Annali Italiani Di Chirurgia[JOURNAL]
Sun
200 papers
Establishment and Validation of a Risk Prediction Model for Early Postoperative Distant Metastasis in Patients With Medullary Thyroid Carcinoma.
Zhu Y, Zheng W, Nie X … +2 more , Shang J, Gu J
Ann Ital Chir · 2026 Feb · PMID 41681093 · Publisher ↗
AIM: This study aimed to investigate risk factors for early postoperative distant metastasis in patients with medullary thyroid carcinoma (MTC) and to establish a risk prediction model. METHODS: A total of 263 patients d...
AIM: This study aimed to investigate risk factors for early postoperative distant metastasis in patients with medullary thyroid carcinoma (MTC) and to establish a risk prediction model. METHODS: A total of 263 patients diagnosed with MTC after initial surgery at Zhejiang Cancer Hospital between March 2015 and August 2023 were included. The patients were divided into metastasis group ( = 75) and non-metastasis group ( = 188) based on the presence of distant tumor metastasis at 3 months postoperatively. Clinical data, including demographic information, laboratory results, and ultrasound findings, were collected for both groups. The collected data were then randomly assigned into a training set ( = 187) and a validation set ( = 76) at a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for early postoperative distant metastasis. Also, the stepwise backward method was used to determine the predictors of early postoperative distant metastasis, which were utilized for developing a nomogram. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves were adopted to evaluate the performance and predictive value of the model developed. RESULTS: Multivariate logistic regression analysis revealed that preoperative calcitonin levels and dissection approach were independent factors associated with postoperative distant metastasis. Tumor diameter and number of lesions also showed trends associated with distant metastasis and were therefore included in the predictive model. The final predictors we used to construct the model were age, preoperative carcinoembryonic antigen (CEA), preoperative calcitonin, tumor diameter, number of lesions, and lymph node dissection method. The model demonstrated superior predictive performance, with an area under the curve (AUC) of 0.823 for the training set and 0.763 for the validation set. Calibration curves confirmed good agreement between predicted and observed probabilities. Results from DCA further supported the model's ability to effectively identify individuals at high risk of postoperative distant metastasis on both training and validation sets. CONCLUSIONS: Incorporating readily available clinical variables, the risk prediction model for early postoperative distant metastasis in MTC demonstrated robust discriminatory ability and calibration. Further large-scale prospective studies with external validation are warranted to evaluate the clinical applicability and utility of this model in surgical decision-making.
Clinical Utility of Ultrasound-Guided Erector Spinae Plane Block in Percutaneous Transforaminal Endoscopic Discectomy.
Zheng X, Jiang J, Yan Y … +6 more , Chen Q, Zheng G, Wang B, Huang B, Chen W, Su Q
Ann Ital Chir · 2026 Feb · PMID 41681092 · Publisher ↗
AIM: To evaluate the feasibility and preliminary effects of ultrasound-guided erector spinae plane block (ESPB) in patients undergoing percutaneous transforaminal endoscopic discectomy (PTED). METHODS: This exploratory r...
AIM: To evaluate the feasibility and preliminary effects of ultrasound-guided erector spinae plane block (ESPB) in patients undergoing percutaneous transforaminal endoscopic discectomy (PTED). METHODS: This exploratory randomized controlled trial enrolled 60 patients with lumbar disc herniation who underwent PTED between May and December 2021 at our institution. Participants were randomly assigned to either a local anesthesia (LA) group or an ESPB group (n = 30). Heart rate (HR), mean arterial pressure (MAP), and visual analogue scale (VAS) scores were recorded at four time points: before anesthesia (T0), during foraminoplasty (T1), during annulus fibrosus manipulation (T2), and at the end of surgery (T3). Additional outcomes included operative time, intraoperative blood loss, length of hospital stay, willingness to undergo reoperation, and outcomes based on the modified Macnab criteria. The Oswestry Disability Index (ODI) and VAS scores were also assessed preoperatively and at 3 and 6 months postoperatively. RESULTS: All patients successfully completed the procedure. Compared with the LA group, the ESPB group exhibited more stable intraoperative HR and MAP, along with significantly lower VAS scores from T1 to T3 ( < 0.05), indicating potential benefits in intraoperative analgesia and hemodynamic control. No significant differences were observed in operative time, blood loss, or length of hospital stay between groups ( > 0.05). Both groups showed significant improvements in VAS and ODI scores over time ( < 0.05), although intergroup differences at follow-up were not statistically significant ( > 0.05). CONCLUSIONS: Ultrasound-guided ESPB may enhance intraoperative comfort and analgesia compared to local anesthesia in PTED. These findings suggest that ESPB is a feasible and potentially beneficial approach in this setting. However, larger-scale confirmatory studies are required to establish definitive clinical efficacy and long-term benefits. CLINICAL TRIAL REGISTRATION: ISRCTN (ISRCTN69505916).
Efficacy of Selective Arterial Perfusion Combined With Core Decompression in Managing Osteonecrosis of the Femoral Head.
Wu D, Chen Y, Zhu Y … +3 more , Sun W, Luo J, Wang D
Ann Ital Chir · 2026 Feb · PMID 41681091 · Publisher ↗
AIM: To compare the effectiveness and safety of selective arterial perfusion (SAP) combined with core decompression (CD) versus CD alone for treating osteonecrosis of the femoral head (ONFH) at association research circu...
