Annali Italiani Di Chirurgia[JOURNAL]
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200 papers
Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty: A Systematic Review.
Evola FR, Vacante M, Cucuzza C … +1 more , Evola G
Ann Ital Chir · 2025 Sep · PMID 41243540 · Publisher ↗
AIM: The demand for total knee arthroplasty (TKA) is projected to double over the next decade; consequently, the incidence of periprosthetic fractures associated with TKA is also rising. One of the most frequently used c...
AIM: The demand for total knee arthroplasty (TKA) is projected to double over the next decade; consequently, the incidence of periprosthetic fractures associated with TKA is also rising. One of the most frequently used constructs is a single lateral locking plate, chosen for its ease of application and familiarity. However, single lateral plating has been associated with a high incidence of nonunion, complications, and revision. Augmenting the lateral plate construct with a medial plate decreases the likelihood of failure, offering stronger fixation for low periprosthetic fractures. The aim of this study was to review the existing literature on dual plating for distal femoral fractures in patients undergoing TKA. METHODS: A systematic review of scientific articles listed in medical databases (PubMed, Scopus) from September 2014 to December 2024 was carried out, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data collected included author name, study design, patient demographic characteristics, clinical results, radiological outcomes, postoperative complications or adverse events, length of follow-up, cause and rate of failure, and time to full weight-bearing. RESULTS: Of the 895 articles identified, 690 did not meet the eligibility criteria and were excluded. Thirty-eight articles underwent full-text review, and six studies were included in the final analysis. Five were retrospective studies and one was a case series. The total number of patients was 137 (16 male, 121 female), with study sizes ranging from 15 to 38 patients. The double plate technique was most frequently applied in Su type 3 fractures. Dual plating resulted in positive clinical outcomes and a satisfactory union rate in comminuted distal femoral fractures: bone callus formation was observed in 135 of 137 patients (98.5%). Immediate postoperative weight-bearing was permitted in three of the six studies, while in two others it was delayed until 10-12 or 23 weeks. Osteosynthesis failure occurred in only two cases (2%). Secondary intervention was required in nine cases (6.5%), and complications were reported in 24 patients (17.6%), primarily due to infection or intolerance of plate screws. CONCLUSIONS: Dual plating is a reliable approach for managing periprosthetic fractures associated with TKA, even in low fractures and when medial or metaphyseal comminution is present, offering high rates of anatomic reduction and low rates of reoperation and complications.
Can Hemogram Parameters Be Used as a Biomarker for Thyroid Carcinomas?
Durmus A, Kesici U, Genc MS … +5 more , Mazlum AF, Ercan LD, Duman MG, Karyagar S, Kesici S
Ann Ital Chir · 2025 Sep · PMID 41243539 · Publisher ↗
AIM: Recently, there have been studies on various parameters that can be used to diagnose and follow up thyroid malignancies. These parameters are mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/l...
AIM: Recently, there have been studies on various parameters that can be used to diagnose and follow up thyroid malignancies. These parameters are mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR), and different results have been reported regarding their diagnostic and prognostic effects. Therefore, there is a need for more comprehensive studies on the use of these parameters in diagnosis and follow-up. In this study, we planned to reveal whether MPV, NLR, PLR, and LMR can be used as biomarkers for thyroid carcinomas and whether they differ according to tumor type and size. METHODS: A total of 242 patients aged 18-79 years who underwent thyroidectomy between October 2016 and December 2021 were included in this study. The following variables were analyzed retrospectively: age, sex, pathology results of thyroidectomy materials, and parameters such as MPV, NLR, PLR and LMR of the preoperative complete blood count. The patients included in the study were divided into two groups according to malignant and benign thyroidectomy pathologies. Group 1 (n = 160): Benign pathology. Group 2 (n = 82): Malignant pathology. RESULTS: NLR and PLR were found to be significantly higher in the patients in Group 2 compared to the patients in Group 1 (p = 0.042 and p = 0.003). For the NLR value, sensitivity was calculated as 67.07%, Specificity as 48.75, and cut-off value as >1.503. Area Under Curve (AUC) value for NLR: 0.580. For the PLR value, sensitivity was calculated as 48.78%, Specificity as 70.62, and cut-off value as >111.429. AUC value for PLR: 0.615. A high level, positive and statistically significant correlation was detected between NLR and PLR in patients with tumor size ≥10 mm within Group 2 (r = 0.548, p < 0.001). CONCLUSIONS: We believe that NLR and PLR values may be important predictive biomarkers for thyroid malignancies. As consistent with the literature, NLR and PLR values were statistically significant in our study. An NLR value of >1.503 and a PLR value of >111.429 can be considered a risk factor for thyroid malignancy.
Endoconversion During b-EVAR for Pararenal Abdominal Aortic Aneurysm.
Zacà S, Casciaro M, Chiarelli A … +3 more , Guerrieri E, Di Stefano L, Angiletta D
Ann Ital Chir · 2025 Oct · PMID 41243538 · Publisher ↗
Adverse events associated with stent-grafts during complex aortic procedures are rare but can be difficult to manage. These occurrences can be reduced by precise planning and anticipating complications by considering the...
Adverse events associated with stent-grafts during complex aortic procedures are rare but can be difficult to manage. These occurrences can be reduced by precise planning and anticipating complications by considering the patient's anatomy and the characteristics of the graft. This paper describes an endovascular conversion following branched endovascular aneurysm repair (b-EVAR) for a pararenal abdominal aortic aneurysm (pAAA) caused by the distal displacement of the stent-graft during delivery system retrieval. A replanned endovascular strategy (endoconversion) was performed by the deployment of another b-EVAR as a bailout technique. Technical success was obtained and the post-operative course and follow-up was uneventful. High technical skills with the ability to predict and manage complications can play a crucial role in the management of intraoperative adverse events.
