Annali Italiani Di Chirurgia[JOURNAL]
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200 papers
Association of Postoperative Nadir Haemoglobin Levels With Long-term Adverse Events After Elective Noncardiac Surgery.
Jawad M, Baigi A
Ann Ital Chir · 2026 Apr · PMID 41987616 · Publisher ↗
AIM: Preoperative anaemia is a well-established risk factor for poor outcomes. However, the impact of postoperative haemoglobin (Hb) levels on long-term outcomes, including mortality and cardiovascular events, remains un...
AIM: Preoperative anaemia is a well-established risk factor for poor outcomes. However, the impact of postoperative haemoglobin (Hb) levels on long-term outcomes, including mortality and cardiovascular events, remains uncertain. This study aims to assess the independent association between postoperative nadir Hb levels and long-term outcomes, considering the potential interaction with preoperative anaemia status. METHODS: This study is a secondary analysis of data from the Myocardial Injury in Noncardiac Surgery in Sweden study, which included patients aged ≥50 years undergoing elective noncardiac surgery. Postoperative Hb levels were measured daily for up to 3 days or until discharge, and the lowest recorded value was used as the primary exposure variable. Multivariable logistic regression analysis was employed to explore the independent association of postoperative nadir Hb with the primary outcome of a composite endpoint comprising all-cause mortality and cardiovascular complications over a one-year period, adjusting for a range of perioperative risk factors, including preoperative anaemia. To account for a potential interaction with preoperative anaemia, an interaction term was added to the model. Secondary outcomes were one-year mortality and one-year cardiovascular morbidity. RESULTS: A total of 1284 patients were included, of whom 521 (40.6%) had preoperative anaemia. The median postoperative nadir Hb level was 102 g·L (interquartile range 92-114). Postoperative nadir Hb was not independently associated with the composite primary outcome; however, it showed a weak but statistically significant association with one-year mortality (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.95-0.99). No significant interaction was found between preoperative anaemia and postoperative nadir Hb. Independent predictors of the primary outcome included university hospital status (aOR 2.83, 95% CI 1.96-4.10), age (aOR 1.05, 95% CI 1.03-1.07), and unplanned postoperative intensive care (aOR 3.17, 95% CI 1.08-9.28). CONCLUSIONS: Postoperative nadir Hb levels, within the observed range well above 70 g·L, were not independently associated with the long-term composite outcome. However, they were weakly associated with one-year mortality. No significant interaction was found between preoperative anaemia and postoperative nadir Hb. These findings highlight the need for further investigation into the clinical significance of postoperative Hb levels in high-risk patients.
Influence of Oral Habits on Color Changes and Patient Satisfaction for Cemented Ceramic Prostheses: A Preliminary Study.
Alahmari NM, Al Moaleem MM, Mehta V … +2 more , Meshni AA, Al-Makramani BMA
Ann Ital Chir · 2025 Nov · PMID 41834560 · Publisher ↗
AIM: In the presence of different oral habits, cemented prostheses should maintain the color and aesthetic for a long clinical period, which results in a high degree of patient satisfaction. This study aims to evaluate t...
AIM: In the presence of different oral habits, cemented prostheses should maintain the color and aesthetic for a long clinical period, which results in a high degree of patient satisfaction. This study aims to evaluate the mean color change (ΔE) values of multilayer zirconia and lithium disilicate restorations after 3, 9 and 12 months among patients with different social oral habits (coffee drinking, khat chewing, and smoking). METHODS: This prospective clinical study was conducted over a 12-month period during 2022-2023 and included 16 participants (mean age: 29.8 ± 8.4 years) with a total of 122 cemented ceramic prostheses (92 zirconia, 30 lithium disilicate). The participants were categorized based on various characteristics, including oral habits, type of ceramic material used, retainer type, and tooth type. Color parameters were measured using a spectrophotometer that adheres to the International Commission on Illumination (CIE) L*a*b* color space system. The ΔE was calculated by measuring the L*a*b* at baseline and after 3, 9, and 12 months to assess color changes. Also, the VitaPan Classical Shade Guide was used. Patient satisfaction was measured using a Visual Analog Scale (VAS), which categorized responses from "very satisfied'' to "not satisfied''. Independent or Mann-Whitney U tests and One-Way Analysis of Variance (ANOVA) or Kruskal-Wallis H were used to compare ΔE values across materials, arch types, retainer types, and social habits, with significance set at < 0.05. RESULTS: Smoking recorded the greatest ΔE for zirconia (5.72 ± 2.74), while coffee showed the lowest (5.02 ± 2.96). For lithium disilicate, coffee had the highest ΔE (6.065 ± 2.49) and smoking had the lowest (5.57 ± 2.18). Significant changes were observed in mandibular lithium disilicate compared to zirconia after exposure to coffee and smoking ( = 0.006 and 0.009) and ( 0.001 and 0.014) at 3 and 9 months. Smoking, coffee drinking, and khat chewing showed a non-significant difference between pontic and separate crown zirconia after all 3, 9, and 12 months ( > 0.05). One-Way ANOVA and Kruskal-Wallis revealed no significant differences in overall mean ΔE across coffee, khat, and smoking for both material types. VAS revealed that most patients were satisfied with all parameters assessed over a 12-month period. CONCLUSIONS: After 12 months, both multilayer zirconia and lithium disilicate prostheses showed color changes due to coffee, khat chewing, and smoking, with no significant differences between materials, arch types, retainer types, or habits. Although color shifts surpassed clinically acceptable levels, lithium disilicate exhibited better shade stability according to VitaPan Classical Shade Guide assessments. Patient satisfaction remained high throughout the study.
