as separate, offline processes, struggle with the dynamic uncertainties and real-time decision requirements of such scenarios. To address these limitations, this paper proposes a novel Evidence–Reinforcement Learning-based Decision and Control (ERL-DC) framework. It operates through a closed-loop architecture consisting of three core modules: A static assessment model for initial target prioritization, a Dempster–Shafer (D–S) evidence-based multi-source data decision generator for dynamic information fusion and uncertainty-aware target selection, and a Deep Reinforcement Learning (DRL) controller for noise-robust sensor steering. A high-fidelity simulation environment was developed to model the multi-source data stream, encompassing radar detection with clutter and false targets, as well as the physical constraints of the electro-optical (EO) servo system. Based on the averaged results from multiple Monte Carlo simulations, the proposed ERL-DC framework reduced the Average Decision Time (ADT) from 7.51 s to 4.53 s, corresponding to an absolute reduction of 2.98 s when compared to the conventional method integrating threshold logic with Model Predictive Control (MPC). Furthermore, the Net Discrimination Accuracy (NDA), derived from the statistical outcomes across all the simulation runs, exhibited an absolute increase of 37.8 percentage points, rising from 57.8% to 95.6%. These results indicate that ERL-DC achieves a more favorable trade-off in terms of scheduling efficiency, decision robustness, and resource utilization. The primary contribution is an intelligent, closed-loop architecture that tightly couples high-level evidential reasoning for multi-source data fusion with low-level adaptive control. Within the simulated environment characterized by clutter, false targets, and angular measurement noise, ERL-DC demonstrates improved target discrimination accuracy and decision efficiency compared to conventional methods. Future work will focus on online parameter adaptation and validation on physical platforms. Full article

Background: Echocardiographic imaging has become central to planning and guiding percutaneous left atrial appendage occlusion (LAAO), particularly in patient populations in whom long-term anticoagulation is unsuitable. This systematic review synthesizes current evidence on transesophageal (TEE) and intracardiac echocardiography (ICE) guidance during LAAO, with special emphasis on outcomes in high-risk cohorts, including chronic liver disease (CLD) and prior gastrointestinal (GI) bleeding. Methods: Following PRISMA 2020 guidelines, four databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) were searched up to 5 December 2025. Eligible studies included adult patients with atrial fibrillation (AF) undergoing percutaneous LAAO with intraprocedural echocardiographic guidance. Eight studies (n = 1739 patients) met the inclusion criteria. Data were synthesized qualitatively due to heterogeneity across devices, imaging protocols, and outcomes. Results: TEE was the predominant imaging modality (62.5%), providing high spatial resolution for transseptal puncture, device positioning, and peri-device leak (PDL) assessment. ICE-guided LAAO (25.0%) was associated with high procedural success and favorable safety profiles in selected observational cohorts, while reducing anesthesia requirements and fluoroscopy time. Across all studies, procedural success ranged from 93 to 100%, with low rates of major complications. Reported follow-up durations varied substantially across studies and were predominantly short- to mid-term, limiting assessment of long-term device-related outcomes. Evidence specific to patients with chronic liver disease and prior gastrointestinal bleeding was limited, with only two included studies directly evaluating these populations, while remaining insights were extrapolated from broader LAAO cohorts. In high-risk groups, LAAO remained feasible: cirrhotic patients demonstrated high implantation success with acceptable bleeding profiles, while patients with prior GI bleeding showed low recurrence after closure. Conclusions: Both TEE and ICE provide reliable intraprocedural imaging for LAAO, with ICE offering workflow and safety advantages in patients unsuitable for general anesthesia. The available evidence suggests that LAAO is a feasible and potentially safe therapeutic option in selected patients with CLD and prior GI bleeding, although direct data remain limited. Future studies should compare imaging modalities prospectively in high-risk cohorts and evaluate emerging 3D/4D ICE technologies. Full article

