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Local therapy for metastatic castration-sensitive prostate cancer (mCSPC) remains controversial. This study aimed to assess the feasibility, safety, and oncologic outcomes of cytoreductive radical prostatectomy (cRP) in patients with synchronous mCSPC, with a particular focus on pathological findings. We retrospectively analyzed 61 patients with mCSPC who underwent cRP following neoadjuvant androgen deprivation therapy (ADT). Clinical, perioperative, and pathological parameters were reviewed. Survival outcomes were assessed in relation to biopsy Gleason grade (GG), metastatic burden, PSA dynamics, and pathological treatment effect (pTE). The 5-year CRPC-free survival and cancer-specific survival (CSS) rates were 50.8% and 77.0%, respectively. Biopsy GG 5 was associated with adverse outcomes, whereas pTE grade ≥ 2 was significantly associated with favorable outcomes, including improved CSS. Biopsy GG 5 was the sole preoperative factor associated with pTE. The rate of major perioperative complications (Clavien-Dindo grade ≥ 3) was 1.6%, underscoring the safety of cRP in this setting. Cytoreductive radical prostatectomy (cRP) appears to be a feasible and safe local treatment option in selected patients with mCSPC. In addition to cytoreductive benefit, cRP provides critical pathological information-particularly pTE-that correlates strongly with survival outcomes but cannot be predicted preoperatively. These findings support the incorporation of cRP as a diagnostic and therapeutic component within a multimodal treatment strategy for mCSPC.
The glucocorticoid receptor beta (GRβ) not only inhibits the function of the glucocorticoid receptor but also possesses unique transcriptional activity. Whereas the role of GRβ varies among different cancer types, its significance in bladder cancer remains unclear. This study aimed to investigate the clinical significance of GRβ expression in bladder cancer. Immunohistochemical analysis was performed on tissue samples obtained from 106 patients who underwent surgery for bladder cancer. The immunoreactivity of GRβ was evaluated using the labeling index (0%-100%). The association between GRβ expression and clinical parameters obtained from medical records was analyzed. GRβ expression was significantly lower in muscle-invasive bladder cancer (≥ pT2) compared with non-muscle-invasive cases (≤ pT1) (p = 0.0177). Furthermore, patients who experienced intravesical recurrence after surgery exhibited significantly lower GRβ expression (p = 0.0179). These findings suggest that GRβ may serve as a potential biomarker for predicting the progression and recurrence of bladder cancer.
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are increasingly used for diabetes and obesity, but their safety and clinical impact after lung transplantation (LTx) are unclear. We performed a single-center retrospective cohort study of adults undergoing primary LTx from 2018 to 2024. GLP-1 RA exposure was defined as either active treatment at the time of transplantation and/or GLP-1 RA use within the first 90 postoperative days. We compared early postoperative complications (including primary graft dysfunction grade 3 (PGD3), acute kidney injury, and respiratory infection), chronic lung allograft dysfunction (CLAD)-free survival, and overall survival according to GLP-1 RA use, using multivariable logistic regression and Cox models adjusted for key clinical covariates. Forty-two recipients received GLP-1 RA for obesity or diabetes and typically initiated months before LTx. Potential GLP-1 RA-related complications after lung transplant occurred in 4 patients (9.5%); therapy was discontinued in 3 patients (7.1%). Compared with non-users, GLP-1 RA recipients had higher body mass index and more diabetes, but pre-LTx GLP-1 RA use was not independently associated with PGD3 or other early complications. GLP-1 RA use within 90 days after LTx was not associated with postoperative aspiration or respiratory infection. In time-to-event analyses, GLP-1 RA use within 90 days was not associated with CLAD-free survival or overall survival. In this small, retrospective cohort with limited GLP-1 RA exposure, GLP-1 RA use before and early after transplantation was not associated with worse early or late outcomes, including CLAD and mortality, and was generally well tolerated. These results are reassuring but should be interpreted cautiously; prospective studies in larger cohorts are needed to confirm safety and to define optimal patient selection and timing.