AIM: To compare the effectiveness and safety of selective arterial perfusion (SAP) combined with core decompression (CD) versus CD alone for treating osteonecrosis of the femoral head (ONFH) at association research circulation osseous (ARCO) stages 1-2. METHODS: Overall, 102 individuals (involving 130 hips) diagnosed with nontraumatic ONFH at ARCO stages 1-2 and admitted into Beijing Jishuitan Hospital Guizhou Hospital (Guizhou Orthopedic Hospital) between January 2021 and December 2023 were enrolled in this retrospective study. They were assigned to two groups based on the treatment protocol: the experimental group (56 patients, 72 hips) treated with SAP combined with CD, and the control group (46 patients, 58 hips) receiving CD only. Both groups were supplemented with conventional treatment: oral aescuven forte (1 tablet/time, 2 times/day for 12 weeks), extracorporeal shock wave therapy (once per week for 4 weeks), nerve block (lateral femoral cutaneous nerve block for visual analogue scale (VAS) >5 points), and rehabilitation training (30 minutes/day, 5 days/week for 12 weeks). All participants were followed up for 12 months, with key outcomes such as effective rate, femoral head collapse rate, lesion size, bone marrow edema grading, VAS score, harris hip score (HHS) score, and complication rate recorded. RESULTS: No statistically significant differences in baseline data (age, gender, disease duration, ARCO staging, etiology, etc.) were identified between the two groups ( > 0.05), indicating their comparability. Twelve months after treatment, the effective rate of the experimental group (91.7%) proved higher than that of the control group (63.8%), whereas the femoral head collapse rate in the experimental group (5.6%) was lower in comparison to that of the control group (19.0%). After treatment, the experimental group also showed more significant improvements in lesion size, bone marrow edema (BME) grading improvement rate, VAS score, and HHS score. The complication rates of the two groups were similar (7.1% vs. 6.5%, > 0.05). CONCLUSIONS: At 12 months of follow-up, compared with CD alone, SAP combined with CD demonstrated better clinical performance in nontraumatic ONFH patients at ARCO stages 1-2, accompanied by a higher effective rate, lower femoral head collapse rate, more significant reductions in lesion size and improved hip joint function, while maintaining a comparable safety profile. This combined regimen provides a valuable option for hip-preservation treatment in early-stage ONFH, with potential clinical implications for optimizing minimally invasive intervention strategies.
Periprostatic Nerve Block vs. Intravenous Ibuprofen for Pain Management During Transrectal Prostate Biopsy Procedures: A Prospective Comparative Study.
Baturu M, Sen E
Ann Ital Chir · 2025 Sep · PMID 41537216 · Publisher ↗
AIM: This study aimed both to compare the efficacy of intravenous (IV) ibuprofen with periprostatic nerve block (PPNB) in pain control during prostate biopsy procedures and to investigate factors influencing pain scores....
AIM: This study aimed both to compare the efficacy of intravenous (IV) ibuprofen with periprostatic nerve block (PPNB) in pain control during prostate biopsy procedures and to investigate factors influencing pain scores. METHODS: A total of 128 patients were prospectively enrolled between June and December 2023 and randomized into two groups: IV ibuprofen was Group 1 (n = 64) and PPNB was Group 2 (n = 64). Pain levels were assessed using a Visual Analog Scale (VAS) at various stages of the procedure. Demographic and clinical data, including age, prostate specific antigen (PSA) levels, prostate volume, body mass index (BMI), histopathology results, and Prostate Imaging-Reporting and Data System (PI-RADS) scores, were recorded and correlated among themselves. RESULTS: The mean ages (64.68 ± 5.87 vs 63.33 ± 7.26 years), and median PSA level was [13.00 (8.04-41.68) ng/mL vs 10.00 (6.73-23.80) ng/mL] of Group 1 and 2 were as indicated, ( = 0.267 and = 0.053, respectively). There were no statistically significant differences between the two groups in terms of prostate volume, BMI, PI-RADS score, and benign-malignant pathology on biopsy ( > 0.05). The median VAS scores estimated during insertion of rectal probe [4 (2-5) vs 2 (0-3)], prostate biopsy needle [3 (2-4) vs 0 (0-1)], and overall median VAS scores [4 (3-4) vs 1 (0-2)] were lower in Group 2 than Group 1 ( < 0.001 for all stages). Correlation analyses revealed that PSA levels, and malignant pathology influenced the pain scores in Group 1 (r = 0.230, = 0.024; r = 0.268, = 0.032, respectively). Regression analysis demonstrated that PSA levels and malignant pathology affected the overall VAS scores in Group 1 ( = 0.024 and = 0.019, respectively). CONCLUSIONS: IV ibuprofen demonstrates promise as an easily applicable analgesic method for prostate biopsy, particularly for patients who are unwilling or unable to undergo PPNB. This study underscores the need for large-scale investigations to validate these findings. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov with identifier (NCT06737939).
Successful Management of an Immature Necrotic Tooth via Intentional Replantation Following Regenerative Endodontic Procedure Failure: A Case Report.
De Fontaine S, Abdellatif D, Iandolo A … +1 more , Mancino D
Ann Ital Chir · 2025 Oct · PMID 41537215 · Publisher ↗
AIM: To present the successful management of an immature necrotic tooth through intentional replantation (IR) following the failure of a regenerative endodontic procedure (REP), highlighting IR as a viable alternative in...
AIM: To present the successful management of an immature necrotic tooth through intentional replantation (IR) following the failure of a regenerative endodontic procedure (REP), highlighting IR as a viable alternative in complex cases. CASE PRESENTATION: A 9-year-old patient presented with necrotic tooth 45 complicated by right mandibular cellulitis. After initial infection management, REP was attempted following European Society of Endodontology (ESE) guidelines. Despite adherence to protocol, REP failed, as evidenced by persistent symptoms and a recurring fistula. IR was chosen given the unfavourable conditions for apexification and the patient's young age. During atraumatic extraction, the root fractured at a pre-existing defect, necessitating a modified reimplantation approach. The canal was treated and sealed with calcium silicate-based cement (CSBC) before reimplantation. RESULTS: At a 36-month follow-up, the tooth remained functional and symptom-free, with no signs of reinfection. CONCLUSIONS: While REPs are promising for managing necrotic immature teeth, failures necessitate alternative strategies. This case highlights IR as a viable treatment, preserving function and aesthetics when regenerative efforts are unsuccessful. Careful case selection, meticulous execution, and long-term follow-up are crucial for optimizing outcomes.