Comparison of the Modified Concentric Cannula and Conventional Concentric Cannula for Single Puncture Arthrocentesis of the Temporomandibular Joint: An Experimental Cadaveric Study.
Ozkan A, Samur Erguven S, Sentürk MF … +2 more , Aksoy Degirmenli S, Yucel C
Ann Ital Chir · 2026 Feb · PMID 41834559 · Publisher ↗
AIM: This study aims to compare the effectiveness of the modified concentric cannula and the conventional concentric cannula for single puncture arthrocentesis (SPA) in terms of irrigation efficiency, procedure duration,...
AIM: This study aims to compare the effectiveness of the modified concentric cannula and the conventional concentric cannula for single puncture arthrocentesis (SPA) in terms of irrigation efficiency, procedure duration, and clinician satisfaction. METHODS: The study was conducted on 18 temporomandibular joints (TMJs) of 9 fresh cadavers between June and July 2022. After determining the entry points, 1 mL 10-μM methylene blue solution was injected into the upper joint cavities. For each cadaver, SPA was randomly conducted using a conventional concentric cannula (Group C) on one side and a modified concentric cannula (Group M) on the other side. The primary outcome variables were irrigation efficiency, procedure duration, and clinician satisfaction. All efflux solutions were analyzed using a spectrophotometer to determine irrigation efficiency based on the amount of methylene blue solution removed from the upper joint cavities. RESULTS: Both cannulas effectively washed the TMJ. However, there were no statistically significant differences in the median absorbance and concentration values between the groups ( = 0.144, = 0.144). Procedure duration was significantly lower in Group M ( = 0.001). The clinician satisfaction scores were significantly higher in Group M ( = 0.001) than in Group C. CONCLUSIONS: Both cannulas could be used in SPA. However, the modified concentric cannula provides easier procedures, less procedure duration, and higher clinician satisfaction in SPA procedures than conventional concentric cannulas.
Correction: Advances in Minimally Invasive Approach for Impacted Mandibular Third Molar Extractions: From Incision Design to Dynamic Navigation.
Wu Y, Lu L, Zhai T … +4 more , Jiang M, Quan X, Jiang Q, Sun Z
Ann Ital Chir · 2026 Mar · PMID 41834558 · Publisher ↗
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Spinal Endoscopy: Just a Recurring Fad?
Dibenedetto R, Ferlito D, Bondurri B … +2 more , Giussani CG, Zoia C
Ann Ital Chir · 2026 Mar · PMID 41834557 · Publisher ↗
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Toward Standardized Outpatient Care for Acute Diverticulitis: A Proposal From the AIMS Academy Clinical Research Network.
Dinuzzi VP, Del Coco F, Scaravilli L … +5 more , Zampino L, Roufael F, Crippa J, Rivolta U, Bertoglio CL
Ann Ital Chir · 2026 Mar · PMID 41834556 · Publisher ↗
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Deep Learning-Based Videomics for Automatic Segmentation in Endoscopic Endonasal Surgery.
Agosti E, Pagnoni A, Zoia C … +5 more , Rampinelli V, Fiorindi A, Panciani PP, Paderno A, Fontanella MM
Ann Ital Chir · 2026 Mar · PMID 41834555 · Publisher ↗
AIM: Videomics, the application of deep learning (DL) to endoscopic video, enables real-time tissue segmentation and anatomical recognition. Within endoscopic endonasal approaches, these methods may improve intraoperativ...
AIM: Videomics, the application of deep learning (DL) to endoscopic video, enables real-time tissue segmentation and anatomical recognition. Within endoscopic endonasal approaches, these methods may improve intraoperative visualization, tumor delineation, and surgical precision. Despite growing interest, its translation into routine clinical practice is still limited and not yet fully characterized. This systematic review aimed to synthesize current evidence on DL-based segmentation in endoscopic endonasal surgery, focusing on model architectures, segmentation targets, and reported outcomes. METHODS: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic search of PubMed, Scopus, and Web of Science was performed on 12 January 2025, and updated on 5 June 2025. Studies published between 2018 and 2025 were included, as no eligible studies were available prior to 2018. Studies were included if they involved human endoscopic endonasal procedures and applied DL techniques to endoscopic video for segmentation purposes. Data extraction included sample size, image resolution, annotated datasets, DL architectures, segmentation targets, and model performance metrics. Study quality was assessed using the Newcastle-Ottawa Scale, and descriptive statistics were used to summarize findings. RESULTS: Out of 223 screened articles, 28 studies met the inclusion criteria, encompassing 154,989 patients and 1,028,440 annotated images. The most common segmentation targets included nasal polyps (25%), nasopharyngeal carcinoma (21.4%), and pituitary adenomas (7.14%). ResNet and YOLO architectures were each used in 5 studies (17.9%), while transformer-based models such as Swin Transformer, NasVLM, and NaMA-Mamba were increasingly utilized in recent years. Performance metrics were high across studies: area under the receiver operating characteristic curve (AUC-ROC) ranged from 87.4% to 99.2%, mean intersection over union [IoU] (mIoU) from 61.2% to 81.7%, and mean average precision (mAP) [0.50] from 53.4% to 94.9%. Inference times varied from 0.14 ms to 100 ms per image. However, only 35.7% of studies reported segmentation tools, and dataset heterogeneity was common. CONCLUSIONS: DL-based videomics demonstrates high segmentation accuracy across various pathologies and anatomical targets in endoscopic endonasal surgery. Models such as Swin Transformer and YOLO show potential for real-time surgical support. However, translation into clinical practice remains limited by dataset heterogeneity and variability in reporting.