Current Evidence on Surgical Approach to Local Recurrence After Nipple-Sparing Mastectomy: Is It Time to Classify in Order to Decide Better?
Sanchez AM, De Lauretis F, Savia E … +12 more , Scardina L, D'Archi S, Bucaro A, Pirrottina CV, Borghesan N, Castagnetta V, Di Guglielmo E, Di Pumpo A, Petrazzuolo E, Mattia A, D'Angiò G, Franceschini G
Ann Ital Chir · 2025 Oct · PMID 41243537 · Publisher ↗
AIM: Nipple-sparing mastectomy has become an increasingly preferred surgical option for selected breast cancer patients, enabling immediate breast reconstruction with either prosthetic implants or autologous tissues whil...
AIM: Nipple-sparing mastectomy has become an increasingly preferred surgical option for selected breast cancer patients, enabling immediate breast reconstruction with either prosthetic implants or autologous tissues while ensuring oncologic safety alongside favorable aesthetic and psychosocial outcomes. Despite its benefits, managing local recurrence remains a clinical concern. Current guidelines recommend complete excision when feasible, following the principles of conservative surgery. However, a standardized classification of local recurrence after conservative mastectomy is still lacking. This review aims to gather current evidence on the incidence, characteristics, and treatment of local recurrence following nipple-sparing mastectomy with immediate breast reconstruction. Additionally, it seeks to propose the development of a standardized classification system to support treatment decision-making and future research. METHODS: A targeted literature search was conducted in PubMed/MEDLINE, Scopus, and EMBASE to identify relevant articles published in English between 1 January 2013 and 31 December 2024. The search string used for PubMed was: ("nipple-sparing mastectomy" OR "skin-sparing mastectomy") AND ("local recurrence" OR "nipple recurrence" OR "chest wall recurrence") AND ("immediate reconstruction" OR "implant-based reconstruction"). For Scopus, the adapted string was: (TITLE-ABS-KEY ("nipple-sparing mastectomy" OR "skin-sparing mastectomy") AND TITLE-ABS-KEY ("local recurrence" OR "nipple recurrence" OR "chest wall recurrence") AND TITLE-ABS-KEY ("immediate reconstruction" OR "implant-based reconstruction")). For EMBASE, the adapted strategy was: ('nipple-sparing mastectomy'/exp OR 'skin-sparing mastectomy'/exp) AND ('local recurrence'/exp OR 'nipple recurrence' OR 'chest wall recurrence') AND ('immediate reconstruction' OR 'implant-based reconstruction'). We included only English-language publications and excluded conference abstracts, letters, and case reports. Given the narrative nature of this review, the process did not follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, and no formal records of deduplication or structured screening flow diagrams were maintained. RESULTS: The reviewed literature reveals significant variability in defining and classifying local recurrence after nipple-sparing mastectomy with immediate reconstruction. This lack of consensus highlights the need for a clear and standardized classification system centered specifically on local recurrences, which could enhance risk stratification and guide personalized treatment strategies, thereby supporting the design of prospective studies and evidence-based guidelines. CONCLUSIONS: The absence of a standardized approach to local recurrence after nipple-sparing mastectomy represents a critical gap in current breast cancer care. Establishing a dedicated classification could streamline clinical decision-making and lay the groundwork for large-scale prospective studies to inform future guidelines.
Efficiency of Radiant Power of Different Light-Curing Unit Brands With Varying Ages and Tip Conditions in Private and Governmental Dental Centers.
Alwadai GS, Alaajam WH, Alqahtani SA … +7 more , Abogazalah NN, Alamoudi NA, Alshehri FH, Alamri MA, Algadhi AA, Moaleem MMA, Mehta V
Ann Ital Chir · 2025 Oct · PMID 41243536 · Publisher ↗
AIM: Insufficient awareness among clinicians regarding the performance of light-curing devices may lead to inadequate polymerization, which can ultimately compromise the long-term success of dental restorations. This stu...
AIM: Insufficient awareness among clinicians regarding the performance of light-curing devices may lead to inadequate polymerization, which can ultimately compromise the long-term success of dental restorations. This study aimed to examine the radiant power of different light-curing unit (LCU) brands by using three types of radiometers in terms of clinic and LCU types, age, tip diameter, and LCU tip condition in the Aseer region. METHODS: LCUs were assembled from selected dental centers. LCU brands and data, including clinical dental age (<1, 1-3, and ˃3 years), nozzle state (intact, damaged, and presence of debris), and tip diameters (6-7, 8-9, and 10 mm), were recorded. The radiant power was categorized into ≤1000, 1000-1200, and >1200 mW/cm, which were labeled as adequate, sufficient, and adequate and sufficient, respectively, and recorded with three brands of digital radiometers (Woodpecker, Ivoclar, and Rogin). Analysis of Variance (ANOVA) and t-test were performed to determine the difference between and within groups, with a significance value of <0.05. RESULTS: Among 132 LCUs surveyed and assessed, a significant difference in the radiant power of LCUs was observed between governmental and private dental clinics, particularly with the Ivoclar radiometer (p < 0.05). No significant differences in radiant power values were detected between the radiometers and the assessed LCUs' nozzle. Older LCUs demonstrated higher radiant power in the ≤1000 mW/cm category when measured with the Ivoclar radiometer. Differences in radiant power were noted on the basis of tip diameter and the presence of remaining bond and composite materials (p < 0.05). CONCLUSIONS: The assessed LCU brands recorded marginally sufficient radiant power values in governmental and private dental clinics. The Rogin radiometer consistently demonstrated increased radiant power values across LCU brands and intact tip conditions. Differences in radiant power were noted in terms of tip diameter and the remaining bond and composite materials.