Background and Objectives: To evaluate pregnancy outcomes and transthoracic echocardiographic (TTE) findings during the antenatal and postpartum periods in women with repaired Tetralogy of Fallot (ToF) who delivered at Çukurova University Faculty of Medicine, Balcalı Hospital, between 2011 and 2025 and to interpret these findings in the context of the 2025 European Society of Cardiology (ESC) recommendations. Materials and Methods: This single-center retrospective cohort study undertaken between 2011 and 2025 included 11 pregnant women with surgically repaired ToF. Maternal demographic characteristics, obstetric outcomes, mode of delivery, neonatal outcomes, and antenatal TTE parameters were recorded. Cardiac measurements obtained during pregnancy were compared with postpartum TTE findings performed 3–6 months after delivery to assess pregnancy-related cardiac adaptation and recovery. Results: A total of 11 pregnancies in women with repaired ToF were analyzed. Nine pregnancies resulted in live births, while one ended in missed abortion at 9 + 2 weeks and one in intrauterine fetal demise at 34 + 2 weeks. Among live births, the mean gestational age was 36 + 2 weeks and the mean birthweight was 2865 g, with a preterm delivery rate of 55.6%. Cesarean section was performed in 70% of cases, while 30% delivered vaginally. During pregnancy, the mean left ventricular ejection fraction was 62.6%, and residual tricuspid regurgitation was the most frequently observed echocardiographic finding. Postpartum TTE evaluations indicated that echocardiographic parameters were largely stable over the observation period, with no numerical change and no clear evidence of deterioration in ventricular function or progression of valvular regurgitation. Conclusions: Despite successful surgical repair, pregnancy may still pose potential risks for women with ToF, underscoring the importance of individualized, multidisciplinary management. In this cohort, pregnancy appeared to be generally well-tolerated when care was provided in accordance with contemporary ESC recommendations. The observation of preserved ejection fraction and overall stable right ventricular function in the early postpartum period suggests that favorable maternal cardiac adaptation may be achievable in carefully selected patients. Early postpartum echocardiographic assessment may be useful for identifying functional changes and informing structured long-term follow-up strategies. Full article

Background: The role of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) management has evolved over recent years. Although it appears that the overall number of procedures is declining, international guidelines now endorse TACE beyond the Barcelona Clinic Liver Cancer (BCLC) intermediate stage, and multiple TACE platforms allow patient-tailored treatments. In this context, degradable starch microspheres TACE (DSM-TACE) may be valuable when the goal is to preserve liver function and spare healthy parenchyma. This study reports multicenter retrospective Italian data to assess the efficacy and safety of DSM-TACE with EmboCept^® in patients with early-to advanced-stage HCC, and to evaluate whether procedural selectivity (superselective vs. lobar) influences outcomes. Methods: This retrospective multicenter study included 201 patients initially; after applying exclusion criteria, 187 patients (334 HCC nodules) treated across eight centers (2014–2024) were analyzed. Treatment indications were discussed in multidisciplinary tumor boards in all centers. Superselective DSM-TACE was performed in 48 patients (66 nodules, 19.8%), while 139 patients (268 nodules, 80.2%) underwent a lobar approach. Repeated sessions were performed on demand and recorded for lobar treatments. Tumor response was assessed using mRECIST criteria at 1, 3–6, 6–9, and 9–12 months; adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). efficacy and safety outcomes were compared according to the DSM-TACE approach. Results: In terms of safety, analysis confirmed the overall good tolerability of DSM-TACE, with no grade ≥ 3 adverse events and no major complications or procedure-related deaths. No significant differences were observed in post-embolization syndrome (PES) rates between groups. With regard to efficacy, for the entire cohort, the overall response rate (ORR) was 70% at 1 month, 31.6% at 3–6 months, 20.5% at 6–9 months, and 13.5% at 9–12 months, while the disease control rate (DCR) was 91.4% at 1 month, 69% at 3–6 months, 38.6% at 6–9 months, and 27% at 9–12 months. At intermediate follow-up, superselective DSM-TACE achieved higher ORR than lobar treatment at 3–6 months (53.8% vs. 26.4%; p = 0.009) and 6–9 months (43.8% vs. 15.3%; p = 0.009). Per-nodule analysis confirmed this advantage at 3–6 months (ORR = 66.7% vs. 31.3%; p = 0.0008). Conclusions: DSM-TACE with EmboCept^® provides favorable tumor control and a good safety profile in routine clinical practice. A superselective approach is associated with improved response at intermediate follow-up compared with lobar strategy, supporting DSM-TACE as a flexible therapeutic option for localized HCC. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with substantial symptom burden and impaired quality of life. Lebrikizumab, a monoclonal antibody targeting interleukin-13, has emerged as a therapeutic option for patients with moderate-to-severe AD; however, a comprehensive synthesis of its efficacy and safety is required. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing lebrikizumab with placebo in patients with moderate-to-severe AD. Searches were performed across major databases and trial registries. The primary outcome was achievement of a 50% improvement in the Eczema Area and Severity Index (EASI-50). Secondary efficacy outcomes included EASI-75, EASI-90, and improvement in pruritus measured by the Numeric Rating Scale (NRS). Safety was assessed through a quantitative meta-analysis of treatment-emergent adverse events (TEAEs) when extractable arm-level data were available. Random-effects models were applied, and certainty of evidence was evaluated using the GRADE framework. Results: Twelve randomized controlled trials were included. Lebrikizumab significantly increased the likelihood of achieving EASI-50 (RR 1.51, 95% CI 1.20–1.89), EASI-75 (RR 1.78, 95% CI 1.43–2.22), and EASI-90 (RR 2.26, 95% CI 1.67–3.06) compared with placebo, and was associated with clinically meaningful improvement in pruritus (RR 1.73, 95% CI 1.38–2.17). Substantial heterogeneity was observed for EASI-75 (I² = 77.5%); predefined subgroup analyses based on dosing regimen and dosing frequency partially explored this variability, but residual heterogeneity persisted, leading to downgrading of the certainty of evidence for EASI-75 to low. The certainty of evidence was moderate for EASI-50 and low for EASI-90 and pruritus improvement. Six trials contributed to the quantitative safety analysis. The pooled meta-analysis showed no significant difference in the risk of treatment-emergent adverse events between lebrikizumab and placebo (RR 1.03, 95% CI 0.82–1.28), with moderate heterogeneity (I² = 60.5%). Serious adverse events and treatment discontinuations were infrequently reported and could not be pooled quantitatively due to inconsistent reporting. Conclusions: Lebrikizumab demonstrates clinically meaningful efficacy and a favorable safety profile in patients with moderate-to-severe atopic dermatitis. However, as the available randomized evidence is predominantly derived from adult populations, the applicability of these findings to adolescents remains limited and warrants confirmation in adequately powered, adolescent-focused studies. Full article

To investigate how different training modes of salt stress priming affect the dynamic variation of the salt tolerance threshold (STT) in summer maize, a micro-plot experiment with staged brackish water irrigation was conducted. Based on physiological and biochemical parameters, along with shoot and root traits, a dynamic salt tolerance coefficient (α_STT) was defined to quantify STT across growth stages. The results revealed a clear two-stage adaptive response to salt stress, consisting of an initial physiological adaptation phase followed by a phenotypic adaptation phase. Different training modes induced distinct salt stress memory effects by regulating the coordination between these two stages. Among treatments, the S_1-2-3 regime—corresponding to mild (2.0 g·L⁻¹), moderate (4.0 g·L⁻¹), and severe (6.0 g·L⁻¹) salinity applied sequentially at the six-leaf, ten-leaf, and tasseling stages—exhibited the most favorable adaptive outcome, with α_STT gradually recovering to 1.0 at later stages and a concomitantly higher STT. Furthermore, a unified predictive framework was established to estimate STT dynamics, within which the process-constrained PCR-STP pathway outperformed purely data-driven pathways. Overall, our study elucidates the dynamic nature of salt tolerance in summer maize and provides a scientific basis for optimizing brackish water irrigation regimes and refining salt stress modules in crop models. Full article

This study investigates regime-dependent forecasting of the Saudi stock market by combining macro-controlled dependence analysis with nonlinear predictive modeling. Using daily data from September 2010 to August 2025, we analyze the interaction between the Tadawul All Share Index (TASI) returns and crude oil returns while controlling for inflation and interest-rate dynamics. A four-variable VAR with macro controls is estimated separately in pre- and post-COVID regimes to characterize directional predictability and changes in transmission lags. We then evaluate out-of-sample return forecasting performance across econometric benchmarks (ARIMA, ARIMAX, and VAR) and machine learning models (LSTM and XGBoost) under a strictly time-ordered expanding-window design with sequential train/validation/test partitioning. The results indicate that traditional linear benchmarks exhibit limited predictive ability in both regimes, with negative out-of-sample explanatory power. By contrast, XGBoost delivers the strongest overall performance, achieving positive out-of-sample R² in both regimes (0.046 in pre-COVID and 0.010 in post-COVID), together with the lowest forecast errors (RMSE = 0.0081 pre-COVID; 0.0078 post-COVID). Interpretability analysis further reveals a regime-sensitive shift in drivers: short-horizon equity lag dynamics dominate during stable periods, whereas oil-related and macro-financial variables gain importance under turbulent conditions. Economic-value evaluation supports the practical relevance of these gains, showing that XGBoost-based signals yield superior risk-adjusted trading outcomes and remain favorable under downside-risk and drawdown-based assessment. Overall, these findings highlight that forecasting in oil-linked emerging markets is inherently regime-dependent and that nonlinear ensemble learners, particularly XGBoost, provide a more robust and economically meaningful approach under structural change. Full article

Background: Computed tomography-guided dye localization facilitates extended segmentectomy with reliable oncologic margins for deep intersegmental early-stage lung cancer. This study evaluated perioperative and long-term outcomes in comparison with those of lobectomy. Methods: We retrospectively reviewed patients with early-stage lung adenocarcinoma ≤ 2 cm who underwent computed tomography-guided dye localization extended segmentectomy between 2013 and 2019 and compared them with those who underwent lobectomy between 2011 and 2016. After 1:1 propensity score matching based on demographic and clinical variables, 30 matched pairs were included in the analysis. Results: Compared with lobectomy, extended segmentectomy with computed tomography-guided dye localization was associated with shorter operative time (102 ± 34 vs. 181 ± 42 min, p < 0.001), less blood loss (0 [0–0] vs. 0 [0–62.5] mL, p < 0.001), shorter chest tube duration (1 [1–2] vs. 2 [2–3] d, p = 0.002), reduced hospital stay (3 [3–4] vs. 5 [4–6] d, p < 0.001), and smaller ipsilateral (10.4 [1.9–15.7] vs. 20.0 [10.0–26.2] %, p = 0.004) and total (1.3 [−3.5–6.4] vs. 6.5 [1.4–12.9] %, p = 0.022) lung volume reductions at 6 months. All patients achieved negative resection margins. Lymph node yield was lower in the segmentectomy group (p < 0.001); however, the 5-year overall and disease-free survival rates were comparable. Conclusions: Computed tomography-guided dye localization extended segmentectomy provides favorable perioperative and functional outcomes and achieves comparable oncologic control in selected patients with deep intersegmental early-stage lung adenocarcinoma, representing a potential alternative to lobectomy. Full article

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder characterized by a dynamic left ventricular outflow tract (LVOT) obstruction and an increased risk of sudden cardiac death. For patients with symptoms refractory to medical management, or intolerant to the new selective myosin inhibitor, septal reduction therapy (SRT) with surgical septal myectomy (SM) is indicated. This narrative review provides a contemporary assessment of septal myectomy, integrating its historical development, technical advancements, and comparative long-term outcomes. SM is established as the current reference standard, offering extensive anatomical relief and favorable long-term survival in clinical registries. It consistently achieves residual LVOT gradients <10 mmHg and enables correction of complex accessory mitral pathologies, leading to significant reverse ventricular and atrial remodeling. In contrast, ASA, a less invasive alternative for high-risk surgical candidates, is limited by incomplete tissue necrosis. This results in higher residual gradients (15–20 mmHg), increased rates of re-intervention (10–20%) and incidence of permanent pacemaker implantation (10–17.4%) and an associated greater risk of long-term all-cause mortality (>5 years). The disparity in long-term survival and the risk associated with sequential septal reduction procedures underscore the critical need for precise patient selection guided by institutional expertise. Furthermore, advancements like virtual surgical myectomy and transapical beating-heart septal myectomy are expanding the scope of intervention. This review synthesizes comparative contemporary data on HOCM management, highlighting the need for prospective, multicenter studies to address enduring knowledge gaps concerning equitable access, genotype integration, and long-term comparative effectiveness as current evidence remains dominated by retrospective studies. Full article

Background: Pediatric salpingitis is rare and often underrecognized, especially in non-sexually active girls in whom symptoms are non-specific and sexually transmitted infections are absent. Delayed diagnosis may increase the risk of complications. We aimed to characterize the clinical presentation, diagnostic features, management, and outcomes of pediatric salpingitis and to identify predisposing factors in non-sexually active pediatric patients. Methods: We retrospectively reviewed pediatric cases of radiologically or surgically confirmed salpingitis at a tertiary children’s hospital (2000–2025) and conducted a narrative review of published pediatric cases. Results: Ten non-sexually active girls were included (median age 12.8 years). Abdominal pain was the most common symptom (80%), followed by fever and gastrointestinal complaints (50% and 30%, respectively); two patients (20%) were asymptomatic. Hydrosalpinx or pyosalpinx was detected on ultrasound in 80%. A causative organism was identified in 30%, predominantly enteric or anaerobic flora. All patients received broad-spectrum intravenous antibiotics; half required procedural or surgical intervention. Clinical outcomes were favorable in all cases. The literature review identified 56 additional non-sexually active girls, most of whom were postmenarchal. Abdominal pain was the predominant presentation, and gastrointestinal or anatomical predisposing factors were common. Conclusions: Non-sexually transmitted salpingitis is an uncommon but clinically relevant condition in children. Its atypical and often subtle presentation in non-sexually active girls warrants heightened clinical awareness. Early imaging and attention to gastrointestinal or postsurgical antecedents can facilitate timely diagnosis. Further multicenter studies are needed to establish diagnostic criteria and clarify long-term reproductive outcomes. Full article