Giant Dedifferentiated Liposarcoma of the Mediastinum.
Khan JA, Aleem MU, Alhawiti T … +4 more , Nardini M, Broggi G, Magro G, Migliore M
Ann Ital Chir · 2026 Mar · PMID 41834554 · Publisher ↗
AIM: Soft tissue sarcomas are rare, accounting for only 1% of adult malignancies, with liposarcoma being a common subtype. However, mediastinal liposarcomas are extremely uncommon, comprising less than 1% of cases. Dedif...
AIM: Soft tissue sarcomas are rare, accounting for only 1% of adult malignancies, with liposarcoma being a common subtype. However, mediastinal liposarcomas are extremely uncommon, comprising less than 1% of cases. Dedifferentiated liposarcoma (DDLPS) is a particularly aggressive variant, characterized by a transition from well-differentiated to high-grade non-lipogenic sarcoma. Due to its rarity and often asymptomatic nature until significant progression, mediastinal DDLPS presents a unique diagnostic and therapeutic challenge. CASE PRESENTATION: An 83-year-old woman with ischemic heart disease presented with progressive dyspnea over two months. Imaging revealed a giant, well-circumscribed mediastinal mass (21 × 23 × 25 cm), occupying 80% of the thoracic cavity and causing significant pulmonary compression and mediastinal shift. A multidisciplinary tumor board recommended surgical resection. RESULTS: Initial uniportal video-assisted thoracic surgery exploration confirmed no pleural invasion. This was followed by a posterolateral thoracotomy for complete tumor excision. The patient recovered without complications. Histopathology confirmed DDLPS with complex histological architecture, including both well-differentiated and dedifferentiated sarcomatous components. The patient is disease-free three years postoperatively. CONCLUSIONS: Our case report emphasizes the requirement of a multidisciplinary approach to treat massive chest malignancy. Complete surgical resection remains the gold standard to obtain long-term survival.
Implications of Glomus Tumor Pathology and Pain Mechanism for Surgical Treatment.
Yu X, Ma Y, Xu Y … +1 more , Wang D
Ann Ital Chir · 2026 Mar · PMID 41834553 · Publisher ↗
Glomus tumor is a rare, benign vascular neoplasm arising from the glomus body, most frequently located in subungual and fingertip regions. Despite its small size, it often causes severe paroxysmal pain and cold sensitivi...
Glomus tumor is a rare, benign vascular neoplasm arising from the glomus body, most frequently located in subungual and fingertip regions. Despite its small size, it often causes severe paroxysmal pain and cold sensitivity, posing diagnostic and therapeutic challenges. This review summarizes current understanding of its pathological characteristics, pain mechanisms, immunohistochemical features, and surgical management. The pain arising from glomus tumors is associated with an abundance of unmyelinated nerve fibers and bioactive substances such as substance P, histamine, and cyclooxygenase-2 (COX-2), which mediate neurogenic inflammation and mechanical stimulation. Immunohistochemical analyses of the glomus tumor typically reveal positive expression of alpha-smooth muscle actin (α-SMA), muscle-specific actin (MSA), high-molecular-weight caldesmon (h-caldesmon), and vimentin, which support smooth muscle differentiation, while genetic alterations such as neurogenic locus notch homolog protein 2 () fusion and alpha-thalassemia mental retardation syndrome X-linked () deletion have been linked to tumorigenesis and malignant transformation. Microscope-assisted excision remains the gold-standard approach for treatment, achieving precise tumor removal with low recurrence and minimal postoperative nail deformity. Radiofrequency ablation emerges as a minimally invasive alternative with satisfactory long-term control for patients with high surgical risk or recurrence. In conclusion, integrating molecular insights with minimally invasive technologies holds significant promise for optimizing individualized management and advancing patient outcomes.
Technology-Assisted Direct Anterior Total Hip Arthroplasty: A Narrative Review of Clinical Evidence, Challenges, and the DAMiS Traction Bed.
Yuan X, Mao J
Ann Ital Chir · 2026 Mar · PMID 41834552 · Publisher ↗
Total hip arthroplasty (THA) is a crucial intervention for managing degenerative hip diseases, with the anterior approach offering potential advantages of reduced postoperative pain and earlier postoperative recovery. De...