Chronic lung allograft dysfunction (CLAD) is the leading cause of late graft failure after lung transplantation. Fibroblast activation protein (FAP) is selectively upregulated in activated fibroblasts under fibrotic conditions. We asked whether FAP expression is increased in CLAD and whether it can serve as an early diagnostic marker. We performed single-cell RNA sequencing on two murine orthotopic lung transplant models (C57BL/6→C57BL/10 and BALB/c→C57BL/6) and human lung tissue from five controls and five patients with CLAD. We quantified FAP expression by immunohistochemistry in transbronchial biopsies from 240 lung transplant recipients (62 with CLAD and 178 without CLAD). Receiver-operating characteristic curves determined an optimal FAP-positive area threshold. Kaplan-Meier analysis and Cox proportional hazards models assessed the association between FAP positivity and CLAD. In both murine and human single-cell data, FAP expression was confined to pathogenic fibroblast subsets and was significantly elevated in CLAD. In the clinical cohort, a threshold of 10.8% FAP-positive area discriminated chronic dysfunction with an area under the curve of 0.78 (95% CI 0.72-0.85), sensitivity of 65% and specificity of 84%. FAP positivity predicted shorter CLAD-free survival (p<0.0001) and overall survival (p=0.03). The hazard ratio for CLAD was 5.23 (95% CI 3.11-8.82; p<0.001), remaining significant after multivariable adjustment (hazard ratio 5.43, 95% CI 3.22-9.16; p<0.001). FAP expression is elevated in CLAD and is associated with subsequent CLAD and survival. Tissue FAP may enable early risk stratification and inform clinical surveillance; however, given its moderate discrimination, prospective validation in multicentre cohorts is warranted.
Autonomous path planning in obstacle-dense environments remains challenging for swarm intelligence methods due to infeasible initialization, insufficient exploration-exploitation balance, and poor trajectory smoothness for real-robot execution. To address these issues, this paper proposes a Kinematic-Aware Improved Hippo Optimization algorithm (KA-IHO) for mobile robot path planning. The proposed method integrates four components: an elite safety pool initialization strategy to improve feasible solution generation in dense maps, a hierarchical elite-scout update mechanism to better balance global exploration and local exploitation, anti-stagnation mechanisms including a Population Stagnation Restart strategy and a 10-Direction Radial Micro-Search to guarantee high feasibility rates across all map complexities, and a late-stage Laplacian Line-of-Sight Ironing Operator to reduce path redundancy and improve trajectory smoothness. Comparative experiments are conducted on five reproducible grid maps with different complexity levels (40×40 and 80×80), where KA-IHO is evaluated against six representative algorithms, including HO, SBOA, PSO, GWO, ARO, and INFO, over 20 independent runs. The results show that KA-IHO consistently achieves collision-free planning and obtains lower mean fitness values with smaller standard deviations than the compared methods, indicating improved robustness and solution quality. In addition, hardware closed-loop experiments on a differential-drive mobile robot demonstrate that the planned paths can be executed reliably in real environments, with trajectory tracking errors controlled within ±4 cm.
The Permian-Triassic mass extinction, the most severe biodiversity crisis of the Phanerozoic, is widely linked to Siberian Traps volcanism, yet mercury (Hg) isotope responses to eruptive phases remain poorly constrained. Here we identify a pronounced negative correlation between Δ199Hg and δ202Hg that occurs exclusively during three coupled volcanic-environmental-biotic crisis intervals ( ~ 150 kyr) and is absent under background conditions. Across multiple sections, crisis-interval samples converge between terrestrial, marine carbonate, and volcanic source fields, whereas background samples are more dispersed, indicating distinct isotopic behaviour. Hg/total organic carbon ratios normalized to background values strongly correlate with the Δ199Hg-δ202Hg relationship, linking Hg loading to isotopic systematics. These results reveal a previously unrecognized isotopic structure and suggest enhanced large-scale source control during crisis intervals, providing a framework for resolving eruptive pulses and tracing volcanism-driven environmental change.
