Atherosclerosis is a significant health concern with a growing incidence worldwide. It is directly linked to an increased cardiovascular risk and to major adverse cardiovascular events, such as acute coronary syndromes. In this review, we try to assess the potential diagnostic role of biomarkers in the early identification of patients susceptible to the development of atherosclerosis and other adverse cardiovascular events. We have collected publications concerning already established parameters, such as low-density lipoprotein cholesterol (LDL-C), as well as newer markers, e.g., apolipoprotein B (apoB) and the ratio between apoB and apoA. Additionally, given the inflammatory nature of the development of atherosclerosis, high-sensitivity c-reactive protein (hs-CRP) or interleukin-6 (IL-6) are also discussed. Additionally, newer publications on other emerging components linked to atherosclerosis were considered in the context of patient evaluation. Apart from the already in-use markers (e.g., LDL-C), emerging research highlights the potential of newer molecules in optimizing the diagnosis of atherosclerotic disease in earlier stages. After further studies, they might be fully implemented in the screening protocols.

Background: Placenta accreta spectrum (PAS) disorders are associated with high mortality and morbidity due to postpartum hemorrhage, hysterectomy, and organ injury, and a multidisciplinary team is required for an individualized case management. In this study, we assessed the diagnostic and prognostic accuracy of the most important ultrasonographic (US) and magnetic resonance imagining (MRI) markers for PAS disorders. Material and Methods: The study included 39 adult pregnant patients with at least one previous cesarean delivery and both US and MRI investigations for placenta previa evaluated at the tertiary maternity hospital ‘Cuza Voda’, Iasi, between 2019 and 2021. The following US signs were evaluated: intra-placental lacunae, loss of the retroplacental hypoechoic zone, myometrial thinning < 1 mm, bladder wall interruption, placental bulging, bridging vessels, and the hypervascularity of the uterovesical or retroplacental space. The MRI signs that were evaluated were intra-placental dark T2 bands, placental bulging, loss of the retroplacental hypointense line on T2 images, myometrial thinning, bladder wall interruption, focal exophytic placental mass, and abnormal vascularization of the placental bed. Results: The US and MRI signs analyzed in our study presented adequate sensitivities and specificities for PAS, but no sign proved to be a useful predictor by itself. The presence of three or more US markers for accretion was associated with a sensitivity of 84.6.6% and a specificity of 92.3% (p < 0.001). The presence of three or more MRI signs supplemented these results and were associated with a sensitivity of 92.3% and a specificity of 61.5% for predicting PAS (p < 0.001). Moreover, US and MRI findings were correlated with FIGO grading and severity of PAS. Conclusions: Even though no US or MRI finding alone can predict PAS with high sensitivity and specificity, our study proves that the presence of three or more imagistic signs could significantly increase the diagnostic accuracy of this condition. Furthermore, US and MRI could be useful tools for evaluating prognostic and perinatal planning.

(1) Background: Pulmonary embolism (PE) represents the third most important cardiovascular cause of death after myocardial infarction and stroke. The proper management of this condition is dependent on adequate risk stratification, due to the life-threatening complications of more aggressive therapies such as thrombolysis. Copeptin is a surrogate marker of vasopressin which is found increased in several cardiovascular conditions. The Mastora score is an imagistic evaluation of the degree of pulmonary arteries thrombotic burden based on computed tomography angiography. In this study, we aimed to evaluate the diagnostic and prognostic role of copeptin in patients with acute PE. Furthermore, we analyzed the relationship between copeptin and Mastora score and their role in PE risk profiling. (2) Methods: We conducted a single center prospective study that included 112 patients with PE and 53 healthy volunteers. Clinical and paraclinical parameters, together with plasma levels of copeptin and the Mastora score, were evaluated in all patients after admission. (3) Results: Copeptin levels were significantly increased in PE patients compared with the general population (26.05 vs. 9.5 pmol/L, p < 0.001), while receiver operating characteristic (ROC) analysis revealed an AUC of 0.800 (95% CI 0.728–0.873, p < 0.001). Copeptin directly correlated with the Mastora score (r = 0.535, p = 0.011) and both parameters were strong predictors for adverse clinical events and death. Receiver operating characteristic (ROC) analysis for death within 30 days revealed a copeptin cut-off of 38.36 pmol/L, which presented a specificity of 79.6% and a sensitivity of 88.9%, and a Mastora score cut-off of 82 points, which presented a specificity of 74.8% and a sensitivity of 77.8%. (4) Conclusions: Our results showed that copeptin and the Mastora score are both correlated with adverse cardiovascular events and mortality in PE patients, and this may pave the way for their use in clinical practice, helping physicians to select the best therapeutical management.

