Weight loss induced by GLP-1 receptor agonists is accompanied by a substantial reduction in lean body mass, typically accounting for 25–40% of total weight loss. Although this proportion is consistent with physiological weight reduction, preservation of skeletal muscle remains essential due to its key role in metabolic health, insulin sensitivity, physical function, and long-term weight maintenance. Excessive muscle loss may increase the risk of sarcopenia, reduced strength, and adverse metabolic adaptations. Current evidence indicates that lean mass loss during GLP-1 therapy is primarily driven by energy deficit, reduced protein intake, and adaptive physiological responses rather than direct drug-induced catabolism. Nevertheless, GLP-1 receptor agonists may improve muscle quality through reductions in intramuscular fat and improved insulin sensitivity. Preservation of muscle mass therefore requires a multimodal strategy combining pharmacotherapy with resistance exercise and adequate protein intake. Among these interventions, resistance training appears to be the most effective approach for minimizing lean mass loss and maintaining functional capacity during treatment.

Background The increasing life expectancy observed in recent decades has led to a growing prevalence of neurological disorders, creating a need for more effective therapeutic strategies. Deep Brain Stimulation (DBS), introduced in the late 20th century, has emerged as a promising neuromodulatory technique. Aim This study aims to summarize current knowledge on DBS and highlight its clinical applications in neurological disorders, particularly Parkinson's disease, epilepsy, and Alzheimer's disease. Methods A narrative review of published literature was conducted using PubMed and Google Scholar, covering publications through March 2026. Articles were selected based on clinical relevance and methodological quality; findings were synthesized descriptively. Results DBS has demonstrated significant efficacy in the management of drug-resistant neurological conditions, particularly Parkinson's disease and epilepsy. Emerging evidence suggests potential benefits in Alzheimer's disease, although findings remain inconclusive. Conclusions DBS represents an important therapeutic option for patients with refractory neurological disorders. Despite its established role in selected conditions, further research is required to better understand its mechanisms and expand its clinical indications.

Background Pulmonary embolism still remains one of the most life-threatening conditions in cardiovascular medicine and remains the third leading cause of death in the United States. Current guidelines recommend surgical treatment of pulmonary embolism in high-risk patients. This procedure is typically performed through a median sternotomy approach with initiation of a cardiopulmonary bypass machine. Patients referred to surgery are often critically ill and burdened with multiple comorbidities that might be a contraindication to conventional surgery. Aim This narrative review screened the available literature on minimally invasive surgical approaches in pulmonary embolectomy and evaluated its potential benefits and limitations. Material and Methods A targeted literature search was performed using PubMed and Google Scholar databases, supplemented by manual screening of references from relevant articles to identify further eligible studies. Abstracts and full texts were screened, resulting in 8 articles included: 1 research paper, 3 case series, and 4 case reports with a total of 22 patients. Results Reported use of minimally invasive approaches in the surgical treatment of pulmonary embolism was described. Across the 22 included patients 1 patient was managed with thoracotomy and 10 patients with a minithoracotomy approach with utilization of various surgical strategies such as: video-thoracoscopic-assistance, or balloon-catheter-assistance. Ministernotomy approach was utilized in 11 patients: 10 patients underwent upper-hemisternotomy with central cannulation, and one patient underwent a right J-ministernotomy. Conclusions Median sternotomy remains the gold standard for surgical pulmonary embolectomy, however reported cases of procedures performed using minimally invasive approaches suggest that these techniques may be safe and effective in selected patients with contraindications to conventional approach.

Introduction. Cholinergic urticaria (CholU) is a subtype of chronic inducible urticaria triggered by increases in core body temperature and sweating. Its trigger profile, encompassing exercise, passive warming, emotional stress, and hot environments, renders it particularly relevant to athletes and physically active individuals, in whom these stimuli are frequent and often unavoidable. Purpose. This narrative review aimed to summarize current evidence on the clinical significance, diagnostic challenges, differential diagnosis, and practical management of cholinergic urticaria in athletes and physically active populations. Current knowledge. CholU predominantly affects young adults and involves heterogeneous pathophysiological mechanisms, including mast cell activation, sweat hypersensitivity, and acetylcholine-mediated pathways. In athletes, recurrent symptoms such as wheals, pruritus, and burning sensations may interrupt training, reduce exercise tolerance, and impair psychological well-being. Diagnosis relies on provocation testing, while differential diagnosis must exclude exercise-induced anaphylaxis, food-dependent exercise-induced anaphylaxis, and other inducible urticarias. Management centers on second-generation antihistamines, trigger modification, and, in refractory cases, omalizumab, which has enabled some patients to resume full athletic participation. Conclusions. CholU poses a distinct and underrecognized burden in physically active individuals. Individualized management combining pharmacotherapy with exercise modification can allow most patients to maintain safe participation in physical activity, though further research is needed to optimize treatment strategies.

