Worldwide, cardiovascular diseases (CVDs) represent one of the main causes of morbidity and mortality, and acute coronary syndromes are responsible for a large number of sudden cardiac deaths. One of the main challenges that still exist in this area is represented by the early detection and targeted monitoring of the pathophysiology involved in CVDs. During the last couple of years, researchers have highlighted the importance of molecular and epigenetic mechanisms involved in the initiation and augmentation of CVDs, culminating in their most severe form represented by acute myocardial infarction. One of the most studied molecular factors involved in this type of pathology is represented by nuclear transcription factor kappa B (NF-κB), as well as the involvement of microRNAs (miRNAs). It has been suggested that miRNAs can also be involved in the complex process of atheromatous plaque vulnerabilization that leads to an acute cardiac event. In this review paper, we describe the most important molecular mechanisms involved in the pathogenesis of CVDs and atheromatous plaque progression and vulnerabilization, which include molecular mechanisms dependent on NF-κB. For this paper, we used international databases (PubMed and Scopus). The keywords used for the search were “miRNAs biomarkers”, “miRNAs in cardiovascular disease”, “NF-κB in cardiovascular disease”, “molecular mechanism in cardiovascular disease”, and “myocardial NF-κB mechanisms”. Numerous molecular reactions that have NF-κB as a trigger are involved in the pathogenesis of CVDs. Moreover, miRNAs play an important role in initiating and aggravating certain segments of CVDs. Therefore, miRNAs can be used as biomarkers for early evaluation of CVDs. Furthermore, in the future, miRNAs could be used as a targeted molecular therapy in order to block certain mechanisms responsible for inducing CVDs and leading to acute cardiovascular events.

Anal canal duplication (ACD) is a very rare condition, diagnosed and treated mostly in childhood. Less than 90 cases have been reported in the literature so far. We are presenting a case of a young woman who underwent surgical excision of the duplication when she was 27 years old. The patient was unaware of her condition and was referred from a gynaecological office to the surgical department with a history of perianal discomfort and mucus discharge. Local examination showed an external orifice posterior to the anal opening, on the median line, which had the macroscopic appearance of a secondary anal orifice. The opening was about 0.5 cm in diameter. Exploration of the tract revealed a length of about 4 cm. MRI described the aforementioned tract, parallel to the anal canal, with no other anomalies mentioned. Under spinal anesthesia, with the patient in jackknife position, the accessory anal canal was surgically excised. The pathology report showed the presence of smooth muscle fibers and typical anal glands in the specimen. After a five-year follow-up, the patient showed no recurrence or any other related local symptoms. Absence of perianal abscess from the patient history, along with the macroscopic aspect of the opening similar to a secondary anal orifice on the midline, should raise the suspicion of ACD. Due to the lack of bothersome symptomatology, the patient did not seek any special investigations for her condition until she was in her late twenties. ACD is a very rare condition in adults that might pass unnoticed, but a midline opening posterior to the anus should always raise the suspicion of a secondary anal canal. Surgery is the only cure for this condition with good results after a proper pre-operative workout to reveal others simultaneous malformations.

This study aimed to compare the outcomes and cost differences between primary lung cancer (PLC) and second primary lung cancer (SPLC) patients who underwent video-assisted thoracoscopic surgery (VATS). This was a retrospective analysis of 124 patients with lung cancer stages I, II, and III who underwent VATS between January 2018 and January 2023. The patients were divided into two groups based on their cancer status that was matched by age and gender: the PLC group (n = 62) and the SPLC group (n = 62). The results showed that there was no significant difference in the clinical characteristics between the 2 groups, except for the Charlson Comorbidity Index (CCI), with a score above 3 in 62.9% of PLC patients and 80.6% among SPLC patients (p = 0.028). Regarding the surgical outcomes, the operative time for the VATS intervention was significantly higher in the SPLC group, with a median of 300 min, compared with 260 min in the PLC group (p = 0.001), varying by the cancer staging as well. The average duration of hospitalization was significantly longer before and after surgery among patients with SPLC (6.1 days after surgery), compared with 4.2 days after surgery in the PLC group (0.006). Regarding the cost analysis, the total hospitalization cost was significantly higher in the SPLC group (15,400 RON vs. 12,800 RON; p = 0.007). Lastly, there was a significant difference in the survival probability between the two patient groups (log-rank p-value = 0.038). The 2-year survival was 41.9% among PLC patients and only 24.2% among those with SPLC. At the 5-year follow-up, there were only 1.6% survivors in the SPLC group, compared with 11.3% in the PLC group (p-value = 0.028). In conclusion, this study found that VATS is a safe and effective surgical approach for both PLC and SPLC patients. However, SPLC patients have a higher VATS operating time and require more healthcare resources than PLC patients, resulting in higher hospitalization costs. These findings suggest that careful pre-operative evaluation and individualized surgical planning are necessary to optimize the outcomes and cost-effectiveness of VATS for lung cancer patients. Nevertheless, the 5-year survival remains very low and concerning.

Background: Medullary thyroid carcinoma (MTC) is a rare but aggressive neuroendocrine thyroid malignancy in which early diagnosis is essential for improving clinical outcomes. Although calcitonin (CT) remains the standard diagnostic biomarker, its interpretation may be limited by false-positive elevations, assay variability, and indeterminate cut-off values. Consequently, alternative biomarkers such as procalcitonin (PCT), circulating microRNA-375 (miR-375), and fine-needle aspiration washout calcitonin (FNA-CT) have gained increasing interest. Methods: A systematic review and diagnostic meta-analysis were conducted to evaluate the diagnostic performance of circulating and tissue-related biomarkers for MTC. Eligible studies reporting sufficient diagnostic accuracy data were included. Pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves were calculated using a bivariate random-effects model. Methodological quality was assessed using the QUADAS-2 tool. Results: Five diagnostic datasets were included in the quantitative synthesis. The pooled sensitivity and specificity were 0.90 (95% CI: 0.84–0.94) and 0.99 (95% CI: 0.97–0.997), respectively. The pooled LR+ was 84.78, while the pooled LR− was 0.10. The pooled diagnostic odds ratio was 857.30, indicating excellent discriminatory diagnostic performance. SROC analysis demonstrated near-perfect overall diagnostic accuracy with an area under the curve (AUC) of 0.986. Procalcitonin-based approaches showed the most consistent diagnostic performance across studies, while combined CT + PCT strategies achieved the highest overall diagnostic accuracy. Emerging biomarkers such as miR-375 and FNA-CT also demonstrated promising results, although evidence remains limited. Conclusions: Biomarker-based diagnostic strategies demonstrate excellent diagnostic accuracy for medullary thyroid carcinoma. Among the evaluated biomarkers, procalcitonin-based approaches, particularly combined CT + PCT strategies, showed the most robust and clinically relevant diagnostic performance. These findings support the potential integration of procalcitonin into future diagnostic algorithms for MTC. Further large-scale prospective studies are required to validate diagnostic thresholds and standardize biomarker assessment protocols.