Effects of Neoadjuvant Chemotherapy on Early Postoperative Anxiety and Depression in Patients With Gastric Cancer: An Observational Study.
Cao D, Yu R, Liu H … +8 more , Li F, Xie W, Tuo C, He J, Hu C, Luo B, Liu Y, Gong W
Ann Ital Chir · 2025 Nov · PMID 41243535 · Publisher ↗
AIM: Neoadjuvant chemotherapy (NACT) improves surgical outcomes in gastric cancer, yet its effect on early postoperative mental health remains unclear. This study aims to investigate the association between NACT and post...
AIM: Neoadjuvant chemotherapy (NACT) improves surgical outcomes in gastric cancer, yet its effect on early postoperative mental health remains unclear. This study aims to investigate the association between NACT and postoperative anxiety and depression. METHODS: A single-center, retrospective cohort study included 201 gastric cancer patients who underwent surgical resection from October 2023 to May 2024, categorized by NACT receipt. Psychological evaluation in the early postoperative phase was conducted using the Hospital Anxiety and Depression Scale (HADS), and associations with NACT were assessed through logistic regression. RESULTS: Of the 201 patients, 57 (28.4%) received NACT. Postoperative assessments showed significantly higher rates of anxiety (78.95% vs. 61.11%, p = 0.016) and depression (56.14% vs. 38.89%, p = 0.026) in NACT recipients compared to non-NACT patients. After adjusting for confounders, NACT remained independently associated with an increased prevalence of anxiety (Odds Ratio [OR] = 2.25) and depression (OR = 2.00, both p < 0.05). Patients undergoing more than three NACT cycles exhibited increased anxiety (91.67% vs. 69.70%, p = 0.045) and depression (75.00% vs. 42.42%, p = 0.014), with higher mean HADS scores (both p < 0.05). These associations persisted in adjusted analyses for depression (OR, 4.07; 95% Confidence Interval [CI], 1.28-12.90; p = 0.017) and were marginal for anxiety (OR, 4.78; 95% CI, 0.94-24.33; p = 0.059). Patients with poor response (tumor regression grade [TRG] 2-3) also showed a trend toward increased anxiety risk (OR, 3.30; 95% CI, 0.83-13.12; p = 0.089). CONCLUSIONS: NACT is independently associated with increased anxiety and depression in the early postoperative period, especially if chemotherapy cycles are prolonged.
The Overlooked Outcome: Decision Regret in the Surgical Management of Differentiated Thyroid Cancer.
Melcarne R, Giacomelli L, Grani G … +4 more , Consorti F, Livi S, Durante C, Biffoni M
Ann Ital Chir · 2025 Nov · PMID 41243534 · Publisher ↗
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Long-Term Efficacy of Conservative Management Versus Minimally Invasive Surgery for Pneumothorax: A Systematic Review and Meta-Analysis.
Zhang B, Wu W, Xiao D
Ann Ital Chir · 2025 Nov · PMID 41243533 · Publisher ↗
AIM: Pneumothorax is a prevalent thoracic disorder, with management strategies primarily consisting of conservative treatment and minimally invasive surgery. However, their long-term efficacy remains controversial. This...
AIM: Pneumothorax is a prevalent thoracic disorder, with management strategies primarily consisting of conservative treatment and minimally invasive surgery. However, their long-term efficacy remains controversial. This study conducted a systematic review and meta-analysis to compare clinical outcomes between these two approaches. METHODS: A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and non-randomized controlled trials published between 1 January 2000 and 31 January 2025. Studies comparing total complications, recurrence rate during hospitalization, and overall recurrence rate between treatment groups were included. Fixed- or random-effects models were applied for meta-analysis. Begg's test was applied to assess publication bias, and sensitivity analysis was performed to evaluate model robustness. RESULTS: A total of nine studies were included in the meta-analysis. Compared to conservative treatment, video-assisted thoracoscopic surgery (VATS) significantly reduced the recurrence rate during hospitalization [odds ratio (OR) = 0.23, 95% CI (0.12-0.43), p < 0.00001] and the overall recurrence rate [OR = 0.16, 95% CI (0.08-0.31), p < 0.00001]. However, no statistically significant difference was found between the groups in terms of complication rate (p = 0.79). Additionally, Begg's test confirmed no significant publication bias (p > 0.05). Subgroup analysis indicated that pneumothorax type may contribute to the observed heterogeneity. CONCLUSIONS: VATS reduces both the short-term recurrence rate during hospitalization and the overall recurrence rate in patients with pneumothorax, offering a clinical advantage in preventing early relapse. Individualized treatment strategies tailored to patient characteristics and pneumothorax type remain essential. Additional high-quality studies are needed to clarify its long-term efficacy.
Reconstruction Scheme of Cancellous Bone Screw Post Combined With Large- and Small-Thick Steel Wire Mesh in Hemihip Replacement Surgery for Unstable Intertrochanteric Fractures in the Elderly.
Gao L, Gao W, Liu J … +2 more , Zhang X, Liu L
Ann Ital Chir · 2025 Nov · PMID 41243532 · Publisher ↗
AIM: Evaluation of the clinical efficacy of pedicle screw fixation combined with hemiarthroplasty versus simple hemiarthroplasty in elderly patients with unstable intertrochanteric fractures of the femur. METHODS: This r...