Retrosternal Goitre: What Options?
Loderer T, Bonati E, Bocchia D … +2 more , Ampollini L, Del Rio P
Ann Ital Chir · 2025 Nov · PMID 41537214 · Publisher ↗
AIM: Goitre is a multifactorial disease whose development is influenced by both genetic and environmental factors. The literature presents no univocal definition of retrosternal goitre. There are more than ten different...
AIM: Goitre is a multifactorial disease whose development is influenced by both genetic and environmental factors. The literature presents no univocal definition of retrosternal goitre. There are more than ten different definitions, making actual classification non-homogeneous. There is no clear consensus concerning the proportion of the gland that must be located in a retrosternal position, nor the depth to which it must descend into the thoracic cavity to be classified as a retrosternal goitre. The therapeutic choice depends on the size of the goitre, the symptomatology, the patient's age, and other patient characteristics. A multidisciplinary evaluation is essential to choosing the best therapeutic approach. Most retrosternal goitres can be safely resected through a cervical approach; however, up to 2% of cases may require a combined cervicothoracic approach. The purpose of this study is to analyze the different surgical approaches used in cases of cervico-mediastinal goitre with real sinking into the thorax, which required a joint surgical procedure with surgeons from the thoracic surgery unit. CASE PRESENTATION: From June 2022 to February 2024, 449 patients underwent surgery for thyroid disease at the general surgery unit of the University Hospital of Parma. Of these patients, we analysed the cases of cervico-mediastinal goitre with real sinking into the thorax, which required a joint surgical procedure with colleagues from the thoracic surgery unit due to the goitre's size and location. We identified a series of 5 cases of thoracic goitre, for an incidence rate of 1.1% of the treated patients. In all 5 cases, there was preoperative tracheal compression or dislocation. Of our cases, we found that 2 patients were treated with Kocher cervicotomy, 2 were treated with cervicotomy associated with thoracoscopy (in 1 case, a concomitant mini-thoracotomy at the IV intercostal space was performed), and 1 was treated with cervicotomy associated with manubriotomy. In 2 cases, total thyroidectomy was performed; in 2 cases, two-stage thyroidectomy was performed; and in 1 case, left lobectomy was performed. RESULTS: Although thoracic goitre is a low-incidence disease, the risks and complications are significantly higher than those of cervical thyroidectomy. Preoperative imaging enables the evaluation of morphology, extension, relationships, and vascularisation, which facilitates preoperative multidisciplinary planning of surgical procedures. Advances in surgical techniques reduce procedure invasiveness by using minimally invasive techniques, which in turn reduce the impact of surgical access, perioperative complications, hospitalisation times, and postoperative recovery. CONCLUSIONS: In our experience, a multidisciplinary approach-in particular, collaboration with thoracic surgeons-is fundamental to improving surgical outcomes.
From Scalpel to Algorithms in Lung Cancer Management: Precision Requires Wisdom-Beware Not Artificial Intelligence, but Natural Stupidity.
Bertolaccini L, Bardoni C, Guarize J … +1 more , Spaggiari L
Ann Ital Chir · 2026 Jan · PMID 41537213 · Publisher ↗
Abstract loading — click title to view on PubMed.
Transanal Opening of the Intersphincteric Space to Treat Anal Fistula: A Systematic Review and Meta-Analysis.
Cui C, Jin W, Wu J … +5 more , Han CP, Li Y, Jin L, Yang HJ, Wang ZY
Ann Ital Chir · 2026 Jan · PMID 41537212 · Publisher ↗
AIM: Transanal opening of the intersphincteric space (TROPIS) is a minimally invasive surgical treatment for anal fistula that not only eliminates the source of infection but also protects anal function to the greatest e...
AIM: Transanal opening of the intersphincteric space (TROPIS) is a minimally invasive surgical treatment for anal fistula that not only eliminates the source of infection but also protects anal function to the greatest extent. This systematic review and meta-analysis aims to evaluate the efficacy of TROPIS in the treatment of anal fistula. METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for information on TROPIS surgery for anal fistulas performed between the inception of each database and 1 November 2024. We used the single-arm studies for analysis, with a total of 918 subjects and a follow-up period ranging from 3 months to 36 months. The analysis focused on the cure rate of different types of anal fistula, postoperative bleeding, infection, and adverse reactions. RESULTS: This systematic review included six single-arm studies involving a total of 918 patients with anal fistula who underwent TROPIS surgery, with follow-up durations ranging from 3 to 36 months. Among the included studies, all were classified as high quality (score ≥7). This study demonstrated an 80% success rate for the initial operation (95% confidence interval (CI): 0.77-0.83), as well as an 80% success rate specifically for high fistulas (95% CI: 0.77-0.83). The success rate for second operations was 73% (95% CI: 0.47-0.99). For patients with high fistulas who underwent a second procedure, the success rate was 78% (95% CI: 0.40-1.00). The cure rate for anal fistulas accompanied by abscesses was 88%, while the cure rate for anal fistulas without abscesses is the same. For horseshoe fistulas, the cure rate was 87%, whereas it was 88% for non-horseshoe fistulas. The overall cure rate in this study was 88% (95% CI: 0.86-0.90). The rate of intraoperative bleeding was 3%, the postoperative infection rate was 5%, and the overall incidence of adverse reactions was 3%. CONCLUSIONS: This study demonstrates that TROPIS holds significant potential in the treatment of anal fistulas, particularly for high fistulas, fistulas with associated abscesses, and horseshoe-shaped fistulas, whilst exhibiting a relatively low incidence of incontinence.