Total hip arthroplasty (THA) is a crucial intervention for managing degenerative hip diseases, with the anterior approach offering potential advantages of reduced postoperative pain and earlier postoperative recovery. Despite significant advantages, the system has several limitations, such as limited surgical exposure and the risk of soft tissue damage, which ultimately affect clinical outcomes. Various technology-assisted strategies have been introduced to address these challenges in anterior THA, aiming to enhance intraoperative stability, surgical precision, and early rehabilitation, among which the Dynamic Adjustable Modular Integrated System (DAMiS) traction bed is a commonly used traction-assisted approach. Recent studies have reported that traction-assisted techniques may be associated with improvements in selected perioperative outcomes, such as complication rates, implant positioning, and early postoperative recovery, although these findings are primarily derived from retrospective studies with heterogeneous designs. Nonetheless, most available studies are limited by single-center, retrospective designs, small sample sizes, and short follow-up durations, and few provide direct comparisons with conventional techniques. This review provides a narrative overview of technology-assisted direct anterior total hip arthroplasty, outlining the clinical applications, benefits, and limitations of various assistive strategies and discussing future directions for their clinical integration. Further high-quality multicenter trials and long-term evaluations are required to validate the clinical utility of technology-assisted approaches and to guide their appropriate adoption in anterior THA.
Development and Validation of a Predictive Model for Poor Pulmonary Rehabilitation Outcomes in Patients After Radical Lung Cancer Surgery.
Zhao S, He J, Sun H … +4 more , Liu Y, Guo J, Huang H, Hu L
Ann Ital Chir · 2026 Mar · PMID 41834551 · Publisher ↗
AIM: This study aims to develop and validate a nomogram model based on surgical parameters and clinical features for predicting the risk of poor pulmonary rehabilitation outcomes in patients with non-small cell lung canc...
AIM: This study aims to develop and validate a nomogram model based on surgical parameters and clinical features for predicting the risk of poor pulmonary rehabilitation outcomes in patients with non-small cell lung cancer (NSCLC) after radical surgery. METHODS: This retrospective cohort study included 320 patients who underwent radical lung cancer surgery between June 2021 and December 2024. Patients were divided into a development cohort (n = 224) and a validation cohort (n = 96) at a 7:3 ratio. A composite surgical trauma score (STS) was developed to integrate key intraoperative variables. Independent predictors were identified through multivariate logistic regression analysis, including surgical trauma score, operative time, intraoperative blood loss, and other clinical factors. A nomogram model was constructed and validated using the bootstrap resampling (1000 repetitions). Model performance was assessed using the area under the curve (AUC) and calibration metrics. RESULTS: The incidence of poor pulmonary rehabilitation was 38.4% in the development cohort and 36.5% in the validation cohort. In the development cohort, 11.2% of patients had a forced expiratory volume in 1 second (FEV1) recovery rate <80% alone, 15.2% had a modified Medical Research Council (mMRC) score ≥2 alone, and 12.0% met both criteria. Multivariable analysis predicted five independent variables: high versus low surgical trauma score (odds ratio (OR) = 3.09, 95% confidence interval (CI): 1.71-5.58), preoperative FEV1% predicted <70% (OR = 2.67, 95% CI: 1.53-4.67), operative time ≥180 minutes (OR = 2.52, 95% CI: 1.41-4.50), intraoperative blood loss ≥80 mL (OR = 2.25, 95% CI: 1.27-3.99), and age ≥65 years (OR = 1.92, 95% CI: 1.10-3.35). The nomogram demonstrated good discrimination, with an AUC of 0.84 (95% CI: 0.78-0.90) in the development cohort and 0.79 (95% CI: 0.70-0.88) in the validation cohort. Calibration was satisfactory in both cohorts ( = 0.23 in the development cohort; = 0.31 in the validation cohort). Decision curve analysis revealed meaningful net benefits across a wide range of threshold probabilities. Predictive performance remained consistent across subgroups defined by age groups, surgical trauma strata, and tumor-node-metastasis (TNM) stages. Furthermore, sensitivity analyses using alternative endpoint definitions and various approaches for handling missing data further confirmed the robustness of the model. CONCLUSIONS: We developed and validated a predictive nomogram for poor pulmonary rehabilitation outcomes after radical lung cancer surgery. This model incorporates readily available clinical and surgical parameters, providing individualized risk assessment that may facilitate personalized rehabilitation strategies and improve postoperative management.
Five-Year Outcomes of Laparoscopic Hiatal Hernia Repair With Dor Fundoplication Versus Endoscopic Microcurrent Radiofrequency for Gastroesophageal Reflux Disease: A Retrospective Cohort Study.
Wang F, Hu Z, Zhang Y … +1 more , Liu T
Ann Ital Chir · 2026 Mar · PMID 41834550 · Publisher ↗
AIM: This study aims to compare the long-term efficacy of laparoscopic hiatal hernia repair with Dor fundoplication (LHRF) and endoscopic microcurrent radiofrequency (EMRF) in the treatment of Gastroesophageal Reflux Dis...
