Zilebesiran represents an innovative antihypertensive therapy employing small interfering RNA (siRNA) to inhibit hepatic angiotensinogen, a key regulator of the renin–angiotensin–aldosterone system. By directly targeting the source of angiotensin II production, zilebesiran offers a novel mechanism distinct from conventional antihypertensive treatments. In the clinical studies KARDIA-1 and KARDIA-2, zilebesiran demonstrated clinically significant reductions in systolic blood pressure, with effects lasting up to 24 weeks after a single subcutaneous injection. In KARDIA-1, doses of 300 mg and 600 mg administered every 6 months resulted in reductions of over 15 mmHg in systolic blood pressure at 3 months compared with placebo. KARDIA-2 further showed an additional reduction of up to 12.1 mmHg at 3 months when zilebesiran was used as an adjunct to standard antihypertensive therapy. KARDIA-3 is currently evaluating the therapy in a larger global population to assess its impact on major cardiovascular outcomes. Zilebesiran has demonstrated a favorable safety profile with minimal adverse events, offering potential advantages for patients with resistant or uncontrolled hypertension and those at high cardiovascular risk, especially where adherence to daily oral medications is challenging. Beyond blood pressure reduction, zilebesiran may protect target organs, including the heart, kidneys, and retina. In conclusion, zilebesiran represents a promising siRNA-based therapy that may redefine the management of difficult-to-control hypertension, offering durable, targeted, and patient-friendly treatment with broad cardiovascular benefits. Future studies will clarify its long-term safety, efficacy across diverse populations, and integration into personalized hypertension management strategies.

Congenital heart defects (CHDs) represent the most common category of congenital malformations and constitute a significant cause of infant morbidity and mortality. Despite advances in prenatal imaging, such as fetal echocardiography, early detection remains challenging, particularly in pregnancies without identified risk factors. Recent studies suggest that maternal circulating non-coding RNAs, including microRNAs and long non-coding RNAs (lncRNAs), may serve as promising non-invasive biomarkers for the prenatal diagnosis of CHDs. Following a review of the most relevant clinical and preclinical studies, it was found that maternal circulating RNA, particularly microRNAs and lncRNAs, shows potential as non-invasive biomarkers for detecting fetal congenital heart defects. Among microRNAs, miR-146a-5p demonstrated the highest diagnostic accuracy for ventricular septal defects (VSDs), while panels of lncRNAs, such as LINC00598, LINC01551, and GATA3-AS1, exhibited high performance for atrial septal defects (ASDs). In addition, miR-19b, miR-29c, and miR-375 were associated with both VSDs and ASDs, suggesting a shared role in septal development. However, the studies displayed variability in biomarker selection and analytical methodologies. The findings indicate that maternal circulating microRNAs and lncRNAs hold significant potential as non-invasive biomarkers for the early detection of CHDs. Nonetheless, methodological heterogeneity and small sample sizes highlight the need for standardized protocols and larger multicenter studies prior to clinical implementation. These observations support the future integration of RNA biomarkers with fetal echocardiography to enhance early CHD screening and to inform prenatal counseling.

Background: The styloid process is a slender, cylindrical bony projection of the temporal bone, showing marked interindividual variability in length, orientation, and degree of ossification. Its abnormal elongation, defined as exceeding 30 mm, is often associated with Eagle’s syndrome but may also occur as an incidental anatomical variant. Objective: This study reports two rare cases of abnormally long styloid processes without ossification of the stylohyoid ligament, identified in adult dry skulls from the osteological collection of the “Olga Necrasov” Centre of Anthropological Research, Iași, Romania, and provides morphological and CT-based characterization. Materials and Methods: Both skulls were examined macroscopically and by CT, with 3D reconstructions being used for morphometric analysis. Results: In Case 1, the left SP measured 62 mm, corresponding to Langlais type I elongation, with no evidence of pseudoarticulation or ligamentous ossification. In Case 2, the left SP was elongated to 33 mm and fusiform in shape, while the contralateral (right) SP was completely absent, a highly uncommon anatomical variation scarcely reported in the literature. Both findings were confirmed by CT imaging. Conclusions: The coexistence shows that the stylohyoid complex cand vary greatly during development. Such findings expand the spectrum of known anatomical variants of the stylohyoid complex and underscore the importance of detailed morphologic and imaging evaluation of the styloid region in both anatomical and clinical contexts.

