Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. Septic shock, a severe subset of sepsis, must be promptly recognized and managed as a medical emergency. We present the case of a 51-year-old male who developed shock during hospitalization for infected leg ulcers, with a background of chronic heart failure (HF), hypertension, and poorly controlled type 2 diabetes mellitus. Despite his history of HF, bedside echocardiography revealed low systemic vascular resistance and preserved cardiac output, findings more consistent with septic shock than cardiogenic shock. This case underscores the pivotal role of early hemodynamic assessment, particularly with echocardiography, in accurately identifying the type of shock in patients with pre-existing HF. Differentiating the underlying etiology is essential to initiate appropriate therapy and improve clinical outcomes.

Menopausal vasomotor symptoms (VMS) represent a significant public health burden, necessitating safe and effective nonhormonal treatments. The recent US Food and Drug Administration approval of elinzanetant, a first-in-class dual neurokinin-1 (NK1) and neurokinin-3 (NK3) receptor antagonist, represents a major shift and warrants a critical assessment of its role. VMS pathogenesis centers on the hypothalamic KNDy neuron network and is primarily mediated by Neurokinin B acting on the NK3 receptor. Elinzanetant’s distinctive dual mechanism, simultaneously blocking NK3 (VMS control) and NK1 (mood and sleep modulation), translates into improved patient outcomes as demonstrated across the OASIS Phase 3 program. Specifically, elinzanetant achieved a 65.2%–67.0% reduction in VMS frequency by Week 12 (OASIS 1/2) and produced clinically meaningful improvement in the PROMIS SD-SF 8b sleep disturbance score. While indirect cross-over study comparisons with fezolinetant (NK3 antagonist) suggest a numerical advantage in sleep quality for elinzanetant, head-to-head trials are required for confirmation. The drug demonstrated sustained efficacy and a favorable long-term liver safety profile, making it strategically important for the general population. Elinzanetant represents a major shift in the nonhormonal treatment approach, offering a safe and sustained alternative for managing menopausal symptoms.

Purpose: Keratoconus (KC) involves a progressive corneal deformation, recognized as having an inflammatory component, despite traditionally being considered noninflammatory. This study investigates the notable tear film cytokines and their correlation with KC disease severity. The objectives of this study were to measure inflammatory tear biomarkers in KC patients and to compare them with healthy controls and to evaluate biomarker levels across different severity stages of KC. This study follows a case-control observational design, comparing inflammatory tear biomarkers in KC patients (cases) and healthy individuals (controls), at a single point in time without intervention. Methods: Eighteen KC patients and 25 healthy individuals were enrolled. Tear samples were collected via Schirmer strips and analyzed for interleukin (IL)-1β, IL-4, IL-6, IL-10, matrix metalloproteinase 9 (MMP-9), and tumor necrosis factor α (TNF-α) using ELISA. Group comparisons were made using nonparametric tests, and Spearman correlation evaluated associations with disease severity. Results: KC patients showed significantly elevated levels of IL-1β, IL-4, IL-6, IL-10, MMP-9, and TNF-α (p < 0.05). IL-1β, MMP-9, and TNF-α demonstrated strong associations with disease severity, while IL-6 and IL-10 exhibited moderate correlations, and IL-4 showed only a weak association with KC progression. Conclusions The study emphasizes inflammation’s role in KC and identifies tear film inflammatory markers as promising tools for diagnosis, prognosis, early detection, disease monitoring, and personalized treatment.

Paragangliomas are rare neuroendocrine tumors that frequently arise in the organ of Zuckerkandl (OZ). Surgical resection remains the cornerstone of treatment. Although vascular resection and reconstruction have been reported in a few cases, no prior reports have documented the simultaneous resection of both the aorta and inferior vena cava (IVC), along with their bifurcation. We present the case of a 50-year-old man with a large paraganglioma of the OZ, successfully managed through combined resection of the aorta, IVC, their bifurcation, and the psoas muscle. Dacron Y-grafts were used to reconstruct both the aorta and IVC. This case underscores the importance of detailed anatomical knowledge of major vessels, meticulous vascular control, and the technical intricacies of vascular reconstruction. We emphasize the significance of comprehensive perioperative management and provide a literature review on en bloc vascular resection for paraganglioma, offering insights into current surgical practices and outcomes.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.

Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with a dismal prognosis. Atezolizumab plus bevacizumab (atezo-bev) is the recommended palliative treatment, and approximately 10% of the patients may experience a complete response (CR), according to the mRECIST criteria. The treatment duration is until disease progression or unacceptable side effects occur. Long-term continuation can cause potential toxicities and a substantial financial burden, making early treatment discontinuation a viable option. This report describes durable CR after discontinuing atezo-bev treatment in three patients with HCC and PVTT.

Since the early days of assisted reproductive technology (ART), the importance of sperm processing, employed to separate the motile, morphologically normal sperm from the semen, has been shown to be beneficial. The aim of the semen processing technique has been to remove seminal plasma and facilitate capacitation. Additionally, the presence of leukocytes, bacteria, and dead spermatozoa has been shown to be detrimental as it may cause oxidative stress that has an adverse effect on oocyte fertilization and embryo development. Hence, removal of leukocytes, bacteria, and dead spermatozoa is an important step of sperm processing for assisted reproduction. Currently, several sperm processing techniques have been evolved and optimized in the field of assisted reproduction. The requirements for in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and testicular sperm extraction (TESE) are different than those of intrauterine insemination (IUI). The yield of as many motile, morphologically normal sperm as possible is a prerequisite for the success of IVF insemination procedure. In ICSI, where injection of a single spermatozoon into the oocyte is performed by the embryologist, sperm selection techniques play a crucial role in the ICSI procedure. Finally, sperm retrieval in TESE samples with very low number of sperm may be challenging and requires extra care during sample processing. Additionally, sperm cryopreservation is necessary in TESE cases in order to avoid multiple biopsies.
Humans ; Sperm Injections, Intracytoplasmic/methods* ; Male ; Fertilization in Vitro/methods* ; Sperm Retrieval ; Andrology/methods* ; Cryopreservation ; Female ; Spermatozoa

The use of fresh versus frozen spermatozoa in men with nonobstructive azoospermia (NOA) undergoing in vitro fertilization (IVF) has been a debated hot topic among reproductive specialists. Each approach presents distinct advantages and disadvantages, with fresh sperm typically showing superior sperm quality, while frozen sperm offers logistical flexibility and a reliable backup for repeated cycles. This review summarizes the latest advancements in sperm retrieval and cryopreservation techniques, providing practitioners with a comprehensive analysis of each option's strengths and limitations. Comparative studies indicate that, although fresh sperm often has better quality metrics, cryopreservation methods such as vitrification have significantly improved postthaw outcomes, making frozen sperm a viable choice in assisted reproductive technologies (ART). The findings show comparable rates for fertilization, implantation, clinical pregnancy, and live birth between fresh and frozen microdissection testicular sperm extraction (micro-TESE) sperm in many cases, although patient-specific factors such as timing, cost-effectiveness, and procedural convenience should guide the final decision. Ultimately, the choice of using fresh or frozen sperm should align with the individual needs and conditions of patients. This tailored approach, supported by the latest advancements, can optimize ART outcomes and provide personalized reproductive care.
Humans ; Cryopreservation/methods* ; Male ; Sperm Retrieval ; Semen Preservation/methods* ; Azoospermia/therapy* ; Pregnancy ; Female ; Fertilization in Vitro ; Spermatozoa ; Microdissection ; Pregnancy Rate