A 16-year-old male (ASA II, BMI 31) underwent reconstructive osteoplasty with insertion of a polymethylmethacrylate (PMMA) spacer. Shortly after cement application, he developed sudden hypotension, tachycardia, and decreased end-tidal CO2, consistent with Grade II BCIS. Supportive management with fluids, ketamine, and norepinephrine stabilized the patient. Postoperatively, he experienced recurrent hypotension, acute kidney injury, and elevated liver enzymes and creatine kinase. Intensive care treatment resulted in recovery, and he was discharged from the ICU on day five. Bone cement implantation syndrome, though exceptionally uncommon in pediatric patients, may develop during orthopedic procedures involving polymethylmethacrylate. Early recognition, continuous anesthetic vigilance, and timely multidisciplinary intervention are crucial to reduce morbidity and improve perioperative outcomes.

We present a clinical case of a 59-year-old male who complained of varicose veins and a burning sensation in the right lower limb. His medical history included bilateral great saphenous vein (GSV) removal (2003), type 2 diabetes mellitus, stage 4 chronic kidney disease, gout, and arterial hypertension. Duplex ultrasound revealed varicothrombophlebitis of the small saphenous vein (SSV) and a floating thrombus in the popliteal vein. Initial treatment consisted of oral anticoagulation with rivaroxaban, followed by EVLA of the SSV and ultrasound-guided sclerotherapy of tributaries. After anticoagulant therapy, partial recanalization of the SSV and thrombus lysis in the popliteal vein were observed. EVLA of the SSV was performed without complications. Anticoagulant therapy was continued in coordination with a hematologist. At 6-month follow-up, duplex ultrasound showed the SSV as a fibrotic cord (diameter 3-4 mm), with regression of symptoms of chronic venous insufficiency. Despite the patient's high-risk profile, individualized management and careful monitoring allowed for the successful performance of a minimally invasive procedure. In selected high-risk patients with recurrent varicose disease complicated by thrombosis, EVLA may be considered following appropriate anticoagulant preparation. This case highlights the potential feasibility of an individualized and staged treatment approach in complex clinical settings.

Alzheimer's disease (AD) is the leading cause of dementia and remains a major global health challenge. Although current disease-modifying therapies primarily target amyloid-β and tau pathology, their clinical efficacy is limited. Increasing evidence indicates that AD is a multifactorial disorder involving neuroinflammation, mitochondrial dysfunction, impaired autophagy-lysosomal pathways, and dysregulated lipid metabolism. These interconnected mechanisms contribute to disease progression and represent promising therapeutic targets. This narrative review summarizes current evidence on emerging treatment strategies beyond the classical amyloid and tau paradigm, with particular emphasis on microglial activation, mitochondrial function, autophagy, and lipid homeostasis. Additionally, the translational potential of lifestyle-based interventions, including physical activity and metabolic regulation, is discussed. A broader understanding of AD pathogenesis may support the development of integrated therapeutic approaches combining pharmacological and non-pharmacological strategies to improve clinical outcomes.

The aim of this work is to critically evaluate the benefits and risks of zilebesiran. A comprehensive literature search was conducted in PubMed and Google Scholar databases to identify relevant studies on zilebesiran and other small-interfering RNA (siRNA)-based therapies for hypertension. The search covered publications from January 2010 to December 2025. The following keywords and combinations were used: "zilebesiran", "siRNA therapy", "angiotensinogen inhibition" "hypertension". Hypertension is one of the most prevalent cardiovascular diseases worldwide. The effectiveness of the therapy is still unsatisfactory, which is caused, among other things, non-adherence to pharmaceutical treatment. A long-acting drug could reduce this non-adherence to some extent. The mechanism of action of zilebesiran is based on silencing the angiotensinogen gen by activation the RNA-induced silencing complex (RISC). In animal studies and then in patients with hypertension (KARDIA I and KADRIA 2), zilebesiran after a single subcutaneous administration reduced angiotensinogen concentrations in blood by 90% and a systolic blood pressure by 10-20 mm Hg compare to placebo for a period of 3-6 months. In the studies conducted so far, apart from a few cases of orthostatic hypotension and a slight increase in creatinine in the blood, no serious side effects were found. A large study, KARDIA 3, is currently underway to assess the antihypertensive efficacy and reduction of cardiovascular complications. Despite the promising results of previous studies further observation are still necessary regarding long-term hypotensive effectiveness, reduction of risk cardiovascular complication and side effects.