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Among young men between the ages of 15 and 40 years, germ cell cancer is the most common solid tumor [1]. The worldwide incidence of germ cell cancer is 70 000 cases. GS-441524 Compared to all solid tumors of men, germ cell cancer accounts for 1% of all male tumors. Nevertheless, the mortality of this rare tumor entity is about 13% since 9507 patients died worldwide of germ cell cancer. The improvement in survival of germ cell cancer patients is due to a multimodal treatment of germ cell cancer including cisplatin-based chemotherapy and surgery leading to higher cure-rates even in advanced stages [1], whereas the increasing incidence of germ cell cancers cannot be thoroughly explained. In this article we review the current indications for surgery in metastatic germ cell cancers, highlight the strength and weaknesses of techniques and indications and raise the question how to improve surgical treatment in metastatic germ cell cancer.The development of germ cell tumors (GCTs) is a unique pathogenesis occurring at an early developmental stage during specification, migration or colonization of primordial germ cells (PGCs) in the genital ridge. Since driver mutations could not be identified so far, the involvement of the epigenetic machinery during the pathogenesis seems to play a crucial role. Currently, it is investigated whether epigenetic modifications occurring between the omnipotent two-cell stage and the pluripotent implanting PGCs might result in disturbances eventually leading to GCTs. Although progress in understanding epigenetic mechanisms during PGC development is ongoing, little is known about the complete picture of its involvement during GCT development and eventual classification into clinical subtypes. This review will shed light into the current knowledge of the complex epigenetic and molecular contribution during pathogenesis of GCTs by emphasizing on early developmental stages until arrival of late PGCs in the gonads. We questioned how misguided migrating and/or colonizing PGCs develop to either type I or type II GCTs. Additionally, we asked how pluripotency can be regulated during PGC development and which epigenetic changes contribute to GCT pathogenesis. We propose that SOX2 and SOX17 determine either embryonic stem cell-like (embryonal carcinoma) or PGC-like cell fate (seminoma). Finally, we suggest that factors secreted by the microenvironment, i.e. BMPs and BMP inhibiting molecules, dictate the fate decision of germ cell neoplasia in situ (into seminoma and embryonal carcinoma) and seminomas (into embryonal carcinoma or extraembryonic lineage), indicating an important role of the microenvironment on GCT plasticity.Staphylococcus lugdunensis, originally identified in 1988, is a coagulase negative staphylococcus (CNS) that has become a significant human pathogen. It has been found as a source of skin and soft tissue infection, endocarditis, urogenital tract infection, joint infection, and meningeal infection. Rarely, it manifests as scrotal infections or complications. Correct identification of the bacterial organism and prompt treatment is crucial in these cases, as delayed intervention can lead to complications requiring orchiectomy. We describe a rare case of a young male who presented with scrotal pain and swelling and was found to have epididymo-orchitis with scrotal pyocele on imaging. He underwent scrotal exploration with incision and drainage and did not require an orchiectomy. Wound cultures grew S. lugdunensis, and the patient clinically improved after being treated with appropriate antibiotics. To our knowledge, this is the first reported case of scrotal abscess and epididymo-orchitis with pyocele formation caused by S. lugdunensis.Consistent with global trends of infections due to multiple-drug resistant Gram-negative bacteria, we report the first official case of native mitral valve endocarditis due to multi-resistant Klebsiella Pneumonia Carbapenemase (KPC) producing Serratia marcescens. The patient underwent mitral valve replacement and was successfully treated with monotherapy ceftazidime-avibactam.We describe a diabetic patient with left eye endogenous endophthalmitis due to hypervirulent hypermucoviscous Klebsiella pneumoniae (HKVP) originating from right renal abscesses. A rare source of HVKP causing endogenous endophthalmitis. Despite treatment with intravenous ceftazidime and pars plana vitrectomy, the patient required evisceration of the left eye. A high index of suspicion for endogenous endophthalmitis and awareness of the virulence and potential antibiotic resistance of HVKP strains in the community is needed to avoid vision and life-threatening consequences.Capnocytophaga canimorsus meningitis is frequently caused by exposure to dog or cat bites and occurs more commonly in immunocompromised individuals. CSF analysis is the first step in diagnosis; however, in situations where CSF cultures turn negative, molecular techniques such as 16S rRNA gene amplification followed by polymerase chain reaction (PCR) product sequencing have shown promise. Next generation sequencing of cell free DNA (NGS cfDNA) can assist in identifying the causative agent in a quick and accurate manner. We present a rare case of C. canimorsus meningitis in an immunocompetent host that highlights the utility of NGS cfDNA in timely diagnosis after exhausting all other available diagnostic techniques.West Nile Virus (WNV) is the most common mosquito-borne virus in the United States and North America. Although WNV disease occurs on a spectrum ranging from a relatively benign febrile illness to life-threatening neuroinvasive disease, the clinical presentations can vary widely and thus necessitates a high degree of suspicion. Here we describe three such cases where each individual presented with a unique constellation of symptoms that made the diagnosis challenging. It is essential for physicians to be well informed on the differing symptomology so early diagnosis and supportive management can mitigate poor prognosis.

We quantify 3-D microarchitectural properties of femoral head cancellous bones from patients with rheumatoid arthritis (RA, n​=​12), osteoarthritis (OA, n​=​15), osteoporosis (OP, n​=​24), or donor controls (CNT, n​=​8); and investigate their rod- and plate-like trabecular morphometric properties of trabecular bone tissues and compare these properties between them.

Femoral heads were harvested during total hip replacement surgeries or collected from donors. Four cubic cancellous bone samples produced from each femoral head were micro-CT scanned to quantify their microarchitectural and rod- and plate-like trabecular properties. The samples were then tested in compression to determine mechanical properties.

The microarchitectural properties of femoral head cancellous bone revealed significant differences among the 4 groups, but not between RA and OA. Bone volume fraction was significantly greater in the RA and the OA than in the OP and the CNT. Structure model index was significantly lower in the RA and the OA than in the OP.