AIM: This study aims to compare the long-term efficacy of laparoscopic hiatal hernia repair with Dor fundoplication (LHRF) and endoscopic microcurrent radiofrequency (EMRF) in the treatment of Gastroesophageal Reflux Disease (GERD). METHODS: This study retrospectively analyzed 340 patients who underwent LHRF and EMRF treatment at our hospital between January 2016 and January 2019. Of these, 160 patients underwent LHRF (surgical group), and 180 patients underwent EMRF (endoscopic group). Baseline information, Gastroesophageal Reflux Disease Health‑Related Quality of Life (GERD‑HRQL) scores, proton pump inhibitor (PPI) use, patient satisfaction, complications, reintervention rates, and other clinical data of both groups were collected and compared. RESULTS: At 6 months after treatment, GERD-HRQL scores were markedly reduced compared with baseline in both groups. Repeated-measures analysis of variance (ANOVA) demonstrated significant effects of group, time, and group × time interaction (all < 0.001). Over the 5-year follow-up period, GERD-HRQL scores remained consistently lower in the surgical group, whereas scores in the endoscopic group showed a gradual increase from the third postoperative year onward. Regarding PPI use, the discontinuation rate was significantly higher in the surgical group than in the endoscopic group at 6 months ( = 0.028), 1 year ( = 0.027), 3 years ( = 0.021), and 5 years ( = 0.017). Patient satisfaction scores were also significantly higher in the surgical group than in the endoscopic group ( < 0.001). In addition, the surgical group experienced nine complications, predominantly transient dysphagia, while the endoscopic group reported 11 complications, including six cases of transient chest pain and five cases of nausea. The difference in overall postoperative complication rates between the two groups was not statistically significant (χ = 0.238, = 0.626). Regarding reintervention, three patients in the surgical group (4.76%) required further treatment, mainly due to wrap disruption. In the endoscopic group, five patients underwent reintervention: two cases of EMRF failures required LHRF, and three required repeat EMRF. The difference in reintervention rates between the two groups was not statistically significant (χ = 0.133, = 0.715). CONCLUSIONS: LHRF demonstrates clear clinical benefits and long-term efficacy in the treatment of GERD, providing evidence to inform the selection of surgical approaches and overall clinical treatment strategies.
Application of a Self-Made Negative Pressure Suction-Assisted Device in Micro-Channel Percutaneous Nephrolithotomy.
Liu Y, Guo B, Jiang Y
Ann Ital Chir · 2026 Mar · PMID 41834549 · Publisher ↗
AIM: This study aims to investigate the effect of a self-made negative pressure suction-assisted device on intrarenal pressure (IRP), surgical efficiency, and postoperative complications in micro-channel percutaneous nep...
AIM: This study aims to investigate the effect of a self-made negative pressure suction-assisted device on intrarenal pressure (IRP), surgical efficiency, and postoperative complications in micro-channel percutaneous nephrolithotomy (mPCNL). METHODS: This retrospective study included 97 patients with renal calculi who underwent mPCNL at Chongqing Traditional Chinese Medicine Hospital between January 2023 and August 2025. Patients were divided into two groups: an observation group ( = 50) that received negative pressure suction-assisted mPCNL and a control group ( = 47) that underwent conventional mPCNL. The baseline characteristics, intraoperative IRP-related parameters, operative time, stone-free rate (SFR), and postoperative complications were compared between the two groups. RESULTS: There were no significant differences between groups in baseline characteristics, including gender, age, body mass index (BMI), and stone parameters ( > 0.05). The mean intraoperative IRP was significantly lower in the observation group than in the control group (15.71 ± 3.62 mmHg vs. 19.19 ± 5.13 mmHg; < 0.001). The cumulative duration of high IRP (>30 mmHg) was significantly shorter in the observation group (16.68 ± 2.59 seconds vs. 24.73 ± 7.53 seconds; < 0.001). However, both the total operative time (46.11 ± 18.79 minutes) and lithotripsy/stone extraction time (29.57 ± 14.35 minutes) were significantly shorter in the observation group than in the control group (54.81 ± 20.78 minutes and 36.98 ± 16.00 minutes, respectively; < 0.05). Furthermore, both the initial postoperative SFR (88.00% vs. 87.23%; > 0.05) and the final SFR (94.00% vs. 95.74%; > 0.05) did not differ between groups. There was no significant difference in the incidence of postoperative fever and urosepsis among the groups ( > 0.05). The decrease in postoperative hemoglobin was also similar between the groups ( = 0.151). CONCLUSIONS: The self-made negative pressure suction-assisted device during mPCNL can effectively reduce intraoperative IRP, shorten operative time, and improve surgical efficiency, without increasing the risk of postoperative complications, demonstrating favorable clinical utility.
The Impact of Critical Shoulder Angle on ACJ Degeneration and Rotator Cuff Tears Severity: A Multivariable Analysis.
Arikan E, Ayanoglu T, Gokkus H … +2 more , Ozdemir C, Kalaycioglu O
Ann Ital Chir · 2026 Mar · PMID 41834548 · Publisher ↗
AIM: This study aimed to evaluate the relationship between the critical shoulder angle (CSA) and acromioclavicular joint (ACJ) degeneration, and its effect on supraspinatus, infraspinatus, and subscapularis tendon tear s...