AIM: Evaluation of the clinical efficacy of pedicle screw fixation combined with hemiarthroplasty versus simple hemiarthroplasty in elderly patients with unstable intertrochanteric fractures of the femur. METHODS: This retrospective analysis included 81 elderly patients with unstable intertrochanteric femoral fractures who underwent hemihip replacement surgery at the Yulin Hospital, the First Affiliated Hospital of Xi'an Jiaotong University, between May 2018 and May 2023. The patients' clinical data were collected and statistically analyzed. Study participants were divided into two groups: the experimental group (n = 40; those treated with the pile-building net fixation method combined with hemiarthroplasty) and the control group (n = 41; patients who received only hemiarthroplasty). The perioperative indicators, postoperative joint function scores, activities of daily living scores, and basic conditions of complications associated with surgical intervention were compared between the two groups. RESULTS: Comparison of perioperative indicators between the experimental and control groups revealed that the experimental group experienced significantly longer operation time and greater intraoperative blood loss than the control group (p < 0.05). Similarly, the average fracture healing time was significantly shorter in the experimental group than in the control group (p < 0.05). Six months postoperatively, the degree of hip joint pain, limping, walking distance, total Harris hip score, and Barthel index score were all found to be significantly higher in the experimental group compared to the control group (p < 0.05). In the experimental group, one case developed a urinary tract infection and two cases had a pulmonary infection after the operation. In the control group, one case showed deep vein thrombosis, two patients had delayed fracture healing, three patients had pulmonary infection, and one case had prosthesis loosening. Moreover, there was no statistically significant difference in the complication rate between the two groups (p > 0.05). CONCLUSIONS: Although the pile-building net fixation method in hemiarthroplasty for unstable intertrochanteric fractures in elderly patients can prolong the operation time and increase blood loss, it facilitates fracture healing and improves postoperative joint function recovery, indicating potential clinical benefit.
Comparative Assessment of Individualized Segmentectomy Versus Standard Lobectomy in Patients With Early-Stage Non-Small Cell Lung Cancer.
Wei R, Deng G, Wang Z … +4 more , Liu Y, Gu C, Yu J, Yang J
Ann Ital Chir · 2025 Nov · PMID 41243531 · Publisher ↗
AIM: The optimal surgical strategy for clinical stage IA non-small cell lung cancer (NSCLC) remains under active investigation. This study aimed to compare the perioperative outcomes, functional preservation, and short-t...
AIM: The optimal surgical strategy for clinical stage IA non-small cell lung cancer (NSCLC) remains under active investigation. This study aimed to compare the perioperative outcomes, functional preservation, and short-term oncologic results between individualized segmentectomy and standard lobectomy. METHODS: This retrospective cohort study included 205 patients with histologically confirmed clinical stage IA (T1a-cN0M0) NSCLC who underwent surgery at Changzhou Cancer Hospital between January 2017 and June 2023. According to the type of surgical procedure, patients were classified into the individualized segmentectomy group or the standard lobectomy group. Perioperative variables, postoperative complications (graded by Clavien-Dindo classification), pulmonary function recovery (forced expiratory volume in one second (FEV1), diffusing capacity of the lung for carbon monoxide (DLCO)), pain scores (visual analog scale (VAS)), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30)), and 2-year recurrence rates were analyzed between these two groups. RESULTS: A total of 205 NSCLC patients were analyzed in this study (segmentectomy: n = 101; lobectomy: n = 104). Compared with the lobectomy group, the segmentectomy group showed significantly reduced intraoperative blood loss, lower drainage volume, earlier chest tube removal, and a shorter length of hospital stay (p < 0.05). Compared with the lobectomy group, the segmentectomy group had significantly lower early postoperative pain scores and significantly higher quality of life scores (p < 0.05). Pulmonary function was better preserved in the segmentectomy group at both 1 and 3 months postoperatively (p < 0.05). However, no significant difference was observed in the 2-year tumor recurrence rate between the two study groups (p > 0.05). CONCLUSIONS: Individualized segmentectomy offers perioperative and functional advantages over standard lobectomy in patients with early-stage NSCLC, without compromising short-term oncologic safety. These findings support its application as a lung parenchyma-sparing surgical option in appropriately selected patients.
Impact of a Responsibility System Management Model on Deep Vein Thrombosis and Functional Recovery Following Internal Fixation for Pelvic Fractures.
Ding M, Huang L
Ann Ital Chir · 2025 Nov · PMID 41243530 · Publisher ↗
AIM: This study evaluates the impact of a responsibility system management model in patients undergoing internal fixation for pelvic fractures, by examining the incidence of deep vein thrombosis (DVT) and postoperative p...
AIM: This study evaluates the impact of a responsibility system management model in patients undergoing internal fixation for pelvic fractures, by examining the incidence of deep vein thrombosis (DVT) and postoperative pelvic functional recovery. METHODS: This retrospective observational study included 145 patients who underwent internal fixation for pelvic fractures at Ganzhou People's Hospital between January 2022 and October 2024. Based on the nursing model, patients were categorized into a responsibility care group (n = 70), which received responsibility system management nursing care and a conventional care group (n = 75), which was managed through conventional postoperative care. The incidence of postoperative lower extremity DVT was compared between the two groups. Furthermore, pelvic function was assessed using the Majeed Pelvic Score and pain levels were evaluated using the Visual Analogue Scale (VAS). Additional parameters assessed were postoperative recovery, compliance with mechanical prophylaxis, and nursing satisfaction. RESULTS: The responsibility system management care group demonstrated a significantly lower incidence of postoperative lower extremity DVT compared to the conventional care group (p < 0.05). Furthermore, the responsibility care group had significantly higher postoperative Majeed functional scores, lower VAS pain scores (p < 0.05), better overall recovery, longer duration of mechanical prophylaxis use, and higher nursing satisfaction (p < 0.05). CONCLUSIONS: The responsibility system management nursing model was significantly associated with a lower risk of early DVT and better short-term pelvic functional recovery during hospitalization. This model represents a promising postoperative management strategy; however, its long-term efficacy and generalizability require further validation through multicenter prospective studies with extended follow-up.
