To the Editor, Regenerative medicine represents an innovative approach to treating chronic-degenerative pathologies. Mesenchymal stem cells (MSCs), particularly those derived from adipose tissue, are widely studied for their self-renewal, differentiation, and paracrine activities [...].

The prevalence of urinary stones range between 1 and 14% in different countries around the world. Men account for approximately 67% of cases, but the gender gap is narrowing over time. A study conducted in the Russian Federation showed that 22.2% of subjects interviewed with a questionnaire reported a history of urolithiasis. Stone formation begins with the urinary crystallization of less soluble solutes contained in urine (calcium oxalate and/or calcium phosphate, uric acid, struvite, and cystine), which often depends on urinary pH values. The most common calcium oxalate stones can grow on calcium phosphate plaques (Randall's plaque) that emerge on the surface of the papilla or on calcium oxalate plugs that form in the collecting ducts due to excessive concentrations of calcium or oxalate. Randall's plaques form due to a proinflammatory process initiated by local macrophages with activation of fibroblasts, matrix modeling, and interstitial calcium phosphate deposition. The inhibitory effect of crystallization and crystal aggregation was studied in vitro demonstrating a reduction in the nucleation inhibition index and in aggregation inhibition index in renal stone formers compared to healthy controls (2.15% vs 6.15% and 34.15% vs 62.15%, respectively). Urolithiasis is a cluster of metabolic phenotypes interacting through urinary supersaturation. The metabolic work-up consists in the identification of high-risk patients requiring full metabolic profiling by basic metabolic panel, two 24-hour urine collections, stone analysis (when available), and software assessment of Relative Supersaturation (RSS) for calcium oxalate, calcium phosphate and uric acid. The endpoint of therapy is to reduce RSS not just to achieve "normal" lab values. The most active agents used for the prevention of calcium oxalate stones are phytate, potassium citrate, and magnesium. Phytate stands as the most potent inhibitor of both calcium oxalate and calcium phosphate crystallization exerting its therapeutic effect without modifying urinary pH. It is the ideal inhibitor of calcium oxalate crystallization, particularly in cases of severe hypercalciuria, because it does not increase the risk of secondary calcium phosphate crystallization. Potassium citrate has a weaker direct inhibitory potential at the concentrations achieved in standard clinical practice and tends to increase urinary pH, posing a risk of inducing calcium phosphate precipitation. Magnesium does not affect urinary pH, but its inhibitory effect of calcium oxalate crystallization is negligible at conventional clinical doses [...].

This study aimed to explore the potential benefits and safety considerations of combining ultrasound-guided quadratus lumborum block (QLB) with low-dose spinal anesthesia (LDSA) versus general anesthesia (GA) for individuals undergoing percutaneous nephrolithotomy (PCNL). This prospective randomized controlled trial included 70 adult patients undergoing PCNL, divided into Group Q (QLB + LDSA, n = 35) and Group G (GA, n = 35). Primary outcomes included postoperative pain, assessed using the Visual Analog Scale (VAS), and opioid consumption, measured by pethidine usage. Secondary outcomes included patient satisfaction, stone clearance rates, hemoglobin and creatinine changes, and adverse events. Multivariate regression analysis identified predictors of outcomes. Postoperative pain scores were significantly lower in Group Q during the first 8 postoperative hours (all p < 0.001). Median pethidine consumption was lower in Group Q (70 mg vs. 105 mg, p < 0.001). Group Q demonstrated superior patient satisfaction, with 82.8% of individuals rating their experience as "satisfied" or "very satisfied," markedly exceeding the 8.6% observed in Group G (p < 0.001). Stone clearance outcomes were comparable between the groups, with no statistically significant difference in residual stone burden (p = 0.348). No significant differences were observed in postoperative hemoglobin levels (Group Q: 11.5 ± 0.6 g/dL vs. Group G: 11.5 ± 0.6 g/dL, P = 1.0) or serum creatinine levels (Group Q: 1.0 ± 0.2 mg/dL vs. Group G: 1.0 ± 0.2 mg/dL, p = 0.611). In PCNL procedures, QLB in conjunction with LDSA demonstrates superior postoperative analgesia, reduced opioid requirements, and improved patient satisfaction while maintaining comparable perioperative and urological outcomes.

Male reproductive dysfunction reflects the interaction of endocrine, metabolic, genetic, environmental, oxidative, and immune-related factors. Although semen analysis remains the principal laboratory assessment, it is largely descriptive and provides limited insight into the systemic biological context in which semen abnormalities arise. Complete blood count (CBC)-derived inflammatory indices may offer a practical, low-cost approach to characterizing this context, but their relationship with semen-analysis phenotypes remains unclear.