Suicide left ventricle (SLV) is a rare cause of hemodynamic collapse due to dynamic left ventricular outflow tract (LVOT) obstruction, usually after surgical or transcatheter aortic valve replacement. We report a 54-year-old man with hereditary hemochromatosis undergoing bilateral lung transplantation. Following the weaning of venoarterial extracorporeal membrane oxygenation, he developed acute severe hypotension refractory to norepinephrine, vasopressin, and epinephrine. Intraoperative transesophageal echocardiography demonstrated a small left ventricular cavity, systolic anterior motion of the mitral valve, and LVOT obstruction, consistent with SLV. Subsequent treatment with very high-dose phenylephrine reversed and stabilized his hemodynamics, and the patient was ultimately discharged home with recovery of cardiac and pulmonary function. This case report presents an unusual occurrence of SLV in the absence of aortic valve intervention and highlights the key importance of clinical vigilance, early detection, and prompt appropriate treatment in this rare but life-threatening situation.

The beneficial effects of molecular hydrogen (H2) have been reported in a wide range of pathological conditions, including cardiovascular and neurodegenerative diseases and cancer. However, its biodistribution is highly dependent on the route of administration, and H2 concentration appears markedly reduced in arterial blood when not delivered by inhalation. In this study, we quantified H2 concentrations in the liver, brain, and left ventricular cavity of male anesthetized rats during H2 inhalation and following intragastric administration of hydrogen-rich water (HRW). Inhalation was the most effective route, producing high and homogeneous H2 concentrations in all organs at steady state. In contrast, HRW administration resulted in increased H2 levels in the liver only, with no detectable elevation in the brain or left ventricle, suggesting complete pulmonary clearance of H2. To further test this hypothesis, we developed an experimental arterioarterial shunt model coupled to a gas exchanger, enabling the delivery of high H2 concentrations downstream of the left ventricle ([Formula: see text] = 65.75 ± 30.86 µmol/L at the hepatic level). Despite considerable variability, no bypassing of the pulmonary clearance was observed, and H2 concentrations in the left ventricular cavity remained unchanged, confirming the dominant role of the lungs in H2 elimination. Together, these findings demonstrate that inhalation is the only route allowing complete systemic distribution of H2, whereas administration downstream of the lungs limits exposure to organs located distal to the point of delivery. These results challenge current assumptions regarding nonpulmonary H2 administration and open new avenues for optimizing H2-based therapeutic strategies.NEW & NOTEWORTHY This study establishes a quantitative framework for hydrogen (H2) pharmacokinetics, demonstrating that inhalation is the only way to achieve rapid and homogeneous systemic exposure, whereas hydrogen-rich water delivers H2 only to downstream organs. Using complementary physiological, intragastric, and high-dose systemic approaches, we validate a nonsaturable pulmonary clearance model across clinically relevant and supraphysiological concentrations. These findings resolve inconsistencies in the literature and redefine how hydrogen-based therapies should be interpreted and optimized.

Glucose and oxygen availability are fundamental drivers of tumor progression, deeply influencing cancer cell proliferation, metabolism, and spatial organization. In this study, we present a simplified microfluidic-based 3D model of tumorigenesis that allows for controlled and dynamic analysis of key tumor parameters under metabolic stress. Using this platform, lung adenocarcinoma (A549) spheroids embedded in a collagen-based extracellular matrix were monitored over time to assess growth kinetics, hypoxic response via HIF-1α expression, and structural organization. A multifactorial experimental design combining variations in glucose, glutamine, and oxygen availability revealed distinct and specific effects of each nutrient. Glutamine deprivation led to widespread cell death, while glucose limitation strongly arrests cell proliferation. Finally, oxygen restriction disrupted spheroid architecture, resulting in loss of the proliferative outer capsule and the formation of internal cavities. Our approach provides a flexible system to study how microenvironmental cues shape tumor behavior, offering insights into metabolic vulnerabilities and the morphofunctional consequences of nutrient stress in cancer.