Chronic lung allograft dysfunction (CLAD) remains a major barrier to long-term survival after lung transplantation. Murine models are essential for mechanistic studies, but the influence of donor-recipient strain direction and histocompatibility mismatch on chronic pathology is not fully defined. We evaluated the reproducibility of B6-background donor lungs across reciprocal strain combinations as a practical experimental platform. Orthotopic left lung transplantation was performed using major-mismatched (C57BL/6 [B6]↔BALB/c) and minor-mismatched (B6↔C57BL/10 [B10]) combinations. Major-mismatched recipients received costimulatory blockades (anti-CD40L/cytotoxic T-lymphocyte-associated protein 4 Ig); minor-mismatched pairs received no immunosuppression. Grafts were procured on day 28. Chronic injury was quantified using standardized histological scoring for airway, parenchymal, and pleural compartments. Lung function was assessed using the FlexiVent system with right hilar clamping. CLAD-like airway and fibrotic lesions developed across all combinations, irrespective of donor-recipient direction. B6 donor lungs reproducibly exhibited chronic pathology comparable with other strains. Notably, the incidence of obliterative bronchiolitis was higher in minor-mismatched groups (B10→B6: 54.5%; B6→B10: 38.5%) compared with major-mismatched groups (BALB/c→B6: 27.3%; B6→BALB/c: 36.4%). Histological severity significantly correlated with impaired lung compliance and increased airflow resistance, supporting the functional relevance of the observed structural injury. Reciprocal murine lung transplantation reveals that CLAD-like pathology develops irrespective of donor-recipient direction, with mismatch degree influencing the qualitative distribution of chronic injury. These findings validate B6-background donor lungs as a versatile platform for interrogating donor-intrinsic immune and stromal mechanisms of chronic rejection, and for hypothesis-driven testing of donor-targeted interventions using genetically modified strains.
Uncommon epidermal growth factor receptor (EGFR) mutations (UCM) account for approximately 10% of EGFR-mutant lung adenocarcinoma (LUAD) cases; however, their prognostic impact remains unclear. This study aimed to evaluate postoperative outcomes in patients with UCM compared to those with common mutations (CM) using a large multicenter database. This retrospective study included 1,636 patients with EGFR-mutant LUAD who underwent complete resection between 2015 and 2018 at 21 Japanese institutions. Patients were classified into the CM and UCM groups. Recurrence-free survival (RFS), overall survival (OS), lung cancer-specific survival (LCSS), and survival after recurrence (SAR) were analyzed using univariable and multivariable analyses and the inverse probability of treatment weighting (IPTW) method. Among the patients, 1,441 (88.1%) had CM and 195 (11.9%) had UCM. RFS was comparable between the groups. However, patients with UCM showed significantly shorter OS and LCSS than those with CM (OS: multivariable hazard ratio [HR] 1.538, 95% confidence interval [CI] 1.003-2.359; LCSS: multivariable HR 1.803, 95% CI 1.064-3.056). This trend was consistently validated using IPTW methods. SAR was also significantly shorter in patients with UCM. Subtype-specific analyses revealed that patients with exon 20 insertions (Ex20ins) had a significantly worse prognosis than those with other UCMs. Patients with UCM had significantly worse OS, LCSS, and SAR than those with CM despite similar RFS. These survival disadvantages in UCM were strongly associated with the Ex20ins subtype. These findings highlight the urgent need for novel perioperative treatments for patients with UCM, especially Ex20ins.
Cellulitis is one of the most common forms of skin and soft tissue infections, traditionally attributed to beta-hemolytic streptococci and Staphylococcus aureus. While Gram-negative organisms, particularly nonfermentative gram-negative bacilli (NFGNB), are ubiquitous in soil and aquatic ecosystems, they are rarely reported as causative pathogens of cellulitis. We report a case of metachronous cellulitis caused by two species of NFGNB: Sphingobacterium and Myroides species. An 81-year-old male was admitted with cellulitis of the left upper extremity. Sphingobacterium species was identified from blood cultures using Oxford Nanopore Technologies MinION sequencer. The patient was treated with antibiotics and recovered. Eleven months later, the patient was readmitted with similar symptoms of cellulitis in the left upper extremity. Myroides species was identified from blood cultures using MinION sequencer and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass-Spectrometry. The occurrence of cellulitis caused by NFGNB is rare, and this case is unique because two different NFGNB species caused cellulitis at separate time points.
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Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems. This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January-May 2020), Period 2 (June-July 2020), Period 3 (October 2020), and Period 4 (December-March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score. A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3-5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53-0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50-0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30-0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42-0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75-0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62-0.80) had lower mortality. Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics. National Institute for Health and Care Research, United Kingdom.