AIM: This study aimed to evaluate the relationship between the critical shoulder angle (CSA) and acromioclavicular joint (ACJ) degeneration, and its effect on supraspinatus, infraspinatus, and subscapularis tendon tear severity. METHODS: A retrospective review of 217 patients (mean age 57.1 ± 12.9 years) between June 2019 and June 2024 was conducted. Patients were grouped based on the presence of ACJ degeneration and rotator cuff tears (RCT). Data collected included age, sex, acromion type, CSA, and ACJ degeneration. CSA was measured on anteroposterior (AP) radiographs; tendon tears were evaluated via magnetic resonance imaging (MRI). Associations among CSA, ACJ degeneration, and RCT were analyzed using receiver operating characteristic (ROC) and logistic regression. RESULTS: Patients with ACJ degeneration had significantly higher CSA (40.0 ± 4.3 vs. 36.6 ± 2.1, < 0.001). Full-thickness supraspinatus tears were more common with ACJ degeneration (34.2% vs. 1.4%), as were partial infraspinatus (54.1% vs. 2.8%) and subscapularis tears (32.9% vs. 0%) ( < 0.001 for all). CSA was highest in patients with full-thickness supraspinatus tears (42.5 ± 5.0). ROC analysis identified 38.4° as the optimal CSA cutoff. High CSA independently predicted ACJ degeneration. The critical shoulder angle predicted ACJ degeneration with good accuracy, as demonstrated by an area under the curve (AUC) of 0.776 (95% confidence interval (CI): 0.715, 0.836; < 0.001) in ROC analysis. CONCLUSIONS: CSA is significantly associated with ACJ degeneration and rotator cuff pathology, especially full-thickness supraspinatus and partial infraspinatus tears. CSA may serve as a useful parameter in the assessment and management of shoulder disorders.
Effects of PDCA Cycle-Guided Individualized Evidence-Based Nursing on Functional Recovery and Quality of Life After Intracerebral Hemorrhage Surgery.
Bai H, Zhang C
Ann Ital Chir · 2026 Mar · PMID 41834547 · Publisher ↗
AIM: Intracerebral hemorrhage (ICH) is a critical neurological condition often associated with severe disability and reduced quality of life. Effective postoperative nursing interventions are essential for promoting func...
AIM: Intracerebral hemorrhage (ICH) is a critical neurological condition often associated with severe disability and reduced quality of life. Effective postoperative nursing interventions are essential for promoting functional recovery. This study aimed to evaluate the impact of individualized evidence-based nursing guided by the Plan-Do-Check-Act (PDCA) cycle on postoperative functional recovery and quality of life in patients with ICH. METHODS: A total of 152 patients with ICH admitted to Gansu Provincial Hospital of TCM between March 2022 and March 2025 were included and divided into a control group (n = 79) and a study group (n = 73) according to different nursing strategies. The control group received routine nursing care, while the study group received individualized evidence-based nursing guided by the PDCA cycle. Psychological status (Self-Rating Anxiety Scale [SAS], Self-Rating Depression Scale [SDS]), neurological function (National Institutes of Health Stroke Scale [NIHSS]), motor function (Fugl-Meyer Assessment [FMA]), activities of daily living (Barthel Index [BI]), self-management ability, and quality of life (Generic Quality of Life Inventory-74 [GQOLI-74]) were evaluated before and after the intervention. RESULTS: There were no significant differences in baseline characteristics between the two groups ( > 0.05). Prior to intervention, no significant differences existed between the two groups in SAS, SDS, NIHSS, FMA, BI, self-management ability, or GQOLI-74 scores (all > 0.05). Post-intervention, the study group exhibited significantly lower SAS and SDS scores than the control group ( < 0.001). NIHSS scores were significantly lower than the control group, while FMA and BI scores were significantly higher than the control group (all < 0.001). Additionally, post-intervention self-management ability and GQOLI-74 scores in the study group were significantly higher than the control group (all ≤ 0.001). CONCLUSIONS: The PDCA cycle-guided individualized evidence-based nursing approach significantly promotes neurological and motor recovery, improves psychological well-being, enhances self-management abilities, and optimizes overall quality of life in patients following ICH. This structured and patient-centered nursing model demonstrates significant clinical value and warrants broader clinical implementation.
Outcomes of Laparoscopic Radical Dissection in Gastric Cancer Patients Based on the Systematic Mesogastric Excision Concept: A Retrospective Study.
Wei J, Wang YM, Xie B … +1 more , Wang YG
Ann Ital Chir · 2026 Mar · PMID 41834546 · Publisher ↗
AIM: Laparoscopic systematic mesogastric excision (LSME) is an innovative theory and may lead to better outcomes for the treatment of locally advanced gastric cancers (LAGC). The purpose of this study was to compare outc...
AIM: Laparoscopic systematic mesogastric excision (LSME) is an innovative theory and may lead to better outcomes for the treatment of locally advanced gastric cancers (LAGC). The purpose of this study was to compare outcomes after LSME to those after traditional laparoscopic D2 dissection (TLD2) in patients with LAGC. METHODS: From January 2018 to December 2020, 675 patients with LAGC underwent LSME and TLD2 at The First Affiliated Hospital of Bengbu Medical University. Of these, 202 conformed to the inclusion criteria and were included in the study after propensity score matching (PSM). The primary endpoints of this study were 5-year disease-free survival (DFS) and overall survival (OS). The secondary endpoints included surgical outcomes and postoperative complications. RESULTS: The demographic and pathological characteristics of the patients in both groups were well balanced after PSM. The 5-year DFS rates were 25.2% and 39.2% in the TLD2 group and the LSME group ( = 0.044), respectively. The difference in 5-year overall survival between the two groups was not statistically significant (39.1% in TLD2 vs. 43.2% in LSME, = 0.370). LSME was associated with less intraoperative blood loss (21.3 ± 9.1 mL in LSME vs. 33.3 ± 11.9 mL in TLD2, < 0.001), more dissected lymph nodes (LNs) (45.0 ± 16.0 LNs in LSME vs. 40.0 ± 14.0 LNs in TLD2; = 0.019), and fewer lower limb thromboses (LSME: 6.9% vs. TLD2: 17.8%; = 0.019). The other postoperative morbidities were similar. CONCLUSIONS: LSME is safe for the treatment of LAGC because it results in fewer postoperative complications. Compared with TLD2, LSME may decrease local recurrence rate and improve 5-year DFS, but there is no significant difference in 5-year OS.