Radiotherapy (RT) remains a cornerstone in the management of head and neck squamous cell carcinoma (HNSCC) across both definitive and multimodality treatment settings. While hypofractionated radiotherapy (HFRT) has become an established standard of care for several solid tumors, including prostate, breast, lung, and rectal cancers, its adoption in HNSCC has been more cautious owing to the complex anatomy of the head and neck region, the proximity of numerous critical organs at risk, and concerns regarding severe late toxicity. However, major advances in intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), image guidance, adaptive radiotherapy, and radiobiological understanding have renewed interest in HFRT as a strategy to maintain oncological efficacy while reducing overall treatment time. Additional drivers include the need to optimize healthcare resource utilization, improve access to radiotherapy in low- and middle-income countries, and minimize hospital visits, as highlighted during the COVID-19 pandemic. Recent prospective evidence has further strengthened the rationale for carefully selected hypofractionated approaches in HNSCC. In elderly and frail patients, the phase III ELAN-RT trial has also provided prospective evidence regarding a tailored hypofractionated approach for patients unable to undergo standard treatment. Among head and neck subsites, laryngeal cancer-particularly early-stage glottic carcinoma-represents the most mature clinical model for HFRT and therefore constitutes the principal focus of this review, while evidence from other HNSCC subsites is examined to assess the broader applicability of hypofractionated treatment strategies. This review critically summarizes the radiobiological rationale, current clinical evidence, technological advances, and ongoing challenges surrounding radical HFRT in HNSCC, with particular emphasis on laryngeal cancer, and discusses future directions for its broader implementation in clinical practice.

Fat embolism syndrome is an under-reported consideration in organ donation and is most often associated with long-bone trauma and intramedullary fixation. We describe a deceased donor who, after a traffic accident with bilateral femoral fractures treated by bilateral intramedullary nailing, developed hypoxemia, encephalopathy out of proportion to sedation, and a petechial rash consistent with fat embolism syndrome by clinical criteria. Despite intensive care, brain death was determined according to national standards and donation after brain death proceeded. Donor optimization followed lung-protective ventilation and standard hemodynamic targets. Predonation assessments met acceptance thresholds, and procurement showed no macroscopic intravascular fat in graft vessels with only scattered fat droplets in the abdominal cavity without luminal obstruction. The heart, bilateral lungs, liver, pancreas, and both kidneys were transplanted. Early courses were uncomplicated, with immediate heart and liver function, primary graft dysfunction grade 0 at 72 hours for the lungs, early insulin independence after pancreas transplantation, and primary kidney graft function. No embolic phenomena attributable to donor fat embolism syndrome were observed, and three-month follow-up was unremarkable. These findings support physiology-based evaluation rather than categorical exclusion of donors with suspected fat embolism syndrome.

General anesthesia for cleft palate surgery carries significant risks, with most complications occurring during induction. We report the case of a 17-month-old boy with complete bilateral cleft lip and palate who developed bronchial obstruction during induction of general anesthesia for cleft palate surgery due to food residues. The foreign body was promptly removed via bronchoscopy. Severe bradycardia, hypoxemia, and atelectasis in the right upper lung field were observed but subsequently resolved. Although such residues rarely pose a problem during induction of general anesthesia, they can lead to serious complications and warrant careful perioperative management. Upon reviewing this case, we identified the risks associated with the induction of general anesthesia in cleft palate surgery and emphasized the importance of perioperative management. Even with adequate preoperative management, it is crucial to check for any foreign bodies in the oral and nasal cavities during induction of general anesthesia to prevent airway obstruction.

Oral melanoma is a rare form of melanoma that typically presents as a black-brown macule or nodule with variable pigmentation and occasional depigmented areas. Oral melanoma typically affects the maxillary gingiva, palate, and retromolar trigone, and tends to be aggressive with high propensity for distant spread and poor prognosis. We report a patient with metastatic visceral melanoma who, upon presentation for dental care, was found to also have advanced gingival melanoma with bone involvement. This may support the oral cavity as the primary site and represents a missed opportunity for early diagnosis.