Accurate clinical staging of upper tract urothelial carcinoma (UTUC) remains challenging, and discrepancies between clinical and pathological T stages may result in missed opportunities for appropriate treatment. This study aimed to elucidate real-world discrepancies between clinical and pathological T staging in UTUC, emphasizing the diagnostic uncertainty associated with clinical T2 (cT2) disease. A retrospective analysis was conducted involving 739 patients with cTa–4N0M0 UTUC who underwent radical nephroureterectomy (RNU) at multiple institutions. Patients who received neoadjuvant therapy or had missing pathological T stage data were excluded. Discrepancies between clinical and pathological staging, treatment patterns, and survival outcomes were evaluated. Among 739 patients, substantial discrepancies between clinical and pathological T stages were observed, with an overall diagnostic concordance rate of 44.7%. Only 16% of cT2 cases were pathologically confirmed as pathological T2 (pT2), whereas most were either down-staged to ≤pT1 or up-staged to ≥pT3, indicating marked diagnostic uncertainty. Clinical heterogeneity within the cT2 group resulted in marked survival differences based on pathological stage, as pT3 patients had significantly worse outcomes than pT2 patients. Within the pT3 subgroup, lymphovascular invasion independently correlated with poor prognosis, whereas adjuvant therapy improved survival. However, only approximately one-third of patients with pT3 disease received adjuvant therapy, indicating a treatment gap in this high-risk population. This multicenter study identified real-world discrepancies between clinical and pathological staging in UTUC. cT2 disease represents a heterogeneous and diagnostically uncertain category, requiring careful interpretation for appropriate treatment planning.
Post-transplant deep vein thrombosis (DVT) is common after lung transplantation and may contribute to pulmonary embolism and other complications. Whether DVT adversely affects contemporary outcomes and how venovenous ECMO (VV-ECMO) bridging influences early DVT patterns remain unclear. We performed a retrospective single-center study of adult lung transplant recipients (2018-2025). DVT and clinical outcomes were ascertained. Primary analyses compared outcomes and overall survival between recipients with and without DVT in the overall cohort. Secondary analyses assessed DVT-free survival and early anatomic distribution among recipients bridged with preoperative VV-ECMO. Comparisons used Fisher's exact/Mann-Whitney U tests; survival used Kaplan-Meier/log-rank tests. Among 502 recipients, 240 developed DVT. Compared with those without DVT, recipients with DVT had higher rates of pulmonary embolism (22.5% vs. 5.0%, p < 0.0001), acute kidney injury (52.9% vs. 41.2%, p = 0.009), PGD grade 3 (18.3% vs. 10.7%, p = 0.016), longer hospitalization (21 vs. 14 days, p < 0.001), and worse overall survival (HR 2.19, 95% CI 1.49-3.23; log-rank p < 0.001). Of 240 DVT cases, 31 (12.9%) were bridged with VV-ECMO. Within 14 days, upper-extremity DVT was more frequent with VV-ECMO (53.3% vs. 23.5%, p = 0.03), whereas lower-extremity and neck distributions were similar. In multivariable models, operative time was independently associated with DVT (OR 1.18 per hour, 95% CI 1.07-1.31, p < 0.001). Post-transplant DVT is frequent and portends worse outcomes. VV-ECMO bridging is associated with an upper-extremity-predominant DVT pattern but is not an independent DVT predictor after adjustment. Vigilant surveillance is warranted in this high-risk population.
Venovenous extracorporeal membrane oxygenation (ECMO) is essential for patients with severe respiratory failure who do not respond to conventional mechanical ventilation. Adequate ECMO flow and safe circuit pressure are critical; however, cannula selection, which has a great impact on these factors, is often based on empirical judgment. This study aimed to develop a simple predictive method based on fluid dynamics for estimating ECMO flow rate and circuit pressures (P1: pre-pump, P2: pre-oxygenator, and P3: post-oxygenator). This experimental predictive model study compared the calculated and measured ECMO parameters across 36 combinations of cannula sizes, pump speeds, and bed heights. A laboratory-based ECMO circuit model was assembled with various drainage and return cannulas, an oxygenator, tubing, and a centrifugal pump. The circuit was primed with a 33% glycerin solution and tested across the 36 combinations. A four-step prediction method was applied: (1) modeling the pressure-flow relationships of ECMO components and the pump using manufacturer data; (2) identifying the expected flow rate by locating the intersection of the total circuit resistance and pump output curves; (3) sequentially calculating pressure drops across the circuit; and (4) adjusting pressures based on bed height. The predicted flow rate and circuit pressure values were compared to experimental measurements across the 36 combinations. The calculated and measured values showed strong agreement (R2 = 0.96-0.97), and predictions were significant. Notably, bed height alterations were confirmed to affect circuit pressure but not flow rate. Our newly developed method reliably predicts the ECMO flow rate and circuit pressure. Hence, it can be considered a valuable tool for preemptively selecting the optimal cannula size for ECMO, thus improving patient safety and circuit management. Furthermore, it may be a valuable educational tool, making complex hemodynamic concepts more intuitive for trainees.