Background: Menopausal hormone therapy (MHT) effectively relieves vasomotor symptoms, but its cardiovascular safety remains influenced by timing, formulation, and route of administration. Methods: This narrative review summarizes evidence from major randomized trials (WHI, HERS, ELITE, DOPS) and observational studies, along with mechanistic data on the vascular and metabolic effects of MHT. Results: Although early studies suggested cardioprotection, randomized trials showed no cardiovascular benefit, and in some cases, increased risks of coronary events, stroke, and venous thromboembolism, particularly in older women or those with established cardiovascular disease. The “timing hypothesis” indicates that early initiation after menopause may have neutral or modestly favorable effects, whereas late initiation is associated with adversity. Oral estrogen is linked to higher thromboembolic and stroke risk compared with transdermal formulations. Evidence on atrial fibrillation and heart failure remains limited. Conclusions: MHT should not be used for cardiovascular disease prevention. Current evidence suggests that younger women in the early postmenopausal period may derive the greatest benefit with the lowest risk from individualized hormone therapy regimens, particularly those using transdermal estrogen. Treatment decisions should be guided by careful cardiovascular risk assessment and targeted to symptom relief and osteoporosis prevention.

Among uterus-preserving treatments for presumed fibroids, only myomectomy yields a specimen. Occult uterine sarcoma is uncommon, but leiomyosarcoma is clinically aggressive and seldom recognised before treatment. This narrative review examines what pretreatment assessment can and cannot establish. Literature from PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library was synthesised narratively. Reported frequencies of unexpected sarcoma differ between clinical populations, mostly from 0.1% to 0.4%, and rise with age. Other predisposing factors are imprecisely quantified; genome-wide association data do not discriminate sarcoma from leiomyoma. Separate meta-analyses, largely of retrospective, enriched studies, report higher accuracy for magnetic resonance imaging (MRI), including diffusion-weighted sequences, than for ultrasound, by indirect comparison. Serum markers, composite scores and circulating nucleic acids remain supportive or investigational; directed biopsy lacks validation in unselected populations. In all-sarcoma scenarios, published likelihood ratios indicate that a negative MRI lowers, but does not eliminate, the probability of sarcoma; an exploratory, assumption-dependent reconstruction from a consecutive cohort illustrates their uncertain transportability. No available test reliably excludes sarcoma; after specimen-free therapy, a missed sarcoma may remain unrecognised until reassessment. We propose a conceptual framework, not a validated decision rule, that considers absolute residual risk alongside the specimen status of the chosen treatment.

Breast arterial calcification (BAC) is a manifestation of medial arterial calcification frequently detected incidentally on screening mammography. Increasing evidence suggests that BAC may also serve as a marker of cardiovascular risk. This narrative review critically synthesizes the evidence on artificial intelligence (AI)-based detection, segmentation, and quantification of BAC. It also evaluates the cardiovascular prognostic significance of automatically quantified BAC and examines the requirements for clinical translation. A targeted literature search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted for English-language publications available from database inception through 3 September 2026, with additional studies identified from reference lists. Deep-learning approaches included convolutional neural networks, U-Net-derived segmentation architectures, transfer-learning models, and semi-supervised methods. Reported technical performance varied according to task and validation strategy. Representative segmentation models achieved Dice/F1 scores ranging from 0.666 to 0.756 and Jaccard indices from 0.581 to 0.614. Case-level BAC detection achieved areas under the receiver operating characteristic curve (AUCs) of up to 0.95–0.96 in selected test cohorts. However, external validation, learning-curve reporting, multivendor evaluation, and robustness assessment remained inconsistent. Prognostic studies demonstrated graded associations between automated BAC burden and cardiovascular outcomes. In a cohort of 21,514 women without known cardiovascular disease, age-adjusted BAC burden was associated with major adverse cardiovascular events (MACEs) among women classified as low risk, with adjusted hazard ratios (HRs) of 1.66 and 2.31 for BAC below and above the age-specific median, respectively. In 123,762 women from two healthcare systems, MACE risk increased progressively with BAC burden after adjustment using the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations, reaching approximately 2.8- to 3.3-fold higher risk with severe BAC. Nevertheless, incremental predictive improvement may be small—in one study, the addition of BAC changed the 5-year AUC from 0.645 to 0.646. Overall, available evidence supports the feasibility of scalable AI-based BAC assessment and demonstrates consistent associations between AI-quantified BAC and cardiovascular outcomes. However, technical performance and independent prognostic associations alone do not establish clinical utility. Standardized BAC definitions, genuinely independent external validation, and prospective implementation studies are required before BAC-guided cardiovascular management can be recommended.