IntroductionMelatonin has been a well-known substance to humanity since ancient times, but itsproperties became the subject of study in the past century. Although today melatoninsupplementation is primarily associated with sleep regulation, there are evidence for itsanti-inflammatory, antioxidant, and free radical-scavenging properties.AimThe aim of this narrative review is to analyze actual research on the effect of melatonin onmale fertility.Materials and methodsPubMed and Google Scholar were searched for studies and research paper related toantioxidant and anti-inflammatory properties of melatonin and its effect on fertility. Afterscreening abstracts and full texts, data were extracted and the findings were synthesized in anarrative manner based on study design, population characteristics, the effects of melatoninon semen quality and reproductive function, and the reported outcomes.ResultsMost studies showed that melatonin may have beneficial effects on male fertility. It improvedsperm parameters such as motility, viability, morphology, and DNA integrity. Positive effectswere also observed in cases of oxidative stress caused by environmental toxins,cryopreservation, chemotherapy, and radiotherapy. There are many studies reportedprotective effects of melatonin on semen quality, but some of them suggest that long-termsupplementation may negatively affect selected semen parameters in some individuals.ConclusionMelatonin seems to be a multifunctional molecule with antioxidant, anti-inflammatory, andreproductive regulatory properties, among others. It may support male fertility. Currentevidence is still insufficient to determine the optimal dose and duration of treatment. Resultsmay vary depending on species, individual variability, and biological context. Furtherresearch is needed to clarify its systemic effects and clinical utility in reproductive medicine.

Background: Alcohol use disorder (AUD) is a grave mental health condition that can result in significant health and social consequences. The medications Naltrexone and Nalmefene are indicated for the treatment of AUD, with Naltrexone having received the most extensive research attention. Methods: The majority of papers assessing universal measures of alcohol consumption employed two primary metrics: total alcohol consumption (TAC) and the number of days per month where individuals engaged in heavy drinking (HDD). Indicators pertaining to the maintenance of complete abstinence were excluded due to the absence of sufficient data. The safety of both substances was also assessed, as were the frequency of side effects and independent patient dropout. The study also incorporated practical factors of the therapy, such as the route of administration, dosage regimen, and the drug’s patient convenience, which can have a significant impact on adherence to therapy. Results: Nalmefene, administered in an “as needed” regimen, demonstrated statistically significant activity in reducing HDD and total alcohol consumption (TAC) among patients with AUD, particularly those with elevated World Health Organization (WHO) DRL risk. Preliminary findings from the ESENSE1 (Efficacy of Nalmefene in Alcohol Dependence; the first phase III study), ESENSE 2 (Efficacy of Nalmefene in Alcohol Dependence, the second phase III study), and SENSE (the final phase III long term-safety and cost-effectiveness study) studies indicate a substantial decrease in HDD and TAC following the initial month of treatment. These effects persist throughout the subsequent follow-up period. Several Japanese studies have corroborated the effectiveness of Nalmefene, demonstrating its efficacy across both short-term and long-term applications. Furthermore, these studies have substantiated its safety profile, indicating that there is no inherent risk of addiction or the emergence of withdrawal symptoms. The mild nature of adverse events (most commonly nausea and dizziness) led to a relatively low discontinuation rate of Nalmefene treatment. A subsequent study, employing a recognized methodology, corroborated the efficacy of psychosocial support in enhancing treatment outcomes. Meta-analyses demonstrate that Naltrexone exhibits comparable efficacy in reducing the frequency and severity of alcohol consumption. In select populations, the injectable form (LAI) of this pharmaceutical agent facilitates less frequent dosing, which is advantageous for the treatment process. A comparison of Nalmefene and Naltrexone reveals that the latter does not demonstrate a significant impact on the likelihood of individuals returning to heavy alcohol consumption. Conclusions: In the treatment of AUD, both naltrexone and nalmefene have been shown to yield positive outcomes, particularly in terms of reducing the HDD and TAC. According to the World Health Organization (WHO) classification, Nalmefene is indicated for individuals with a high risk of developing serious conditions. It has been demonstrated to produce rapid and sustained results while exhibiting a favorable safety profile, characterized by the absence of significant adverse effects. Naltrexone is a medication that has proven to be effective. LAI may have a positive impact on the efficacy of treatment.