SGLT2 (sodium-glucose cotransporter 2) mediates renal glucose reabsorption, and its pharmacological inhibition exerts cardio- and renoprotective benefits. Despite widespread clinical interest, reliable detection of SGLT2 protein remains challenging due to concerns regarding antibody specificity. Eight commercially available anti-SGLT2 antibodies were evaluated by immunohistochemistry and Western blotting using kidneys and hearts from genetically engineered Sglt2-deficient mice and rats. Human kidney tissues, including renal cell carcinoma samples, were also examined. Among the antibodies tested, ab306558 and HPA041603 showed specific immunostaining in rodent kidneys, with minimal background in wild-type tissues and complete absence of staining in Sglt2-deficient samples. However, ab306558 was unsuitable for human samples because of nonspecific staining. In renal cell carcinoma, HPA041603 detected SGLT2 immunostaining in proximal tubules of nontumor regions but not in tumor areas. Subcellular analyses revealed that SGLT2 was enriched within proximal tubular microvilli, partially overlapping with PDZK1IP1 (MAP17), but not with LRP2 (megalin) or NHE3. Western blotting identified an SGLT2-specific band at ≈55 kDa in rodent kidney lysates using ab306558, 20802, 24654-1-AP, and HPA041603 under optimized conditions, whereas no SGLT2-specific signals were detected in heart lysates. In contrast, ab85626 detected a weak ≈55 kDa band even in Sglt2-deficient kidneys. N-linked glycan removal shifted the SGLT2-specific band from ≈55 kDa to ≈45 kDa. HPA041603 consistently detected SGLT2 in rodent and human kidney tissues, whereas other antibodies showed limited specificity. Knockout-based antibody validation and optimized experimental conditions are essential for accurate interpretation of SGLT2 protein expression in experimental and translational studies.
Lung transplantation (LTx) remains a life-saving intervention for patients with end-stage lung diseases, yet complications such as infections, rejection, and thromboembolic events hinder long-term outcomes. Aspergillus galactomannan antigen (AGA) is a fungal biomarker traditionally used for diagnosing invasive pulmonary aspergillosis, but its broader clinical significance in LTx remains unclear. This study aimed to identify risk factors for serum AGA positivity after LTx and to evaluate whether AGA positivity is associated with postoperative infections, thromboembolic events, and survival. This retrospective study analyzed 293 lung transplant recipients at Northwestern University from January 2018 to June 2023. Patients were stratified based on AGA positivity, and demographic, intraoperative, and postoperative outcomes were compared. The association between AGA positivity, postoperative complications, and survival outcomes was evaluated using Cox proportional hazards and logistic regression models. AGA positivity was detected in 24% of patients, primarily within the first 100 days post-transplant. AGA-positive patients had significantly higher rates of respiratory infections (88.7% vs. 47.8%, P<0.0001) and pulmonary embolism (23.9% vs. 12.6%, P=0.04). AGA positivity was independently associated with increased infection risk (hazard ratio: 2.47, 95% confidence interval: 1.68-3.65, P<0.0001). Key predictors of AGA positivity included older age, chronic kidney disease (CKD), and prolonged ischemic time, whereas female donor status was protective. Serum AGA positivity is an early biomarker for increased infectious and thrombotic complications in lung transplant recipients. Routine AGA surveillance in post-transplant management may facilitate early identification of high-risk patients, allowing for timely interventions. Further prospective studies are warranted to assess the utility of AGA monitoring in optimizing lung transplant outcomes.