Intraluminal Gastric Band Migration Causing Small Bowel Occlusion.
Iossa A, Martini L, De Angelis F … +3 more , Micalizzi A, Lelli G, Cavallaro G
Ann Ital Chir · 2026 Jan · PMID 41537211 · Publisher ↗
Abstract loading — click title to view on PubMed.
Lentigo Maligna: Contemporary Surgical Management and Outcome: A Review.
Cánovas Seva C, Martínez Leboráns L, Batalla A … +2 more , Sánchez-Aguilar Y Rojas MD, Flórez Á
Ann Ital Chir · 2026 Jan · PMID 41537210 · Publisher ↗
AIM: Lentigo maligna (LM) is the commonest melanoma variant and frequently arises on chronically sun-exposed facial skin, where subclinical radial spread and background actinic melanocytic atypia complicate both surgica...
AIM: Lentigo maligna (LM) is the commonest melanoma variant and frequently arises on chronically sun-exposed facial skin, where subclinical radial spread and background actinic melanocytic atypia complicate both surgical clearance and histological interpretation. The aim of this study is to appraise contemporary surgical options for LM and their oncological outcomes, focusing on conventional wide local excision (WLE), Mohs micrographic surgery (MMS), Paraffin embedded margin-controlled ("slow Mohs") techniques and staged excision (SE). METHODS: A comprehensive search of PubMed and Web of Science (January 2015-January 2025) retrieved retrospective cohorts, systematic reviews and meta-analyses that detailed technique, margin policy and outcomes for LM or lentigo maligna melanoma (LMM). Forty-six studies met prespecified criteria and were synthesised qualitatively. RESULTS: WLE remains the most widely performed procedure but showed the greatest heterogeneity in practice. Initial clinical margins of 5 mm often required histological extensions to 7-12 mm to secure clearance; under WLE, residual disease rates reached 16.7% and recurrences ranged from 5.7% to 27.3%. In contrast, MMS, especially when using immunohistochemistry, achieved recurrence rates between 0-3% with ≥5 years of follow-up. Slow Mohs and staged excision provided intermediate recurrence control (0-5.7%) while preserving tissue but were limited by procedural variability and delayed reconstruction. Although one retrospective study reported improved disease-specific survival with MMS, most studies showed no significant differences in melanoma-specific or overall survival across surgical techniques. Limited long-term follow-up and inconsistent statistical reporting (e.g., confidence intervals) were common. CONCLUSIONS: Margin-controlled approaches (MMS, slow Mohs, SE) afford superior local control to WLE and are preferable for lesions on cosmetically or functionally critical sites. Because survival appears equivalent, the choice of technique should be guided by anatomical location, lesion size, available expertise, patient characteristics and preferences as well as cost-effectiveness and available resources. Well-designed prospective trials with standardised protocols are essential to refine margin recommendations and compare long-term outcomes.
Development and Validation of a Machine Learning-Based Radiomics Model Using Ultrasound Image Features for Prostate Cancer Risk Stratification.
Zhao A, Du S, Du Y … +4 more , Zhang M, Wu J, Wang Z, Hu L
Ann Ital Chir · 2026 Jan · PMID 41537209 · Publisher ↗
AIM: This study aimed to construct a risk stratification model for prostate cancer (PCa) ultrasound imaging data and machine learning algorithms, with the goal of providing an effective tool for early diagnosis, personal...
AIM: This study aimed to construct a risk stratification model for prostate cancer (PCa) ultrasound imaging data and machine learning algorithms, with the goal of providing an effective tool for early diagnosis, personalized treatment, and clinical decision-making. METHODS: A total of 211 histopathologically confirmed PCa patients were retrospectively enrolled and categorized into low-risk ( = 65), intermediate-risk ( = 55), and high-risk ( = 91) groups based on prostate-specific antigen levels, Gleason scores, and clinical T stage. From ultrasound images, 135 quantitative radiomic features-including morphological, texture, and edge descriptors-were extracted using the PyRadiomics toolkit. Feature dimensionality was reduced using the Pearson correlation coefficient (PCC), followed by recursive feature elimination (RFE) with 10-fold nested cross-validation to select the most informative features. Three machine learning algorithms-support vector machine (SVM), random forest (RF), and logistic regression (LR)-were trained and evaluated. Model performance was assessed using accuracy, sensitivity, specificity, and area under the curve (AUC). RESULTS: The RF model achieved the best performance in both training and test cohorts, with AUCs of 0.87 and 0.86, and accuracies of 90% and 88%, respectively. DeLong's test confirmed that RF significantly outperformed SVM ( = 0.016) and LR ( = 0.004) in AUC comparison. The RF model also demonstrated robust predictive ability across risk subgroups: in the high-risk group, it achieved an AUC of 0.89, accuracy of 89%, sensitivity of 88%, and specificity of 90%; in the intermediate- and low-risk groups, AUCs were 0.86 and 0.81, respectively. Feature importance analysis revealed that wavelet-transformed Gray Level Dependence Matrix (GLDM) texture features, particularly DependenceEntropy and DependenceVariance, were the most predictive, highlighting the value of intratumoral textural heterogeneity in risk classification. CONCLUSIONS: The RF-based ultrasound radiomics model enables accurate stratification of PCa risk, with remarkable performance in identifying high-risk patients.
Surgically Oriented Ultrasound-Based AI of Median Nerve Morphology as a Decision Support for Carpal Tunnel Release: A Calibrated ConvNeXt-CBAM Framework With Supervised Contrastive Warm-Up.