Radiographic Evaluation of Femoral Offset Reconstruction in Hip Arthroplasty: A Retrospective Analysis.
Zheng W, Wu C, Xu H
Ann Ital Chir · 2025 Nov · PMID 41243529 · Publisher ↗
AIM: To investigate the impact of femoral offset (FO) reconstruction on postoperative hip function recovery and complication rates following total hip arthroplasty (THA) via the posterolateral approach. METHODS: A retros...
AIM: To investigate the impact of femoral offset (FO) reconstruction on postoperative hip function recovery and complication rates following total hip arthroplasty (THA) via the posterolateral approach. METHODS: A retrospective analysis was performed on 146 patients who underwent primary unilateral THA between January 2019 and April 2024. Patients were divided into two groups based on whether the postoperative FO difference (≤4 mm vs. >4 mm): the reconstruction group (n = 92) and the control group (n = 54). Baseline characteristics, radiographic parameters, postoperative functional outcomes (Harris Hip Score (HHS), visual analogue scale (VAS) for pain, and gait parameters), complications, and prosthesis failure cases were compared between the groups, accompanied by a representative case analysis. RESULTS: No significant differences were observed in baseline data between the two groups (p > 0.05). Compared with the control group, the postoperative FO in the reconstruction group was significantly closer to that of the contralateral healthy side (p < 0.05). There were no significant differences in acetabular prosthesis parameters between the two groups (p > 0.05). However, the femoral stem neck-shaft angle in the control group was significantly smaller than in the reconstruction group (p < 0.05). At all postoperative time points, the reconstruction group demonstrated superior outcomes in HHS, VAS, and gait parameters than the control group (p < 0.05). The incidence of complications was significantly lower in the reconstruction group than that in the control group (p < 0.05), whereas no significant difference was found in prosthesis revision rates (p > 0.05). Representative cases indicated that patients who failed to achieve FO reconstruction criteria were more susceptible to postoperative dislocation. CONCLUSIONS: Precise femoral offset reconstruction contributes to improved postoperative hip function and a reduced risk of complications in THA.
Clinical Outcomes and Functional Evaluation of Autologous Tendon Grafting for Acromioclavicular Joint Reconstruction.
Zhao D, Yang Y, Xie R … +9 more , Hu S, Lv Y, Ma T, Zhao H, Zhang H, Jin Z, Yan Y, Sun H, Yan F
Ann Ital Chir · 2025 Nov · PMID 41243528 · Publisher ↗
AIM: To evaluate the clinical efficacy and functional outcomes of autologous tendon grafting in reconstructing Rockwood type III-V acromioclavicular (AC) joint dislocations, and to compare its performance with convention...
AIM: To evaluate the clinical efficacy and functional outcomes of autologous tendon grafting in reconstructing Rockwood type III-V acromioclavicular (AC) joint dislocations, and to compare its performance with conventional titanium fixation. METHODS: A total of 276 patients who underwent AC joint reconstruction between January 2019 and March 2024 were retrospectively analyzed. Following propensity score matching (PSM), 87 patients were included in the autologous tendon and titanium fixation groups. Primary outcome measures comprised radiographic parameters (acromioclavicular distance [ACD], coracoclavicular distance [CCD], magnetic resonance imaging [MRI] signal intensity), functional scores (Constant-Murley, University of California at Los Angeles [UCLA] shoulder score, visual analog scale [VAS]), biomechanical indices (horizontal motion displacement [HMD], range of motion [ROM] loss ratio, CCD maintenance rate), and complication rates. Prognostic factors were identified using Cox proportional hazards and logistic regression models. An extreme gradient boosting (XGBoost)-based machine learning model was constructed to predict postoperative functional recovery. RESULTS: After matching, no significant differences in baseline characteristics were observed between groups (n = 87 each). Compared with the titanium group, autologous tendon grafting achieved significantly superior joint stability (ACD, CCD, HMD, ROM loss) and radiological outcomes (tendon signal intensity, bone remodeling score) (all p < 0.01). It was also associated with a lower incidence of redislocation and implant-related failures (p < 0.05). Cox regression identified four independent prognostic factors, including surgical technique, Rockwood classification, preoperative CCD, and ROM limitation. A multivariable risk scoring system demonstrated high predictive accuracy for recurrence at 12 months (area under the curve [AUC] = 0.91). Logistic regression revealed that titanium fixation, Rockwood type V, older age, and impaired bone healing capacity were significant risk factors for complications. The XGBoost model highlighted surgical technique and tissue quality as key predictors of functional recovery, though its external generalizability warrants further validation. CONCLUSIONS: Compared to conventional titanium-based fixation, autologous tendon graft reconstruction yields superior joint stability, improved radiographic outcomes, and better functional scores within 12 months postoperatively, suggesting more favorable early clinical efficacy and biomechanical restoration.
The Clinical Efficacy and Prognostic Impact of Intramedullary Nail Combined With Either Plates or Titanium Cable Internal Fixation in the Treatment of Femoral Subtrochanteric Fractures.