Caesarean delivery is rising worldwide, and for breech presentation at term, external cephalic version (ECV) reduces non-cephalic presentation at birth and, at very low certainty, caesarean delivery. Procedural evidence is reported per attempt, whereas losses determining whether an eligible woman reaches an attempt occur earlier and, in the literature we retrieved, are rarely measured. This narrative review compares procedural evidence with what is recorded about progression to ECV. Immediate success occurs in roughly half to six in ten attempts. Severe procedure-attributable complications are uncommon under strict definitions, at 0.24% in pooled data and 0.45% in a large series, whereas broader short-term composites reach 6–10% and count different events. Attempt rates were 62.2% and 72.5% of eligible women in two Dutch cohorts and 7.9% of a source-defined cohort in United States data, over non-comparable denominators. No contemporary study identified in our search reports the proportion of eligible women offered ECV in ordinary clinical practice, with eligibility assessed in every term breech presentation, despite an auditable standard targeting 100%. We identified no study measuring procedural effects and losses before the attempt within one population. Utilisation varies markedly, but the extent of any underuse cannot be quantified from this documented, non-exhaustive search. We set out an author-derived nine-state pathway with explicit denominators and three proposed process indicators as a reporting framework, not as validated measures.

Acute fatty liver of pregnancy (AFLP) is a rare microvesicular steatotic liver disease of late gestation, linked to impaired mitochondrial fatty acid β-oxidation, in which management centres on recognition and delivery before overt hepatic and multiorgan failure has developed. The Swansea criteria, which require six or more of fourteen features in the absence of an alternative explanation, define AFLP in guidelines and in most published cohorts. This narrative review examines how the criteria behave across the course of the illness and which markers might signal the disease earlier. The criteria are frequently fulfilled once AFLP is clinically established, but their accuracy against an independent reference standard derives from one small, high-prevalence biopsy series, and their specificity against haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and other causes of acute liver failure appears limited. Because several criteria index established organ failure, the threshold may remain unmet earlier in the illness, a hypothesis consistent with limited retrospective evidence; to our knowledge, no study has evaluated the criteria prospectively at initial presentation. We relate each criterion to hepatic energy failure and appraise candidate early markers, including coagulation indices, antithrombin, conjugated hyperbilirubinaemia, hypocholesterolaemia, soluble fms-like tyrosine kinase-1 and metabolite-level signals of fatty acid oxidation failure; none has a validated early diagnostic threshold. We outline a conceptual, hypothesis-generating framework for prospective research that would complement, not replace, the Swansea case definition.

Cervical excision increases the risk of preterm birth, while active surveillance for grade 2 cervical intraepithelial neoplasia offers no active treatment. Topical therapy for human papillomavirus (HPV)-associated lower genital tract disease could address this gap, yet no agent is approved for intraepithelial neoplasia of the cervix, vagina, or vulva, and a 2026 systematic review left open whether cervical treatment reduces progression. Scarcity does not explain this: 52 randomized trials have evaluated adjuvant treatment after excision, but heterogeneity in phenotype, comparator, and endpoint, and incomplete access to primary reports limit their interpretability. Three problems recur. First, the target epithelial population differs by phenotype and mechanism, yet local exposure was seldom characterized, although measurement strategies are set out here. Second, some antiviral claims rely on systems that do not reproduce the differentiation-dependent HPV life cycle. Third, endpoints are read against spontaneous regression approaching the effect sought. Randomized evidence supports imiquimod as a non-surgical option for appropriately selected women with vulvar high-grade squamous intraepithelial lesions; cervical conclusions depend on comparator and endpoint. We propose a conceptual eight-element sequence from clinical intention to inference, an interpretive aid, and not a validated appraisal instrument. Future studies should prespecify these elements and characterize exposure where feasible.