Yang K, He X, Ye P … +5 more , Qian Y, Teng X, Li X, Wang X, Chen H
Ann Ital Chir · 2026 Jan · PMID 41537208 · Publisher ↗
AIM: Carpal tunnel syndrome (CTS) is a compressive neuropathy commonly encountered in hand surgery, and decisions regarding whether operative decompression should be conducted rely on accuracy and clinical interpretabili...
AIM: Carpal tunnel syndrome (CTS) is a compressive neuropathy commonly encountered in hand surgery, and decisions regarding whether operative decompression should be conducted rely on accuracy and clinical interpretability of imaging findings. Ultrasound is commonly used to directly visualize the median nerve in this condition, but remains operator-dependent and is limited by inconsistent diagnostic thresholds. This study aimed to develop a surgically oriented ultrasound-based artificial intelligence (AI) model that provides strong discriminative power, reliable probability calibration for preoperative counseling, and anatomy-aware explainability aligned with the nerve targeted in carpal tunnel release. METHODS: In this retrospective study, adults with suspected CTS, who had ultrasound image of adequate quality and met criteria for the clinical standard, were included; cases with prior carpal tunnel surgery or non-diagnostic images were excluded. We analyzed 2900 wrist ultrasound examinations, reserving an a priori 20% test set (n = 580 images) at the patient level. DenseNet-121 was utilized as the reference baseline. The proposed model used ConvNeXt-T augmented with Convolutional Block Attention Modules (CBAM), optimized with a supervised contrastive warm-up before standard fine-tuning; probabilities were post-hoc calibrated by temperature scaling. Images underwent de-identification, normalization, and ultrasound-appropriate augmentation. Primary outcome was discrimination (receiver operating characteristic (ROC), area under the curve (AUC), average precision (AP)) with bootstrap bands; secondary outcomes included accuracy, precision, recall, F1 score (harmonic mean of precision and recall), confusion matrices, probability distributions, class-conditional score separation, and Grad-CAM++ agreement with expert-defined regions of interest. Test set labels used a fixed 0.5 threshold. RESULTS: The proposed model outperformed the baseline in terms of discrimination (AUC 0.904 vs 0.821; AP 0.907 vs 0.831). Aggregate metrics also favored the proposed approach (accuracy 0.91 vs 0.83; precision 0.89 vs 0.81; recall 0.88 vs 0.82; F1 score 0.88 vs 0.81). Confusion matrices showed concurrent reductions in false positives (58→33, -43%) and false negatives (52→35, -33%): baseline true-negatives (TN)/false-positives (FP)/false-negatives (FN)/true-positives (TP) = 232/58/52/238; proposed TN/FP/FN/TP = 257/33/35/255. Predicted-probability histograms and class-conditional densities indicated more confident, better-separated outputs with calibration. Grad-CAM++ overlays were more compact and nerve-concordant relative to expert contours, supporting anatomy-aligned interpretability for surgical planning. CONCLUSIONS: A calibrated, explainable ConvNeXt-CBAM ultrasound classifier delivers reliable probabilities and anatomically faithful saliency that are directly actionable for surgical triage, timing of decompression, and preoperative counseling in CTS. These findings support ultrasound-based AI as a practical adjunct to clinical assessment and nerve conduction studies in hand surgery, warranting prospective, multicenter validation and workflow integration.
Comparison of the Efficacy and Safety of Ultrasound-Guided Percutaneous Balloon Dilatational Tracheotomy and Surgical Tracheotomy in Patients With Acute Respiratory Failure.
Han X, Wei J, Zhang J … +1 more , Huang S
Ann Ital Chir · 2026 Jan · PMID 41537207 · Publisher ↗
AIM: This study aimed to compare the efficacy and safety of ultrasound-guided percutaneous balloon dilatational tracheotomy (US-PDT) versus surgical tracheotomy (ST) in patients with acute respiratory failure (ARF). METH...
AIM: This study aimed to compare the efficacy and safety of ultrasound-guided percutaneous balloon dilatational tracheotomy (US-PDT) versus surgical tracheotomy (ST) in patients with acute respiratory failure (ARF). METHODS: In this retrospective cohort study, 278 patients with ARF were enrolled from January 2022 to January 2025. These patients were divided into the US-PDT group ( = 135) and the ST group ( = 143) based on the surgical method used. Perioperative indicators, procedural success rates, inflammatory markers, hospitalization outcomes, and complications were systematically compared between the two groups. RESULTS: The US-PDT group demonstrated superior outcomes across all measures. It was associated with a significantly shorter procedure time, smaller incision length, reduced intraoperative blood loss, and shorter duration of mechanical ventilation (all < 0.001). The US-PDT group also showed a higher single-attempt procedural success rate, alongside a lower accidental extubation rate (all < 0.001). Postoperative inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and procalcitonin [PCT]) were significantly lower in the US-PDT group ( < 0.001). Furthermore, the US-PDT group experienced reduced ventilator-associated pneumonia (VAP) incidence, higher weaning success, shorter intensive care unit (ICU) and hospital stays, and lower ICU and overall mortality (all < 0.05). Complication rates were also significantly lower in the US-PDT group ( < 0.05). CONCLUSIONS: US-PDT is a more efficient, safer, and less invasive alternative to ST for ARF patients, resulting in better clinical outcomes, reduced inflammation, fewer complications, and improved survival rates.
Differentiating Complicated Acute Appendicitis From Non-complicated Acute Appendicitis Based on Ultrasound Characteristics.
