The plasma protein fibrinogen is critical for haemostasis and wound healing, serving as the structural foundation of the blood clot. Through a complex interaction between coagulation factors, the soluble plasma fibrinogen is converted to insoluble fibrin networks, which form the skeleton of the blood clot, an essential step to limit blood loss after vascular trauma. This review examines the molecular mechanisms by which fibrinogen modulates bleeding, focusing on its interactions with other proteins that maintain fibrin network stability and prevent premature breakdown. Moreover, we also cover the role of fibrinogen in ensuring clot stability through the physiological interaction with platelets. We address the therapeutic applications of fibrinogen across various clinical contexts, including trauma-induced coagulopathy, postpartum haemorrhage, and cardiac surgery. Importantly, a full understanding of protein function will allow the development of new therapeutics to limit blood loss following vascular trauma, which remains a key cause of mortality worldwide. While current management strategies help with blood loss following vascular injury, they are far from perfect and future research should prioritise refining fibrinogen replacement strategies and developing novel agents to stabilise the fibrin network. Exploiting fibrinogen’s molecular properties holds significant potential for improving outcomes in trauma care, surgical interventions and obstetric haemorrhage.

Obesity is a modifiable driver of cardiovascular disease and coexistent diabetes adds to adverse vascular outcomes. Guidelines uniformly highlight weight management as a cornerstone of cardiovascular prevention and recommend stepwise strategies starting with lifestyle modifications, then pharmacotherapies, followed by bariatric surgery in non‑responders. Despite a large body of evidence, use of weight loss cardiovascular protective agents remains low in clinical practice due to high costs and limited familiarity. Additional barriers include inadequate prioritisation of weight management in cardiac care, fragmented cross-specialties coordination, and lack of specific guidance in some high‑risk groups (e.g. those with type 1 diabetes). Given various difficulties, implementation of effective anti-obesity strategies remains suboptimal and requires more support of non-specialists together with greater efforts to align healthcare provider practices and system-level policies to ensure the delivery of equitable and sustainable weight loss interventions at scale.

Background/Objectives: Extremity leiomyosarcoma is an uncommon soft tissue sarcoma with a more favorable prognosis than other anatomical subtypes. Risk stratification currently rests on tumor grade, size, and metastatic status. Vascular invasion is an established predictor of metastasis in mixed soft tissue sarcoma cohorts but has seldom been formally examined in extremity leiomyosarcoma. We assessed its prognostic value in a single-center cohort. Methods: We retrospectively studied 62 adults who underwent resection of primary localized extremity leiomyosarcoma at a tertiary sarcoma center between January 2015 and February 2025. Vascular invasion was reported contemporaneously at original diagnostic reporting by specialist sarcoma histopathologists. Overall (OS), disease-specific (DSS), local recurrence-free (LRFS), and metastasis-free (MFS) survival were estimated by the Kaplan–Meier method and compared using log-rank tests. Death from another cause was treated as a competing event for disease-specific death and distant metastasis in a sensitivity analysis. Multivariable Cox models were refitted using Firth’s penalized likelihood, with discrimination corrected for optimism by bootstrapping. Results: Median follow-up was 59.5 months. Five-year OS, DSS, and MFS were 71.0%, 80.2%, and 74.6%. Vascular invasion was reported in 11 of 62 patients (17.7%) and was associated with inferior OS (p = 0.002), DSS (p < 0.001), and MFS (p < 0.001), but not LRFS (p = 0.631). Adjusted for grade, it was associated with inferior OS (HR 3.89, 95% CI 1.35–11.26), DSS (HR 5.48, 95% CI 1.46–20.58), and MFS (HR 5.63, 95% CI 1.69–18.80). The association persisted on separate adjustment for tumor size, depth, and neoadjuvant radiotherapy. Conclusions: Vascular invasion was associated with inferior survival in localized extremity leiomyosarcoma. With 17 deaths and 14 metastatic events, these are exploratory estimates, but they support documenting vascular invasion explicitly, as present or absent, in routine histopathological reporting so that its role can be evaluated at scale.