Extracellular vesicles (EVs) are membrane-bound structures released by cells that contain bioactive cargo such as cytokines or non-coding RNA. It is widely known that EVs influence the activity of other cells; they take part in the pathogenesis and compensatory mechanisms of multiple diseases. Frequently, EVs can share the properties of their source cells, thus allowing the use of EVs as non-cellular vectors or therapeutic agents. Importantly, these structures can express the ligand for the programmed cell death protein 1 (PD-L1). It binds to the PD-1 protein present on the immune cells, which suppresses the activity of T cells. The PD-1/PD-L1 axis is widely known in the field of oncology, as PD-L1 present on the surface of cancer cells inhibits cytotoxic activity of T cells, thus promoting cancer growth and treatment resistance. Immunotherapy prevents PD-1/PD-L1 binding and restores anticancer properties of the immune cells. By contrast, the above-mentioned binding is desired in the context of autoimmunity, where abnormal activity of immune cells is a hallmark element in the pathogenesis of these conditions. The aim of this review is to present and discuss the latest findings regarding the role of EVs-PD-L1 in cancer and autoimmunity.

Median Arcuate Ligament Syndrome, also known as Dunbar’s syndrome, is a rare condition caused by stenosis of the celiac artery (CAS) through the fibrous arch connecting the diaphragmatic branches. It manifests as postprandial abdominal pain, nausea, vomiting, weight loss and increased epigastric tenderness. The condition most commonly affects young females without coexisting vascular comorbidities. Diagnosis is difficult due to the non-specific symptoms, often overlapping with other gastrointestinal diseases. Standard investigations include duplex ultrasound, computed tomography angiography (CTA) and contrast-enhanced magnetic resonance imaging (CE-MRA). Treatment mainly consists of surgical release of the arch ligament, which can be performed by open, laparoscopic or robotic methods. Surgery is often supported by celiac truncal stenting for residual stenosis, which significantly improves vascular flow. Alternative approaches include visceral plexus blocks and novel hybrid techniques, such as a combination of ligament release and endovascular treatment of the celiac trunk. In severe cases, vascular by-passes are recommended. The aim of this paper is to discuss the clinical manifestations, diagnostic possibilities, therapeutic options and directions for further research on MALS from the perspective of a vascular surgeon. It emphasizes the need for a multidisciplinary approach, including collaboration between the surgeon, radiologist, gastroenterologist and psychologist, which enables comprehensive disease management and improved quality of life for patients. In addition, the need for further development of diagnostic and therapeutic methods for early diagnosis and effective treatment was pointed out.

Background/Objectives: After pneumonectomy, the right ventricular stroke volume is pumped into pulmonary vessels whose volume has been reduced by approximately 50%. To sustain conditions for pulmonary flow, the flow reserve is increased in the remaining lung, which is conducive to the development of pulmonary hypertension symptoms. This study sought to examine pulmonary flow in one lung and the size of the right atrium (RA), right ventricle (RV) and pulmonary artery (PA) in patients who had undergone pneumonectomy and to establish the influence of time since pneumonectomy on these parameters, as well as their potential mutual dependencies. Methods: The retrospective analysis included 34 patients who had undergone pneumonectomy. Pulmonary flow was measured by means of perfusion scintigraphy. The diameters of the RA, RV and PA were evaluated based on computed tomography with contrast. Results: We observed complete or near-complete utilization of flow reserve in 38.2% (13/34) of patients, enlarged transversal and longitudinal dimensions of the RA in 17.6% (6/34) and 32.3% (11/34) of patients, respectively, and enlarged transversal and longitudinal dimension of the RV in 67.6% (23/34) and 44.1% (15/34) of patients, respectively. Dilatation of the PA was discovered in 23.5% (8/34) to 26.5% (9/34) of patients, as well as the presence of an extensive complex of radiographic features of pulmonary hypertension (PH) syndrome in 23.5% (8/34) of cases. Conclusions: Radiological features of PH were present in a significant number of patients. These features developed at varying rates but were present in all patients followed >10 years after the procedure.

Treatment for complex pleural empyema often requires thoracoplasty with rib(s) resection to remodel the thoracic cage and obliterate chronic infected pleural cavities. Such procedures are complicated and result in permanent body deformation, which is not acceptable by most adults. Standard decortication often fails as there is residual space for reinfection development, and often necrotizing pneumonia co-exists. Here we describe the surgical management of three complicated adult patients using the modified version of the Sawamura technique which involves debridement and partial decortication followed by ribs stripped of periosteum and surrounding soft tissues, to allow collapse deep into the pleural cavity, thereby obliterating the chronic space in conjunction with partial lung re-expansion. We utilized the serratus muscular flap to repair any bronchial defects due to resected gangrenous parenchyma. No further reoperations were necessary, and no residual effusions were drained. At the 6-month follow-up, these three patients experienced no complications, and their body shapes and functionality were unaltered. This modified Sawamura technique offers an effective single-step treatment while being cosmetically suitable for young adults, and presents an extremely attractive option in countries with limited healthcare resources.

Long non-coding RNAs (lncRNAs) constitute an important group of regulatory RNA molecules involved in the control of gene expression at the epigenetic, transcriptional, and post-transcriptional levels. In recent years, their crucial role in the pathophysiology of cardiovascular diseases, particularly coronary heart disease, has become increasingly evident. The aim of this review is to present current knowledge regarding the mechanisms of lncRNA action in the cardiovascular system, their involvement in the molecular processes associated with myocardial ischaemia, and their potential diagnostic and therapeutic applications. We discuss the molecular mechanisms responsible for the regulation of cardiomyocyte apoptosis, oxidative stress, mitochondrial dysfunction, angiogenesis, coronary vessel remodelling, and cardiac fibrosis. Particular attention is paid to selected lncRNAs involved in coronary heart disease, including MIAT, MALAT1, ANRIL, and H19, which influence inflammatory processes, vascular smooth muscle cell proliferation, responses to hypoxia, and cardiac fibrosis. The potential of lncRNAs as diagnostic and prognostic biomarkers in coronary artery disease is also discussed. Current evidence suggests that molecules such as MALAT1, MIAT, LIPCAR, and HCG11 may have considerable diagnostic and prognostic value, including for predicting major adverse cardiovascular events and the no-reflow phenomenon following percutaneous coronary intervention. Furthermore, contemporary therapeutic strategies targeting lncRNAs are presented, including antisense oligonucleotides, siRNAs, and CRISPR/Cas9 genome-editing technologies. Despite promising preclinical findings, the clinical application of lncRNA-based therapies remains limited by challenges related to safety, delivery of therapeutic molecules, and translation of experimental findings into clinical practice. Nevertheless, lncRNAs represent a promising avenue for the development of precision medicine and may play an important role in the future diagnosis and treatment of cardiovascular diseases.

Chest impalement is a rare type of injury resulting from penetration by a large foreign object that remains in the body. Each case of chest impalement is unique, and the outcome largely depends on the trajectory of the foreign object. Here we present the case of a 48‐year‐old male who accidentally fell from the rooftop of his house (from a height of several meters), onto a scaffolding tube, which penetrated through the 10th left posterior intercostal space into his chest. Upon transport of the patient to the trauma center, computed tomography (CT) surprisingly revealed no significant damage to the internal organs. The foreign body was successfully removed by left posterolateral thoracotomy, and the postoperative course was uneventful. A good outcome following a chest injury requires timely transport to the trauma center, and multidisciplinary management by an experienced team. In the presented case, the foreign object’s trajectory did not cause damage to the internal organs, which was also an important factor contributing to the good outcome.