Xu Z, Yang J, Niu Y
Ann Ital Chir · 2026 Jan · PMID 41537206 · Publisher ↗
AIM: This study aimed to identify key ultrasound (US) characteristics that differentiate complicated acute appendicitis (CAA) from non-complicated acute appendicitis (NCAA) and to develop and validate a US-based predicti...
AIM: This study aimed to identify key ultrasound (US) characteristics that differentiate complicated acute appendicitis (CAA) from non-complicated acute appendicitis (NCAA) and to develop and validate a US-based predictive model for preoperative diagnosis. METHODS: A retrospective analysis was conducted on 178 patients with surgically confirmed acute appendicitis between June 2022 and May 2025. All patients underwent a standardized preoperative US examination. Clinical and sonographic variables were compared between the CAA (n = 63) and NCAA (n = 115) groups. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for variable selection, followed by multivariable logistic regression to construct a predictive model. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). RESULTS: Compared to the NCAA group, the CAA group had significantly older age, longer symptom duration, higher white blood cell (WBC), and higher neutrophil percentage (NE%) ( < 0.05). Significant US-based predictors included greater appendiceal outer diameter (AOD), increased periappendiceal inflammatory fat thickness (PIFT), and higher incidences of periappendiceal fluid collection (PAFC), marginal indistinctness (MI), and altered bowel peristalsis (ABP). The final model identified eight independent predictors: age, symptom duration, WBC, NE%, PIFT, PAFC, MI, and ABP. The nomogram showed excellent discrimination (AUC = 0.890), good calibration (Hosmer-Lemeshow test, = 0.108), and sustained performance during internal validation (AUC = 0.902). DCA confirmed high clinical utility. CONCLUSIONS: The proposed US-based nomogram provides an accurate, non-invasive tool for preoperative differentiation of CAA from NCAA, potentially aiding in risk stratification and treatment decision-making.
The Predictive Performance of Tumor Morphological Features on MRI Combined With Serum CA19-9 for the Efficacy of TACE Treatment in Patients With Primary Liver Cancer.
Shen M, Zhang W, Shen H … +1 more , Wang B
Ann Ital Chir · 2026 Jan · PMID 41537205 · Publisher ↗
AIM: To explore the predictive performance of magnetic resonance imaging (MRI) combined with serum carbohydrate antigen 19-9 (CA19-9) for the efficacy of transarterial chemoembolization (TACE) treatment in patients with...
AIM: To explore the predictive performance of magnetic resonance imaging (MRI) combined with serum carbohydrate antigen 19-9 (CA19-9) for the efficacy of transarterial chemoembolization (TACE) treatment in patients with primary liver cancer. METHODS: In this retrospective study, a total of 174 patients with primary liver cancer who underwent TACE treatment at Hangzhou Xixi Hospital between January 2022 and January 2025 were selected as the study subjects. The patients were divided into an effective group and an ineffective group according to the treatment efficacy at 3 months postoperatively, and the clinical data of the two groups were compared. Multifactorial logistic regression analysis was conducted to identify factors affecting patient efficacy, and a predictive model was constructed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of MRI combined with serum CA19-9 and the model. RESULTS: Among the 174 patients, 50 cases achieved complete remission (CR) (28.74%), 29 cases attained partial remission (PR) (16.67%), 58 cases had stable disease (SD) (33.33%), and 37 cases experienced disease progression (PD) (21.26%). The results of multifactorial logistic regression analysis showed that low tumor differentiation, continuous multi-nodular tumor margins, incomplete tumor capsule, higher ALT levels, and high CA19-9 were risk factors for compromised efficacy of TACE treatment in patients with primary liver cancer ( < 0.05), while tumor tissue necrosis was a protective factor ( = 0.001). The area under the curves (AUCs) of MRI, CA19-9, MRI combined with CA19-9, and the model were 0.883, 0.772, 0.904, and 0.958, respectively; the sensitivities were 79.84%, 70.18%, 86.95%, and 89.96%, respectively; and the specificities were 82.69%, 67.88%, 84.02%, and 91.05%, respectively. CONCLUSIONS: MRI demonstrates promising utility in predicting the efficacy of TACE treatment in patients with primary liver cancer, with its predictive performance enhanced by the combination with serum CA19-9.
Efficacy of Modified Antegrade Digital Artery-Nerve V-Y Island Flap and Bilateral Neurovascular Bundle-Bearing V-Y Island Flap in Repairing Distal Fingertip Defects: A Comparative Analysis.
Liu G, Yao Y
Ann Ital Chir · 2026 Jan · PMID 41537204 · Publisher ↗
AIM: Fingertip defects are common injuries in hand surgery, and their functional reconstruction remains a clinical challenge. This study aims to compare the clinical efficacy of the modified antegrade digital artery-nerv...
