Aim: This study aims to develop and externally validate machine-learning models that effectively predict the risk and severity of postoperative symptoms one week following mandibular third molar extractions.
Methods: This retrospective cohort study included 321 patients (18-35 years old) who underwent lower third-molar surgery. Demographics, Pell-Gregory vertical (PGV) and Pell-Gregory level (PGL) classifications, surgical variables, and day-7 pain visual analogue scale (VAS) were recorded for all participants. The data were randomly divided into training (70%) and validation (30%) datasets. Five machine-learning algorithms-Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), and Neural Network (NNET)-were developed using nested cross-validation. Model performance was assessed through area under the receiver operating characteristic (AUROC) values, Brier scores, and calibration slopes, with a nomogram constructed from the best-performing model.
Results: GBM achieved the highest discrimination on the validation dataset with an AUROC of 0.687 (95% CI, 0.624-0.744), followed by the Neural Network (AUROC = 0.677). The GBM model yielded a calibration slope of 0.98 and a Brier score of 0.225, indicating excellent predictive accuracy. However, the top six predictors were found to be operative time, mouth opening, PGV, PGL, smoking, and preoperative symptoms. The GBM model, which underlies the nomogram, achieved an area under the curve (AUC) value of 0.666, indicating its discrimination capability. Additionally, the calibration curve confirmed the model's accuracy, and the decision curve analysis (DCA) suggested that the nomogram provides clinically promising potential for effective risk stratification.
Conclusions: A GBM-based nomogram provides moderate yet clinically useful discrimination for healthy adults aged 18-35 years at risk for severe early symptoms after third-molar extraction. However, this approach requires external validation in older or medically complex patients before it is recommended for clinical predictions.
{"title":"Predicting the Severity of Postoperative Symptoms Following Mandibular Third Molar Extractions Using Machine Learning Techniques.","authors":"Qianqian Hou, Huan Ge, Jiayue Xiang, Yiming Gao","doi":"10.62713/aic.4090","DOIUrl":"https://doi.org/10.62713/aic.4090","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to develop and externally validate machine-learning models that effectively predict the risk and severity of postoperative symptoms one week following mandibular third molar extractions.</p><p><strong>Methods: </strong>This retrospective cohort study included 321 patients (18-35 years old) who underwent lower third-molar surgery. Demographics, Pell-Gregory vertical (PGV) and Pell-Gregory level (PGL) classifications, surgical variables, and day-7 pain visual analogue scale (VAS) were recorded for all participants. The data were randomly divided into training (70%) and validation (30%) datasets. Five machine-learning algorithms-Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), and Neural Network (NNET)-were developed using nested cross-validation. Model performance was assessed through area under the receiver operating characteristic (AUROC) values, Brier scores, and calibration slopes, with a nomogram constructed from the best-performing model.</p><p><strong>Results: </strong>GBM achieved the highest discrimination on the validation dataset with an AUROC of 0.687 (95% CI, 0.624-0.744), followed by the Neural Network (AUROC = 0.677). The GBM model yielded a calibration slope of 0.98 and a Brier score of 0.225, indicating excellent predictive accuracy. However, the top six predictors were found to be operative time, mouth opening, PGV, PGL, smoking, and preoperative symptoms. The GBM model, which underlies the nomogram, achieved an area under the curve (AUC) value of 0.666, indicating its discrimination capability. Additionally, the calibration curve confirmed the model's accuracy, and the decision curve analysis (DCA) suggested that the nomogram provides clinically promising potential for effective risk stratification.</p><p><strong>Conclusions: </strong>A GBM-based nomogram provides moderate yet clinically useful discrimination for healthy adults aged 18-35 years at risk for severe early symptoms after third-molar extraction. However, this approach requires external validation in older or medically complex patients before it is recommended for clinical predictions.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"162-174"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luca Bertolaccini, Claudia Bardoni, Juliana Guarize, Lorenzo Spaggiari