Bridging critically ill patients to lung transplantation with veno-venous extracorporeal membrane oxygenation (VV-ECMO) may increase infection risk, yet its impact on post-transplant outcomes remains unclear. We evaluated the incidence, timing, and risk factors for respiratory and bloodstream infections in patients supported with pre-operative VV-ECMO and assessed one-year survival. We conducted a retrospective cohort study of 293 adult lung transplant recipients at a single center between January 2018 and June 2023. Thirty-seven patients received pre-transplant VV-ECMO, and 256 did not. We compared the incidence and median time to first respiratory and bloodstream infections and estimated one-year survival. Cox proportional hazard models identified independent predictors of infection. VV-ECMO patients were younger (median 53.0 vs 63.0 years) and more often underwent bilateral transplantation for acute respiratory distress syndrome. Respiratory infections occurred in 64.9% of the VV-ECMO group versus 56.6% of controls (p = 0.38), with a shorter median time to first respiratory infection (8 vs 63 days). Bacterial bloodstream infections were more frequent after VV-ECMO (18.9% vs 6.3%, p = 0.016) and occurred earlier (99 vs 162 days). In multivariate analysis, VV-ECMO independently predicted bloodstream infection (HR 2.36, 95% CI 1.00-5.53; p = 0.049) but not a respiratory infection. One-year survival was equivalent (81.1% vs 89.8%; p = 0.16). Pre-transplant VV-ECMO is associated with earlier and increased bloodstream infections but does not compromise one-year survival, supporting its continued use as a bridge to lung transplantation.
Sternal wound dehiscence and infection affect up to one-third of lung transplant recipients and are associated with mediastinitis, prolonged hospitalization, impaired graft function, and increased mortality. Despite advances in perioperative care, contemporary data on the patient- and procedure-related risk factors for these complications after lung transplantation remain scarce. Therefore, this study aimed to identify independent pre- and postoperative predictors of sternal dehiscence/infection in modern lung-transplant practice. A retrospective review of the lung transplant database identified 290 consecutive patients who underwent lung transplantation with sternotomy from 2018 to 2024. A cohort of 33 with sternal dehiscence/infection and 257 patients without sternal complications were compared. The patient demographics, pre-operative medical conditions, surgical factors, and postoperative outcomes were analyzed. Univariate and multivariate logistic regression analysis was used to predict sternal complications after lung transplantation. The incidence of sternal dehiscence/infection was 11.4%, and the median interval between initial lung transplantation and reoperation for sternal complications was 99 days. In the univariate analysis, the sternal complication was more common in men, patients who developed postoperative acute kidney injury (AKI), and required post-operative veno-venous extracorporeal membrane oxygenation (ECMO). The multivariate analysis showed preoperative factors such as being female were associated with a lower risk of sternal complications [odds ratio (OR) =0.39; 95% confidence interval (CI): 0.16-0.94; P=0.04] while post-operative complications such as AKI increased the risk for sternal complications (OR =2.67; 95% CI: 1.08-6.61; P=0.03). Sternal complications after lung transplantation were associated with patient factors such as male and post-operative complications such as renal failures. Patients with these risk factors may develop impaired sternal healing, requiring additional measurements to prevent sternal complications.
Situs inversus is a rare congenital condition where the organs in the chest and abdomen are reversed, thus complicating surgeries such as lung transplantation. Kartagener syndrome (KS), associated with situs inversus, includes chronic sinusitis and bronchiectasis, which can progress to end-stage lung disease requiring transplantation. This review discusses the unique surgical considerations, technical challenges, and outcomes of lung transplantation in patients with situs inversus, particularly KS. The review highlights anatomical and physiological challenges in lung transplantation due to reversed organ positioning, requiring customized surgical approaches and intraoperative modifications. Preoperative imaging, anesthesia adjustments, and tailored surgical techniques are crucial for successful transplantation. Postoperative care focuses on managing complications such as primary graft dysfunction, infections, and anastomotic issues. Literature on survival rates, chronic lung allograft dysfunction, and quality of life is analyzed, indicating outcomes comparable to other lung transplant recipients. Despite significant challenges, lung transplantation in patients with situs inversus and KS is feasible with outcomes similar to traditional cases. Advances in imaging, surgical planning, and minimally invasive techniques offer promise for improved outcomes. Ongoing research, collaboration, and ethical considerations are essential to optimizing care and expand treatment possibilities for this high-risk patient population.