Zhou L, Zhang XQ, Wang GX
Ann Ital Chir · 2025 Nov · PMID 41243527 · Publisher ↗
AIM: This study aims to compare the clinical efficacy of intramedullary nail combined with plate and intramedullary nail combined with titanium cable approaches in the treatment of femoral subtrochanteric fractures. METH...
AIM: This study aims to compare the clinical efficacy of intramedullary nail combined with plate and intramedullary nail combined with titanium cable approaches in the treatment of femoral subtrochanteric fractures. METHODS: This retrospective analysis included 85 patients who underwent treatment with intramedullary nails combined with plates and titanium cables at Shengzhou People's Hospital between January 2018 and December 2024. Among them, 40 cases received intramedullary nails combined with plates (the plate group) and 45 cases received intramedullary nails combined with titanium cables (the titanium cable group). Clinical data were collected and compared between the two groups of patients, which included surgery duration, length of hospital stay, incision length, blood loss, fluoroscopy time, fracture healing time, follow-up duration, time to first full weight bearing after surgery, quality of fracture reduction, changes in the neck-shaft angle, complications, and Harris Hip Score. RESULTS: In the titanium cable group, both the incision length and intraoperative blood loss were superior to those in the plate group (p < 0.05). Conversely, the fluoroscopy time and fracture-healing time in the plate group were better than those in the titanium cable group (p < 0.05). Furthermore, both surgical time and length of hospital stay were significantly shorter in the titanium cable group than in the plate group; however, this difference did not achieve statistical significance (p > 0.05). Moreover, there were no significant differences in follow-up duration or time to first full weight-bearing between the two groups (p > 0.05). In the plate group, 2 cases were presented with postoperative complications (5.00%), including 1 case of cerebral infarction and 1 case of deep vein thrombosis. In the titanium cable group, 6 cases had postoperative complications (13.33%), which included 3 cases of delayed varus, 1 case of delayed healing, 1 case of acute coronary syndrome (ACS) combined with delayed varus, and 1 case of nonunion. However, the difference in the overall incidence of postoperative complications between the two groups was not statistically significant (χ = 0.886, p = 0.347). Additionally, no statistically significant differences were observed in the quality of fracture reduction and changes in the neck-shaft angle between the two groups (p > 0.05). Similarly, the Harris Hip Score at the last follow-up between the two groups did not differ significantly (χ = 2.011, p = 0.156). CONCLUSIONS: Internal fixation with intramedullary nails combined with titanium cables for unstable femoral subtrochanteric fractures offers advantages of a smaller incision length and less intraoperative blood loss. In contrast, internal fixation with intramedullary nails combined with locking plates requires less fluoroscopy time, faster fracture healing, and fewer complications. Both approaches have specific strengths and limitations, providing promising guidance for surgical decision-making and achieving favorable outcomes.
Impact of Neoadjuvant Chemotherapy Combined With Modified Radical Mastectomy on Immune Function, Oxidative Stress, and Prognosis in Patients With Different Molecular Subtypes of Breast Cancer.
Cao D, Sun Y, Pan H
Ann Ital Chir · 2025 Nov · PMID 41243526 · Publisher ↗
AIM: The objective of this study is to explore the impact of neoadjuvant chemotherapy (NACT) combined with modified radical mastectomy on immune function, oxidative stress and prognosis in patients with different molecul...
AIM: The objective of this study is to explore the impact of neoadjuvant chemotherapy (NACT) combined with modified radical mastectomy on immune function, oxidative stress and prognosis in patients with different molecular subtypes of breast cancer (BC). METHODS: A total of 150 patients diagnosed with BC who received NACT and modified radical mastectomy from January 2020 to January 2024 were collected for retrospective analysis. All patients were divided into four groups according to the molecular subtype: luminal A group (n = 39), luminal B group (n = 44), human epidermal growth factor receptor 2 (HER-2) overexpression group (n = 34), and triple-negative group (n = 33). Data on pathological complete remission (pCR), recurrence, recurrence-free survival (RFS) and overall survival (OS) were collected. The serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNF-α) were detected using assay kits. RESULTS: The pCR rate of the entire sample cohort was 20.67% after NACT, with a recurrence rate during follow-up recorded at 22.67%. The pCR rate was significantly higher in the HER-2 overexpression group (13/34, 38.24%) than in the triple-negative (11/33, 33.33%), luminal A (1/39, 2.56%), and luminal B groups (6/44, 13.64%) (p < 0.001). Compared to the triple-negative (10/33, 30.30%), luminal A (5/39, 12.82%), and luminal B groups (6/44, 13.64%), the HER-2 overexpression group (13/34, 38.24%) had a significantly higher recurrence rate (p = 0.019). Both HER-2 overexpression and triple-negative groups also featured greater changes in IL-6, TNF-α, and SOD levels than the luminal A and luminal B groups (p < 0.05). Changes in MDA levels were the greatest in the HER-2 overexpression group among the tested group (p < 0.05). HER-2 overexpression was identified as the independent risk factor affecting RFS (hazard ratio [HR] = 3.883; 95% confidence interval [CI] = 1.371-11.004; p = 0.011). Clinical stage III (HR = 2.031; 95% CI = 1.023-4.030; p = 0.043), pCR (HR = 0.111; 95% CI = 0.015-0.809; p = 0.030) and recurrence (HR = 4.512; 95% CI = 2.412-8.441; p < 0.001) were the independent factors affecting OS in BC patients. The Kaplan-Meier curve analysis demonstrated significant differences in RFS among the four patient groups (p = 0.005), with no marked differences in OS (p = 0.303). The RFS of the HER-2 overexpression group was shorter than that of the other groups. CONCLUSIONS: In BC patients undergoing NACT combined with modified radical mastectomy, the HER-2 overexpression subtype was associated with a shorter RFS. However, no significant differences in OS were observed among the four molecular subtypes during the follow-up period. Inflammatory and oxidative stress markers showed improvements three months postoperatively across all subtypes, with more pronounced changes observed in the HER-2 overexpression and triple-negative subtypes.