{"title":"From Scalpel to Algorithms in Lung Cancer Management: Precision Requires Wisdom-Beware Not Artificial Intelligence, but Natural Stupidity.","authors":"Luca Bertolaccini, Claudia Bardoni, Juliana Guarize, Lorenzo Spaggiari","doi":"10.62713/aic.4306","DOIUrl":"https://doi.org/10.62713/aic.4306","url":null,"abstract":"","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"1-3"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keyue Yang, Xinkun He, Pingping Ye, Yao Qian, Xiaofeng Teng, Xueyuan Li, Xin Wang, Hong Chen
<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>A calibrated, explainable ConvNeXt-CBAM ultrasound classifier delivers reliable probabilities and anatomically faithful saliency that are directly actionable for su
目的：腕管综合征（Carpal tunnel syndrome， CTS）是在手外科手术中常见的一种压迫性神经病变，决定是否进行手术减压取决于影像学表现的准确性和临床可解释性。在这种情况下，超声通常用于直接观察正中神经，但仍然依赖于操作者，并且受到不一致的诊断阈值的限制。本研究旨在开发一种以手术为导向的基于超声的人工智能（AI）模型，该模型具有较强的判别能力，为术前咨询提供可靠的概率校准，并具有与腕管释放目标神经一致的解剖意识解释性。方法：本回顾性研究纳入了具有足够质量的超声图像并符合临床标准的成人疑似CTS；既往有腕管手术或非诊断性影像的病例被排除在外。我们分析了2900个手腕超声检查，在患者水平上保留了一个先验的20%的测试集（n = 580张图像）。采用DenseNet-121作为参考基线。该模型使用卷积块注意模块（CBAM）增强的ConvNeXt-T，在标准微调之前使用有监督的对比预热进行优化；概率通过温度标度事后校准。图像进行去识别、归一化和超声适当增强。主要结果为自举带鉴别（受试者工作特征（ROC）、曲线下面积（AUC）、平均精度（AP））；次要结果包括准确性、精密度、召回率、F1分数（精确率和召回率的调和平均值）、混淆矩阵、概率分布、类别条件分数分离以及Grad-CAM++与专家定义的感兴趣区域的一致性。测试集标签使用固定的0.5阈值。结果：提出的模型在区分方面优于基线（AUC 0.904 vs 0.821; AP 0.907 vs 0.831）。综合指标也支持该方法（准确率0.91 vs 0.83；精密度0.89 vs 0.81；召回率0.88 vs 0.82； F1分数0.88 vs 0.81）。混淆矩阵显示假阳性（58→33,-43%）和假阴性（52→35,-33%）同时减少：基线真阴性(TN)/假阳性(FP)/假阴性(FN)/真阳性(TP) = 232/58/52/238；建议TN/FP/FN/TP = 257/33/35/255。预测概率直方图和类别条件密度表明更有信心，更好地分离输出与校准。与专家轮廓相比，Grad-CAM++覆盖层更加紧凑和神经协调，支持手术计划的解剖对齐可解释性。结论：经过校准的、可解释的ConvNeXt-CBAM超声分类器提供了可靠的概率和解剖学上忠实的显著性，可直接用于CTS的手术分诊、减压时机和术前咨询。这些发现支持基于超声的人工智能作为临床评估和手外科神经传导研究的实用辅助手段，保证前瞻性，多中心验证和工作流程集成。
{"title":"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.","authors":"Keyue Yang, Xinkun He, Pingping Ye, Yao Qian, Xiaofeng Teng, Xueyuan Li, Xin Wang, Hong Chen","doi":"10.62713/aic.4332","DOIUrl":"https://doi.org/10.62713/aic.4332","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>A calibrated, explainable ConvNeXt-CBAM ultrasound classifier delivers reliable probabilities and anatomically faithful saliency that are directly actionable for su","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"74-83"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelo Iossa, Lorenzo Martini, Francesco De Angelis, Alessandra Micalizzi, Giulio Lelli, Giuseppe Cavallaro
{"title":"Intraluminal Gastric Band Migration Causing Small Bowel Occlusion.","authors":"Angelo Iossa, Lorenzo Martini, Francesco De Angelis, Alessandra Micalizzi, Giulio Lelli, Giuseppe Cavallaro","doi":"10.62713/aic.4324","DOIUrl":"https://doi.org/10.62713/aic.4324","url":null,"abstract":"","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"15-17"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Minghai Shen, Weidong Zhang, Huihui Shen, Bei Wang
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 (p < 0.05), while tumor tissue necrosis was a protective factor (p = 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.
{"title":"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.","authors":"Minghai Shen, Weidong Zhang, Huihui Shen, Bei Wang","doi":"10.62713/aic.4298","DOIUrl":"https://doi.org/10.62713/aic.4298","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>p</i> < 0.05), while tumor tissue necrosis was a protective factor (<i>p</i> = 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"104-110"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carmen Cánovas Seva, Lorena Martínez Leboráns, Ana Batalla, Maria Dolores Sánchez-Aguilar Y Rojas, Ángeles Flórez
Aim: Lentigo maligna (LM) is the commonest melanoma in situ 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.