AIM: Fingertip defects are common injuries in hand surgery, and their functional reconstruction remains a clinical challenge. This study aims to compare the clinical efficacy of the modified antegrade digital artery-nerve V-Y island flap with that of the bilateral neurovascular bundle-bearing V-Y island flap in repairing distal fingertip defects. METHODS: This single-center retrospective study included 120 patients with distal fingertip defects treated between October 2021 and October 2024. Among them, 50 underwent repair using the modified antegrade digital artery-nerve V-Y island flap (group A), while 70 received the bilateral neurovascular bundle-bearing V-Y island flap (group B). Perioperative metrics (operative time, intraoperative blood loss, hospital stay duration), sensory function (static two-point discrimination [s2-PD], excellent/good rate based on S3+ grading), joint mobility (metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints), Michigan Hand Outcomes Questionnaire (MHQ) scores, peripheral circulation parameters (transcutaneous partial pressure of oxygen [TcPO], blood perfusion units [BPU]), and complication rates at 6 months postoperatively were compared between the two groups. RESULTS: Baseline characteristics showed no statistically significant differences between the two groups ( > 0.05). Group A had longer operative times than group B but demonstrated significantly lower intraoperative blood loss and shorter hospital stay ( < 0.05). At 6 months postoperatively, group A demonstrated superior s2-PD and a higher excellent/good rate based on S3+ grading ( < 0.05); however, there was no significant difference in joint mobility between groups ( > 0.05). Compared to group B, group A achieved significantly higher total MHQ scores and subscale scores for hand function, daily activities, work performance, aesthetic appearance, and patient satisfaction, as well as lower pain scores, at 6 months postoperatively ( < 0.001). Additionally, TcPO and BPU values were higher in group A ( < 0.001). No significant between-group difference in overall complication rates was observed ( > 0.05). CONCLUSIONS: Compared to the bilateral neurovascular bundle-bearing V-Y island flap repair surgery, the modified antegrade digital artery-nerve V-Y island flap repair surgery reduces intraoperative blood loss and shortens hospitalization time. This technique offers advantages in sensory recovery, overall hand function, patient satisfaction, and restoration of peripheral circulation without increasing the risk of complications. These results suggest its potential as a more effective reconstructive option for fingertip defects.
Construction of an ICU Pre-experience Pattern for Patients Undergoing Lung Cancer Surgery and Their Family Members: A Delphi Study.
Chen D, Liang H, Lan X … +3 more , Wang C, Liu Y, Tian Y
Ann Ital Chir · 2026 Jan · PMID 41537203 · Publisher ↗
AIM: This study aims to construct an intensive care unit (ICU) pre-experience pattern for patients undergoing lung cancer surgery and their family members, to provide a novel mechanism of communication between healthcare...
AIM: This study aims to construct an intensive care unit (ICU) pre-experience pattern for patients undergoing lung cancer surgery and their family members, to provide a novel mechanism of communication between healthcare professionals and patients that may improve treatment adherence and satisfaction with hospitalisation. METHODS: Initially, an item pool was created for pre-experienced ICUs through a comprehensive literature review, prior qualitative research, and expert panel discussions, resulting in 146 items. Inputs from experts were sought through Delphi surveys to construct an ICU pre-experience pattern for patients undergoing lung cancer surgery and their family members. The Delphi study included 22 multidisciplinary experts from intensive care, nursing management, clinical medicine, and social psychology. Subsequent rounds of consultation were guided by consistency in the findings of the consultation. Two rounds of consultations were performed using 5-point Likert scales to assess importance and feasibility. Consensus criteria included a mean score of ≥3.5 and a coefficient of variation (CV) of ≤0.25. RESULTS: A total of 146 items, including 5 primary, 29 secondary, and 112 tertiary items, were incorporated in the final pattern. These included items structured around 5 critical time phases: '24 hours preceding ICU admission', 'Postoperative ICU admission before anaesthesia emergence', 'Postoperative ICU admission after anaesthesia emergence', 'First postoperative day/transfer day', and 'Following ICU discharge'. Key dimensions include the objectives of ICU admission, description of ICU personnel and environment, psychological preparation, clinical procedures, and post-ICU care. Two rounds of expert consultations yielded a 100% recovery rate (RR). An acceptable level of consensus was achieved, with mean importance and feasibility scores ranging from 4.41 to 5.00 in Round 2, and a CV below 0.25 for all items. The high authority coefficients (Cr) (0.84 and 0.83) confirm a trend toward higher expert consensus on the clinical relevance and practical applicability of the developed pattern. CONCLUSIONS: This study developed an ICU pre-experience pattern for patients undergoing lung cancer surgery and their family members. This pattern provides a theoretical framework and a potential approach that may help alleviate anxiety and enhance treatment adherence.
Impact of Comprehensive Postoperative Incisional Analgesia and Scar-Prevention Interventions on Rehabilitation Outcomes in Patients Undergoing Scar Revision Surgery.
Guo M, Liao J
Ann Ital Chir · 2026 Jan · PMID 41537202 · Publisher ↗
AIM: Patients undergoing scar revision surgery have high expectations for both aesthetic restoration and functional recovery, with postoperative pain management and scar prevention being key factors that influence the qu...
AIM: Patients undergoing scar revision surgery have high expectations for both aesthetic restoration and functional recovery, with postoperative pain management and scar prevention being key factors that influence the quality of rehabilitation. This study, through a retrospective analysis, examined the impact of comprehensive postoperative incisional analgesia and scar-prevention intervention on rehabilitation outcomes in patients undergoing scar revision surgery, aiming to provide evidence for optimizing clinical postoperative management strategies. METHODS: A retrospective analysis was conducted using the clinical data of 170 patients who underwent scar revision surgery in our hospital between March 2022 and August 2024. Based on the intervention approach, patients were assigned to a comprehensive intervention group (n = 90) and a control group (n = 80). Both groups received standardized optimal wound care, including layered suturing of incisions and routine dressing changes every 3 days, until suture removal. The comprehensive intervention group received multimodal analgesia combined with a comprehensive scar-management protocol, while the control group received routine analgesia combined with a basic scar-management plan. Visual Analog Scale (VAS) scores, Vancouver Scar Scale (VSS) scores, and complication rates were compared between the two groups. RESULTS: Preoperative baseline characteristics showed no significant differences between the two groups ( > 0.05). Postoperative VAS scores in the comprehensive intervention group were significantly lower than those in the control group ( < 0.001). Furthermore, the total VSS score in the comprehensive intervention group was significantly superior to that in the control group ( < 0.001). Regarding complications, the overall complication rate in the comprehensive intervention group (25.56%) was significantly lower than in the control group (51.25%) ( < 0.01). Subgroup analyses based on scar type (hypertrophic vs. keloid) demonstrated consistent benefits of the intervention, with no significant interaction observed ( > 0.05). CONCLUSIONS: Comprehensive postoperative analgesia and scar-prevention intervention can effectively alleviate postoperative pain, improve scar appearance, and enhance rehabilitation among patients undergoing scar revision surgery, indicating that such an approach is suitable for clinical application.