Comparative Efficacy of Antegrade Versus Retrograde Island Flaps Based on the Second Dorsal Metacarpal Artery With Nerve Anastomosis for Thumb Soft Tissue Defect Repair.
Liu G, Yao Y
Ann Ital Chir · 2026 Mar · PMID 41834545 · Publisher ↗
AIM: This study seeks to compare the clinical outcomes of antegrade versus retrograde second metacarpal dorsal artery island flaps with nerve anastomosis, thereby providing evidence-based guidance for surgical decision-m...
AIM: This study seeks to compare the clinical outcomes of antegrade versus retrograde second metacarpal dorsal artery island flaps with nerve anastomosis, thereby providing evidence-based guidance for surgical decision-making. METHODS: This single-center retrospective study included 180 patients with thumb soft tissue defects treated via nerve-anastomosed second metacarpal dorsal artery island flaps between December 2021 and December 2024. Among them, 96 underwent antegrade island flap repair (antegrade group) and 84 received retrograde island flap repair (retrograde group). Key evaluated metrics included surgical parameters, sensory recovery indicators [static two-point discrimination (s2PD), British Medical Research Council (BMRC) sensory grading], motor function metrics [interphalangeal joint range of motion (ROM), grip strength, and pinch strength], and postoperative complication rates. RESULTS: The antegrade group demonstrated significantly longer operative times and higher intraoperative blood loss than the retrograde group ( < 0.001). The antegrade group exhibited superior s2PD at both 3-month and 6-month postoperative assessments ( < 0.05). 6 months postoperatively, 81.25% of antegrade group patients reached S4 grade compared to only 42.86% in the retrograde group ( < 0.001). For motor function outcomes, the retrograde group displayed significantly greater interphalangeal joint ROM at 1 month and 3 months after surgery ( < 0.05). This difference was no longer present by 6 months ( > 0.05). No significant differences were observed in grip or pinch strength between groups at either postoperative 3- or 6-month evaluations ( > 0.05). Multivariable analysis confirmed the antegrade group's advantages in sensory restoration ( < 0.05), while the retrograde group retained a substantial benefit in early ROM recovery ( < 0.001). Additionally, venous crisis was observed less frequently in the antegrade group ( < 0.05). CONCLUSIONS: For soft tissue reconstruction of the thumb, both antegrade and retrograde second dorsal metacarpal artery island flaps combined with nerve anastomosis are feasible options. The antegrade approach is beneficial for the recovery of sensory function, while the retrograde approach is beneficial for early joint mobilization and has less surgical trauma. The choice of surgical approach should be based on clinical needs.
A Prediction Model for Surgical Decision-Making in Rotator Cuff Tears Using Anatomical and Functional Factors.
Xie N, Liu C, Xu F
Ann Ital Chir · 2026 Mar · PMID 41834544 · Publisher ↗
AIM: This study aims to develop a clinical prediction model that integrates anatomical characteristics, functional status, and relevant clinical factors to guide surgical decision-making for rotator cuff tears. METHODS:...
AIM: This study aims to develop a clinical prediction model that integrates anatomical characteristics, functional status, and relevant clinical factors to guide surgical decision-making for rotator cuff tears. METHODS: This retrospective study included patients with rotator cuff tears treated at Peking University International Hospital between March 2019 and February 2022. A total of 337 patients meeting the predefined inclusion criteria were selected and divided into a surgical group (n = 100) and a non-surgical group (n = 237) based on whether they underwent surgical or non-surgical treatment. By systematically reviewing electronic medical records, we collected demographic information, clinical characteristics (affected shoulder, history of shoulder trauma, and duration of symptoms), Neer classification, Neer impingement test results, and Jobe test results. Based on magnetic resonance imaging data, professional physicians evaluated acromion morphology classification and measured the acromion-humeral distance. Quantitative evaluation of shoulder function was performed using the modified Constant-Murley Score, with individual component scores systematically recorded to enable a detailed functional assessment. Statistical analysis was completed using R software. Specifically, baseline characteristics of the two patient groups were compared and analyzed. A backward stepwise selection method was subsequently used in the multivariate logistic regression analysis to identify independent predictors related to surgical decisions and construct a prediction model that estimates the probability of surgical intervention for patients with rotator cuff tears. The model's performance was comprehensively evaluated across three dimensions: discrimination ability, calibration, and clinical utility. RESULTS: There were significant differences between the two groups in terms of age, shape of the acromion, positive rate of the Jobe sign, Neer classification, and functional score ( < 0.05). Multivariate logistic regression analysis demonstrated that age (odds ratio [OR] = 1.070), tear depth (OR = 4.414), types II and III acromion (OR = 8.138 and 11.209), and increased abduction angle (OR = 1.800) were independent predictors of surgical intervention. In contrast, external rotation (OR = 0.566), increased internal rotation angle (OR = 0.696), and Neer classification (OR = 0.297) were negative predictors (all < 0.05). The constructed nomogram prediction model based on these predictors displayed excellent discrimination (area under the curve = 0.934, sensitivity = 0.890, specificity = 0.840) and calibration (Hosmer-Lemeshow test, = 0.9977). Furthermore, the decision curve analysis confirmed its clinical utility. CONCLUSIONS: This study developed a prediction model based on a nomogram, utilizing selected anatomical, functional, and clinical factors to assess the probability of surgical treatment for patients with rotator cuff tears. Internal validation demonstrated the model's good discriminatory ability and acceptable calibration. These findings suggest the model may aid in risk stratification and treatment selection; however, external validation and prospective impact studies are required before routine clinical implementation.