目的：恶性Lentigo （LM）是最常见的黑色素瘤原位变异，经常发生在长期暴露在阳光下的面部皮肤上，其中亚临床放射状扩散和背景光化黑素细胞异型性使手术清除和组织学解释复杂化。本研究的目的是评估LM的当代手术选择及其肿瘤预后，重点是传统的大面积局部切除（WLE）、莫氏显微手术（MMS）、石蜡包埋边缘控制（“慢莫氏”）技术和分期切除（SE）。方法：全面检索PubMed和Web of Science（2015年1月- 2025年1月），检索回顾性队列、系统综述和荟萃分析，详细介绍LM或lentigo恶性黑色素瘤（LMM）的技术、边缘政策和结果。46项研究符合预先规定的标准，并进行了定性综合。结果：WLE仍然是应用最广泛的手术，但在实践中表现出最大的异质性。最初的临床边缘为5毫米，通常需要组织学扩展到7-12毫米以确保清除；在WLE下，残留病率达16.7%，复发率为5.7%至27.3%。相比之下，MMS，特别是使用免疫组织化学时，在随访≥5年的情况下，复发率在0-3%之间。缓慢Mohs和分期切除在保留组织的同时提供了中度复发控制（0-5.7%），但受到手术变异性和延迟重建的限制。尽管一项回顾性研究报告了MMS可改善疾病特异性生存率，但大多数研究显示，不同手术技术在黑色素瘤特异性或总体生存率方面没有显著差异。有限的长期随访和不一致的统计报告（如置信区间）是常见的。结论：边缘控制入路（MMS, slow Mohs， SE）对WLE提供了更好的局部控制，更适合于美容或功能关键部位的病变。由于生存似乎是相等的，技术的选择应根据解剖位置、病变大小、可用的专业知识、患者特征和偏好以及成本效益和可用资源来指导。精心设计的具有标准化方案的前瞻性试验对于完善边际推荐和比较长期结果至关重要。
{"title":"Lentigo Maligna: Contemporary Surgical Management and Outcome: A Review.","authors":"Carmen Cánovas Seva, Lorena Martínez Leboráns, Ana Batalla, Maria Dolores Sánchez-Aguilar Y Rojas, Ángeles Flórez","doi":"10.62713/aic.4228","DOIUrl":"https://doi.org/10.62713/aic.4228","url":null,"abstract":"<p><strong>Aim: </strong>Lentigo maligna (LM) is the commonest melanoma <i>in situ</i> 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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"36-62"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jie Zhou, Xuezhi Yang, Xiaoxiu Xie, Hongli Zhou, Xin Chen, Juanjuan Liu
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.
{"title":"Factors Associated With Intraoperative Acquired Pressure Injury in Total Knee Arthroplasty Patients: Development of Predictive Models.","authors":"Jie Zhou, Xuezhi Yang, Xiaoxiu Xie, Hongli Zhou, Xin Chen, Juanjuan Liu","doi":"10.62713/aic.4195","DOIUrl":"https://doi.org/10.62713/aic.4195","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"150-161"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianye Zhang, Junyan Feng, Cuizhi Yin, Zhe Dong, Guangyan Xu, Lan Yao
<p><strong>Aim: </strong>Gynecological malignancies are common cancers in women, with postoperative liver and kidney function impairment significantly impacting long-term prognosis. Therefore, this study aimed to evaluate the effects of anesthesia and surgical interventions on postoperative liver and kidney function in patients with gynecological malignancies and explore its association with long-term survival outcomes.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 153 patients who underwent surgery for ovarian cancer (50 cases), endometrial cancer (63 cases), and cervical cancer (40 cases) at Peking University International Hospital between 2018 and 2023. Demographic data, anesthesia methods (general or regional), surgical approaches (laparoscopic or open), and perioperative hepatorenal function indicators (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Total Bilirubin (TBIL), creatinine and urea) were analyzed. Multivariate regression analysis adjusted for potential confounders, and survival models assessed long-term patient outcomes.</p><p><strong>Results: </strong>Analysis of variance (ANOVA) revealed significant differences among the three cohorts in postoperative levels of ALT (<i>p</i> = 0.044), AST (<i>p</i> < 0.001), TBIL (<i>p</i> < 0.001), creatinine (<i>p</i> = 0.026), and urea (<i>p</i> < 0.001). Within each cohort, significant postoperative elevations were observed for ALT, AST, TBIL, creatinine, and urea compared to preoperative levels (all <i>p</i> < 0.05). Intergroup comparisons revealed that cervical cancer patients exhibited the most severe biochemical disturbances (95% stage IV, <i>p</i> < 0.001), with significant postoperative decreases in red blood cell (RBC) count (<i>p</i> < 0.001), hemoglobin (Hb) levels (<i>p</i> < 0.001), and platelet count (<i>p</i> = 0.003), alongside a substantial increase in white blood cell (WBC) count (<i>p</i> < 0.001). Multivariate linear regression analysis revealed that advanced tumor stage (Stage IV vs. I) was independently associated with elevated postoperative ALT (<i>p</i> = 0.001), AST (<i>p</i> < 0.001), TBIL (<i>p</i> < 0.001), and urea (<i>p</i> = 0.002) levels; however, its association with creatinine levels did not reach statistical significance (<i>p</i> > 0.05). Further