Association Between Preoperative Systemic Inflammation Response Index and Postoperative Recurrence in Patients With Intrahepatic Bile Duct Stones.
Pan M, Ye X, Zhou L … +1 more , Liu L
Ann Ital Chir · 2025 Nov · PMID 41243525 · Publisher ↗
AIM: Intrahepatic bile duct stones (IHBDS) are characterized by a high postoperative recurrence rate. Their pathophysiological core lies in a vicious cycle of bile stasis, infection, and inflammation. Inflammatory respon...
AIM: Intrahepatic bile duct stones (IHBDS) are characterized by a high postoperative recurrence rate. Their pathophysiological core lies in a vicious cycle of bile stasis, infection, and inflammation. Inflammatory responses play a crucial role in the onset, progression, and recurrence of IHBDS. This study aimed to evaluate the predictive performance of the preoperative systemic inflammation response index (SIRI) for postoperative recurrence in patients with IHBDS. METHODS: This retrospective study analyzed 152 patients with IHBDS who underwent surgical resection between January 2018 and December 2024. Data, including demographic characteristics, comorbidities, and preoperative laboratory parameters, were collected. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values for the systemic immune-inflammation index (SII), SIRI, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR). Furthermore, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative recurrence. RESULTS: ROC analysis demonstrated that SIRI had superior predictive performance compared with SII, NLR, MLR, and PLR, with an area under the curve (AUC) of 0.756 (95% confidence interval [CI]: 0.671-0.842). Multivariate analysis identified prior IHBDS-related surgical history (odds ratio [OR] = 3.06, 95% CI: 1.28-7.34, p = 0.012), preoperative SIRI (OR = 1.81, 95% CI: 1.21-2.72, p = 0.004), and total bilirubin level (OR = 1.07, 95% CI: 1.02-1.13, p = 0.011) as independent risk factors for postoperative recurrence. CONCLUSIONS: Preoperative SIRI is a novel, independent, and readily detectable biomarker for predicting postoperative recurrence in patients with IHBDS. When combined with a history of prior biliary surgery and total bilirubin levels, SIRI can aid in risk stratification and guide surgical planning and postoperative management.
Ultrasound-Guided vs. Conventional Dorsoulnar Fragment Reduction Combined With Volar Locking Plate Fixation for Distal Radius Fractures: A Comparative Clinical Study.
Shi Z, Lu D, Zhao M … +3 more , Fan Y, Liu S, Su J
Ann Ital Chir · 2025 Nov · PMID 41243524 · Publisher ↗
AIM: Distal radius fractures (DRFs) are among the most common traumatic injuries. Reduction of dorsoulnar fragments combined with volar locking plate fixation yields satisfactory outcomes. However, conventional fluorosco...
AIM: Distal radius fractures (DRFs) are among the most common traumatic injuries. Reduction of dorsoulnar fragments combined with volar locking plate fixation yields satisfactory outcomes. However, conventional fluoroscopy-guided techniques present inherent limitations in accuracy. This study aimed to evaluate the feasibility and efficacy of ultrasound-guided reduction of dorsoulnar fragment (DUF) combined with volar locking plate fixation for DRFs. METHODS: This retrospective study included 116 patients with DRFs who underwent reduction of dorsoulnar fragments combined with volar locking plate fixation at our hospital between January 2022 and January 2024. Patients were allocated into two groups based on the intraoperative guidance technique: the observation group (n = 54, ultrasound-guided) and the control group (n = 62, X-ray-guided). Surgical indicators, healing progress, and outcome measures were assessed, including wrist function (Gartland-Werley score), range of motion (dorsiflexion, volar flexion, supination, pronation), radiological parameters (volar tilt, radial inclination, radial height), Visual Analog Scale (VAS) score, Modified Mayo Wrist Score (MMWS), grip strength, and complications. RESULTS: Baseline characteristics and all preoperative outcome metrics (Gartland-Werley score, range of motion, radiological parameters, VAS score, MMWS, grip strength) showed no significant differences between the two groups (p > 0.05). The observation group demonstrated significantly shorter operation time, less intraoperative blood loss, and reduced hospital stay compared to the control group (p < 0.05). No significant difference in fracture healing time was observed (p > 0.05). Postoperatively, both groups exhibited significant reductions in Gartland-Werley scores (p < 0.001), with lower scores in the observation group (p < 0.001). Dorsiflexion, volar flexion, pronation, and supination angles significantly improved in both groups (p < 0.001); the observation group demonstrated larger dorsiflexion, pronation and supination angles (p < 0.001), but no intergroup difference was observed in volar flexion (p > 0.05). The radiological outcomes improved significantly in both groups postoperatively (p < 0.001). The observation group achieved superior volar tilt and radial height (p < 0.001), while radial inclination showed no significant difference (p > 0.05). The complication rate was significantly lower in the observation group than in the control group (p < 0.05). CONCLUSIONS: Ultrasound-guided reduction of dorsoulnar fragments combined with volar locking plate fixation significantly enhanced postoperative wrist function, anatomical alignment, and reduced complication rates compared to conventional X-ray guidance. These findings suggest that intraoperative ultrasound is a valuable adjunct for dorsoulnar fragment (DUF) reduction in DRF fixation, contributing to greater precision and improved clinical outcomes.