Clinical Efficacy of OLIF, TLIF, and UBE-TLIF in the Treatment of Lumbar Disc Herniation-A Comprehensive Evaluation Based on Imaging and Inflammatory Indicators.
Zhou Y, Zhu Y, Lv H … +6 more , Wang Y, Shi L, Wang X, Chu Q, Wang Y, Wang H
Ann Ital Chir · 2026 Jan · PMID 41537201 · Publisher ↗
AIM: Oblique Lateral Interbody Fusion (OLIF), Transforaminal Lumbar Interbody Fusion (TLIF), and Unilateral Biportal Endoscopy (UBE)-TLIF are widely used surgical approaches in the clinical treatment of Lumbar Disc Herni...
AIM: Oblique Lateral Interbody Fusion (OLIF), Transforaminal Lumbar Interbody Fusion (TLIF), and Unilateral Biportal Endoscopy (UBE)-TLIF are widely used surgical approaches in the clinical treatment of Lumbar Disc Herniation (LDH). However, comparative studies on their efficacy remain insufficient. Therefore, this study aims to compare the clinical effectiveness of the three surgical approaches for treating LDH across multiple dimensions, providing evidence-based surgical decision-making tailored to individual patient requirements. METHODS: This retrospective study included 210 patients with LDH who underwent surgical treatment in our hospital between May 2021 and May 2024. They were divided into the OLIF group (n = 68), TLIF group (n = 72), and UBE group (n = 70) according to the surgical method, and all patients completed a follow-up of at least 3 months. Baseline characteristics of all three groups were collected, and perioperative indicators were compared and analyzed. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were used to assess pain intensity and functional recovery in patients. Serum levels of C-reactive protein (CRP), D-dimer, and hemoglobin were used to assess inflammatory response and blood loss-related indicators. Differences in imaging indicators were also compared among the three groups. The types and incidence of postoperative complications were also assessed among these groups. RESULTS: No statistically significant differences were observed in the baseline data among the three groups ( 0.05). The OLIF group had a significantly shorter operation time than the TLIF and UBE groups ( < 0.001) and a shorter hospital stay than the TLIF group ( 0.05). The UBE group had significantly less intraoperative blood loss than the OLIF and TLIF groups ( 0.05). At 3 months postoperatively, VAS and ODI scores were substantially lower for all three groups than the baseline values ( 0.001), with no statistically significant differences among the three groups ( 0.05). At postoperative day 3, serum CRP and D-dimer levels in all three groups were higher than the preoperative levels, whereas hemoglobin levels were lower ( 0.001). However, the UBE group had lower CRP and D-dimer levels than the TLIF group ( 0.05), and a smaller decrease in hemoglobin level than the TLIF group ( 0.05). Imaging evaluation showed that the intervertebral space height was significantly restored in all three groups at 3 months postoperatively compared with preoperative values ( 0.001), and there was no significant difference in the rate of good spinal canal decompression ( 0.05). There was no significant difference in the total incidence among the three groups ( 0.05). CONCLUSIONS: OLIF, TLIF, and UBE-TLIF are all effective in alleviating pain and improving lumbar function and have comparable safety profiles. OLIF is associated with shorter operative time and hospital stays, and UBE offers less surgical trauma as well as a milder early postoperative inflammatory response.
Factors Associated With Intraoperative Acquired Pressure Injury in Total Knee Arthroplasty Patients: Development of Predictive Models.
Zhou J, Yang X, Xie X … +3 more , Zhou H, Chen X, Liu J
Ann Ital Chir · 2026 Jan · PMID 41537200 · Publisher ↗
AIM: To construct and validate a risk prediction model for intraoperatively acquired pressure injury (IAPI) in total knee arthroplasty (TKA), thereby improving the accuracy of early diagnosis and intervention. METHODS: T...
AIM: To construct and validate a risk prediction model for intraoperatively acquired pressure injury (IAPI) in total knee arthroplasty (TKA), thereby improving the accuracy of early diagnosis and intervention. METHODS: This retrospective study included 546 patients who underwent elective total knee arthroplasty at Chengdu 363 Hospital Affiliated to Southwest Medical University and Chengfei Hospital. According to predefined inclusion and exclusion criteria, 278 cases from Chengdu 363 Hospital Affiliated to Southwest Medical University between January 2022 and December 2023 were used as the training set, while 118 cases from 2024 served as the internal validation set; 150 cases from Chengfei Hospital in 2024 were used as the external validation set. Feature variables were screened using multivariable logistic regression and Lasso regression analyses. Sensitivity, specificity, accuracy, F1-score (F1), and area under the curve (AUC) were used to evaluate discriminative performance. External validation was performed using AUC to evaluate generalizability. The optimal model was further interpreted by the Shapley additive explanation (SHAP) method to identify key risk factors. RESULTS: Among the four machine learning algorithms tested, the gradient boosting decision tree (GBDT) model demonstrated the best discriminative performance (AUC 0.867, sensitivity 0.725, specificity 0.836, accuracy 0.788, and F1 value 0.747). The five most influential variables associated with IAPI risk were body mass index (BMI), Braden score, age, American Society of Anesthesiologists (ASA) classification, and surgical duration. CONCLUSIONS: The GBDT-based prediction model, combined with the SHAP interpretation, effectively identifies risk factors for intraoperative IAPI in TKA. This model provides strong support for early clinical intervention and contributes to improving the outcomes of IAPI care.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe