Objective: The objective of our study was to characterize the sperm parameters of men consulting for infertility in our fertility center. Methods: The study included 3,025 patients investigated from September 2021 to July 2023. Demographic data, infertility risk factors, and the primary or secondary nature of infertility were recorded for each patient. The sperm parameters were analyzed according to World Health Organization (WHO) criteria (2021). Results: The average age of the patients was 40 years. The average duration of infertility was 5.5 years. Primary infertility was noted in 2,736 patients (88.97%). The most common risk factors for infertility were occupational exposure, followed by varicocele. Lifestyle factors associated with male infertility included smoking (24.29%), alcohol consumption (12.49%), and high temperature exposure (30.08%). Spermogram abnormalities were observed in 78.71% of cases. Spermocytogram abnormalities were found in 63.1% of cases. Sperm count, morphology, total motility, and vitality below WHO (2021) reference values were found in 25.60%, 34.13%, 32.29%, and 62.46% of the analyzed samples, respectively. Seminal fluid analysis revealed oligozoospermia in 29.07% of cases, asthenozoospermia in 24.68%, and azoospermia in 17.56%. Oligo-astheno-necrospermia was the most frequently observed combined abnormality (10.0%). Conclusion This study showed a high rate of abnormal semen quality in male partners of infertile couples. Male infertility is often multifactorial and results in quantitative and/or qualitative sperm abnormalities.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

Background/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC. Methods: This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023. Results: A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours. Conclusions EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

Objective: The objective of our study was to characterize the sperm parameters of men consulting for infertility in our fertility center. Methods: The study included 3,025 patients investigated from September 2021 to July 2023. Demographic data, infertility risk factors, and the primary or secondary nature of infertility were recorded for each patient. The sperm parameters were analyzed according to World Health Organization (WHO) criteria (2021). Results: The average age of the patients was 40 years. The average duration of infertility was 5.5 years. Primary infertility was noted in 2,736 patients (88.97%). The most common risk factors for infertility were occupational exposure, followed by varicocele. Lifestyle factors associated with male infertility included smoking (24.29%), alcohol consumption (12.49%), and high temperature exposure (30.08%). Spermogram abnormalities were observed in 78.71% of cases. Spermocytogram abnormalities were found in 63.1% of cases. Sperm count, morphology, total motility, and vitality below WHO (2021) reference values were found in 25.60%, 34.13%, 32.29%, and 62.46% of the analyzed samples, respectively. Seminal fluid analysis revealed oligozoospermia in 29.07% of cases, asthenozoospermia in 24.68%, and azoospermia in 17.56%. Oligo-astheno-necrospermia was the most frequently observed combined abnormality (10.0%). Conclusion This study showed a high rate of abnormal semen quality in male partners of infertile couples. Male infertility is often multifactorial and results in quantitative and/or qualitative sperm abnormalities.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

Objective: The objective of our study was to characterize the sperm parameters of men consulting for infertility in our fertility center. Methods: The study included 3,025 patients investigated from September 2021 to July 2023. Demographic data, infertility risk factors, and the primary or secondary nature of infertility were recorded for each patient. The sperm parameters were analyzed according to World Health Organization (WHO) criteria (2021). Results: The average age of the patients was 40 years. The average duration of infertility was 5.5 years. Primary infertility was noted in 2,736 patients (88.97%). The most common risk factors for infertility were occupational exposure, followed by varicocele. Lifestyle factors associated with male infertility included smoking (24.29%), alcohol consumption (12.49%), and high temperature exposure (30.08%). Spermogram abnormalities were observed in 78.71% of cases. Spermocytogram abnormalities were found in 63.1% of cases. Sperm count, morphology, total motility, and vitality below WHO (2021) reference values were found in 25.60%, 34.13%, 32.29%, and 62.46% of the analyzed samples, respectively. Seminal fluid analysis revealed oligozoospermia in 29.07% of cases, asthenozoospermia in 24.68%, and azoospermia in 17.56%. Oligo-astheno-necrospermia was the most frequently observed combined abnormality (10.0%). Conclusion This study showed a high rate of abnormal semen quality in male partners of infertile couples. Male infertility is often multifactorial and results in quantitative and/or qualitative sperm abnormalities.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

Objective: The objective of our study was to characterize the sperm parameters of men consulting for infertility in our fertility center. Methods: The study included 3,025 patients investigated from September 2021 to July 2023. Demographic data, infertility risk factors, and the primary or secondary nature of infertility were recorded for each patient. The sperm parameters were analyzed according to World Health Organization (WHO) criteria (2021). Results: The average age of the patients was 40 years. The average duration of infertility was 5.5 years. Primary infertility was noted in 2,736 patients (88.97%). The most common risk factors for infertility were occupational exposure, followed by varicocele. Lifestyle factors associated with male infertility included smoking (24.29%), alcohol consumption (12.49%), and high temperature exposure (30.08%). Spermogram abnormalities were observed in 78.71% of cases. Spermocytogram abnormalities were found in 63.1% of cases. Sperm count, morphology, total motility, and vitality below WHO (2021) reference values were found in 25.60%, 34.13%, 32.29%, and 62.46% of the analyzed samples, respectively. Seminal fluid analysis revealed oligozoospermia in 29.07% of cases, asthenozoospermia in 24.68%, and azoospermia in 17.56%. Oligo-astheno-necrospermia was the most frequently observed combined abnormality (10.0%). Conclusion This study showed a high rate of abnormal semen quality in male partners of infertile couples. Male infertility is often multifactorial and results in quantitative and/or qualitative sperm abnormalities.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

Background/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC. Methods: This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023. Results: A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours. Conclusions EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.