Correction: The Relationship of Microsatellite Instability With BRAF and p53 Mutations and Histopathological Parameters in Colorectal Adenocarcinoma.
Gündoğar Ö, Bektaş S, Yıldırım E … +1 more , Gönüllü D
Ann Ital Chir · 2025 Oct · PMID 41099124 · Publisher ↗
Abstract loading — click title to view on PubMed.
New Application of Remimazolam Tosilate in ICU Ventilation: Benefits in Reducing Iatrogenic Stress and Maintaining Stable Immune Function.
Li C, Zhang B, Shen M
Ann Ital Chir · 2025 Jun · PMID 41099123 · Publisher ↗
AIM: To evaluate the sedative effect of remimazolam tosilate and its impact on iatrogenic stress and immune function biomarkers, in order to explore its feasibility and potential advantages as a novel sedative for mechan...
AIM: To evaluate the sedative effect of remimazolam tosilate and its impact on iatrogenic stress and immune function biomarkers, in order to explore its feasibility and potential advantages as a novel sedative for mechanically ventilated Intensive Care Unit (ICU) patients. METHODS: In a retrospective analysis, 136 ICU patients who were admitted to the Second Affiliated Hospital of Jiaxing University between March and December 2022 and received mechanical ventilation were enrolled and divided into two groups based on the sedation protocol during intubation: conventional propofol group (Control group, n = 79) and remimazolam tosilate group (Remi group, n = 57). The sedation success rate and adverse reaction rate were recorded. The iatrogenic stress markers including epinephrine (E), norepinephrine (NE), and cortisol (Cor) and the T lymphocyte subpopulation including CD3T%, CD4T%, CD8T% were determined using enzyme-linked immunosorbent assay and flow cytometry assay before anesthesia induction (T0), at one week (T4), and at one month after anesthesia (T5). RESULTS: The sedation success rate was significantly higher in the Remi group (80% [50%, 88%]) compared to the Control group (72% [43%, 85%]) (p < 0.05). The Remi group exhibited significantly lower Cor levels at T4 and lower E, NE, and Cor levels at T5 compared to the Control group (p < 0.05). The Remi group exhibited significantly higher CD4T% levels at T4 and lower CD8T% levels at T5 time points compared to the Control group (p < 0.05). No significant difference was found in the overall incidence of adverse events between the two groups (p > 0.05). CONCLUSIONS: Compared with propofol, remimazolam tosilate may offer potential benefits in mitigating iatrogenic stress and preserving immune homeostasis, while ensuring adequate sedation during ICU mechanical ventilation. It could be a promising sedative agent for use in the ICU setting.
The Role of Immature Granulocytes in Predicting Complicated Appendicitis: A Retrospective Observational Study.
Üstüner MA, Ay OF, Özen AV … +1 more , Aydın MC
Ann Ital Chir · 2025 Aug · PMID 41099122 · Publisher ↗
AIM: Differentiating complicated appendicitis (CA) from uncomplicated appendicitis (UA) is a critical aspect of preoperative evaluation that influences surgical planning and patient outcomes. This study explored the role...
AIM: Differentiating complicated appendicitis (CA) from uncomplicated appendicitis (UA) is a critical aspect of preoperative evaluation that influences surgical planning and patient outcomes. This study explored the role of the immature granulocyte count (IG#) and percentage (IG%) as accessible and reliable biomarkers to enhance the diagnostic precision of CA. METHODS: This retrospective observational study analyzed 482 emergency appendectomies performed at a single tertiary hospital between January 2020 and June 2023. After excluding 23 cases due to haematological disorders, malignancies, additional procedures, or incomplete data, 459 patients were included in the final analysis. Patients were categorized into the UA and CA groups based on histopathological examination. CA was defined as a perforation or gangrene. Laboratory parameters, including IG#, IG%, and inflammatory markers, were compared between groups. RESULTS: Among the 459 patients, 386 (84.1%) had UA and 73 (15.9%) had CA. The median age of CA patients was significantly higher than that of UA patients (36 vs. 33 years, p = 0.016). CA patients also demonstrated significantly elevated levels of C-reactive protein (CRP), direct bilirubin, white blood cell count (WBC), IG#, IG%, and neutrophil-to-lymphocyte ratio (NLR) compared to UA patients (p < 0.001). Receiver operating characteristic (ROC) analysis identified an IG# cut-off of 0.06 (area under the ROC curve [AUROC] = 0.699, sensitivity = 68.5%, specificity = 65.2%) and an IG% cut-off of 0.35 (AUROC = 0.663, sensitivity = 75.3%, specificity = 49.6%). In the multivariable logistic regression analysis, none of the evaluated laboratory parameters, including WBC count (Odds ratio (OR): 1.133, 95% Confidence interval (CI): 0.979-1.313, p = 0.095), IG# (OR: 0.000, 95% CI: 0.000-1.595, p = 0.056), IG% (OR: 6.740, 95% CI: 0.873-52.064, p = 0.067), and NLR (OR: 1.070, 95% CI: 0.980-1.169, p = 0.131), remained significant independent predictors of CA. CONCLUSIONS: Elevated IG# and IG% levels were associated with CA in univariate analysis; however, they did not remain significant independent predictors in the multivariable model. Although the potential of these markers may still provide complementary information in certain clinical scenarios, further large-scale prospective studies are needed to better define their role in clinical practice.
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