Application of 3D Reconstruction-Based Stereoscopic Visualization Combined With a Flipped Classroom Teaching Model in Undergraduate Clinical Medicine Education in Thoracic Surgery.
Lan G, Ye Y, Li X … +7 more , Zhu Y, Chen H, Huang L, Gao Y, Chen P, Min Y, Zhai Z
Ann Ital Chir · 2026 Mar · PMID 41834543 · Publisher ↗
AIM: This study aimed to investigate the application effect of a stereoscopic visualization teaching method combined with a flipped classroom model in the clinical internship of thoracic surgery for undergraduate clinica...
AIM: This study aimed to investigate the application effect of a stereoscopic visualization teaching method combined with a flipped classroom model in the clinical internship of thoracic surgery for undergraduate clinical medicine students. METHODS: Based on teaching methods documented in instructional records, students were retrospectively assigned to a control group (n = 59) and an experimental group (n = 53). The control group employed the flipped classroom teaching model, while the experimental group utilized a three-dimensional visualization approach integrated with the flipped classroom model. Three-dimensional (3D) reconstructed anatomical models of the chest were exclusively used for clinical instruction within the experimental group. Theoretical examinations, case analyses, and clinical practice assessments were adopted to evaluate teaching effectiveness. Teaching satisfaction was measured through a questionnaire survey. RESULTS: The theoretical scores, case analysis scores, and clinical practice scores of the experimental group were significantly higher than those of the control group ( < 0.001). Satisfaction with teaching content in the experimental group was higher than in the control group, although the difference was not statistically significant ( = 0.347). Satisfaction with teaching methods, teaching effectiveness, learning experience, and overall evaluation in the experimental group was significantly improved compared with the control group ( < 0.001). CONCLUSIONS: Stereoscopic visualization, based on 3D reconstruction combined with a flipped classroom teaching model, has the potential to improve theoretical knowledge, case analysis skills, and clinical practical skills among undergraduate clinical medicine students during thoracic surgery internships. Compared with the flipped classroom alone, the combined teaching model results in higher teaching satisfaction.
Risk Factors for Recurrence and Complications Following Cytoreductive Surgery in Platinum-Resistant Ovarian Cancer: A Retrospective Cohort Study.
Wang L, Yao L, Wan J … +1 more , Xiao Z
Ann Ital Chir · 2026 Mar · PMID 41834542 · Publisher ↗
AIM: This study aims to identify independent risk factors for tumor recurrence and postoperative complications in platinum-resistant ovarian cancer patients undergoing cytoreductive surgery. METHODS: This study retrospec...
AIM: This study aims to identify independent risk factors for tumor recurrence and postoperative complications in platinum-resistant ovarian cancer patients undergoing cytoreductive surgery. METHODS: This study retrospectively included 96 patients with platinum-resistant ovarian cancer who underwent cytoreductive surgery between January 2020 and December 2022. Of these, 76 patients were in the recurrence group, and 20 patients were in the non-recurrence group. Among them, 84 patients developed postoperative complications and 12 did not. Recurrence was defined as disease progression evidenced by radiological findings according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, or tumor recurrence confirmed by histopathology. Complications within 30 days were graded using the Clavien-Dindo system (grade ≥II). Collected clinicopathological variables included surgical duration, peritoneal cancer index (PCI), surgical complexity score (SCS), and postoperative cancer antigen 125 (CA125), the latter measured after two cycles of adjuvant chemotherapy to assess recurrence. Variables with < 0.05 in univariate analysis were included in a multivariate logistic regression model to identify independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative power of the identified predictors. RESULTS: Recurrence was significantly associated with longer surgical duration, elevated postoperative CA125, increased PCI, fewer chemotherapy cycles, and suboptimal cytoreductive surgery (all < 0.05). Multivariate analysis identified surgical duration (odds ratio (OR) = 2.076), postoperative CA125 (OR = 1.193), and PCI (OR = 1.247) as independent risk factors for recurrence. Exploratory ROC analysis suggested moderate discriminative ability of the combined factors (area under the curve (AUC): 0.84), although no model validation was performed. Surgical duration, CA125, and PCI each demonstrated moderate predictive values, with AUCs of 0.77, 0.66, and 0.67, respectively. Complications were independently associated with elevated postoperative CA125; however, the complication model demonstrated only modest discriminative ability (AUC = 0.71). These results should be interpreted as exploratory. CONCLUSIONS: Prolonged surgical duration, elevated postoperative CA125 levels, and higher PCI scores were independently associated with recurrence in patients with platinum-resistant ovarian cancer, while elevated postoperative CA125 levels were also associated with postoperative complications. These factors demonstrated moderate discriminative ability and may serve as potential markers for postoperative risk stratification. However, these findings are exploratory in nature and require external validation.
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