analysis demonstrated that open surgery (vs. laparoscopic) significantly predicted increased creatinine (<i>p</i> = 0.002) and urea (<i>p</i> = 0.015) levels and TBIL (<i>p</i> = 0.002), whereas no significant effects were observed on ALT or AST (<i>p</i> > 0.05). Moreover, prolonged operative time (per 10 minutes) independently contributed to elevated AST (<i>p</i> = 0.015), TBIL (<i>p</i> = 0.018), and urea levels (<i>p</i> < 0.001). Similarly, intraoperative blood loss (per 100 mL) was associated with higher AST (<i>p</i> = 0.002), TBIL (<i>p</i> = 0.003), and urea levels (<i>p</i> = 0.003), while its associations with ALT (<i>p</i> = 0.083) and creatini
{"title":"The Impact of Anesthesia and Surgical Intervention on Liver and Kidney Function in Patients With Gynecological Malignancies.","authors":"Jianye Zhang, Junyan Feng, Cuizhi Yin, Zhe Dong, Guangyan Xu, Lan Yao","doi":"10.62713/aic.4025","DOIUrl":"https://doi.org/10.62713/aic.4025","url":null,"abstract":"<p><strong>Aim: </strong>Gynecological malignancies are common cancers in women, with postoperative liver and kidney function impairment significantly impacting long-term prognosis. Therefore, this study aimed to evaluate the effects of anesthesia and surgical interventions on postoperative liver and kidney function in patients with gynecological malignancies and explore its association with long-term survival outcomes.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 153 patients who underwent surgery for ovarian cancer (50 cases), endometrial cancer (63 cases), and cervical cancer (40 cases) at Peking University International Hospital between 2018 and 2023. Demographic data, anesthesia methods (general or regional), surgical approaches (laparoscopic or open), and perioperative hepatorenal function indicators (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Total Bilirubin (TBIL), creatinine and urea) were analyzed. Multivariate regression analysis adjusted for potential confounders, and survival models assessed long-term patient outcomes.</p><p><strong>Results: </strong>Analysis of variance (ANOVA) revealed significant differences among the three cohorts in postoperative levels of ALT (<i>p</i> = 0.044), AST (<i>p</i> < 0.001), TBIL (<i>p</i> < 0.001), creatinine (<i>p</i> = 0.026), and urea (<i>p</i> < 0.001). Within each cohort, significant postoperative elevations were observed for ALT, AST, TBIL, creatinine, and urea compared to preoperative levels (all <i>p</i> < 0.05). Intergroup comparisons revealed that cervical cancer patients exhibited the most severe biochemical disturbances (95% stage IV, <i>p</i> < 0.001), with significant postoperative decreases in red blood cell (RBC) count (<i>p</i> < 0.001), hemoglobin (Hb) levels (<i>p</i> < 0.001), and platelet count (<i>p</i> = 0.003), alongside a substantial increase in white blood cell (WBC) count (<i>p</i> < 0.001). Multivariate linear regression analysis revealed that advanced tumor stage (Stage IV vs. I) was independently associated with elevated postoperative ALT (<i>p</i> = 0.001), AST (<i>p</i> < 0.001), TBIL (<i>p</i> < 0.001), and urea (<i>p</i> = 0.002) levels; however, its association with creatinine levels did not reach statistical significance (<i>p</i> > 0.05). Further analysis demonstrated that open surgery (vs. laparoscopic) significantly predicted increased creatinine (<i>p</i> = 0.002) and urea (<i>p</i> = 0.015) levels and TBIL (<i>p</i> = 0.002), whereas no significant effects were observed on ALT or AST (<i>p</i> > 0.05). Moreover, prolonged operative time (per 10 minutes) independently contributed to elevated AST (<i>p</i> = 0.015), TBIL (<i>p</i> = 0.018), and urea levels (<i>p</i> < 0.001). Similarly, intraoperative blood loss (per 100 mL) was associated with higher AST (<i>p</i> = 0.002), TBIL (<i>p</i> = 0.003), and urea levels (<i>p</i> = 0.003), while its associations with ALT (<i>p</i> = 0.083) and creatini","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"175-184"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Can Cui, Wei Jin, Jiong Wu, Chang-Peng Han, Ying Li, Lei Jin, Hao-Jie Yang, Zhen-Yi Wang
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.
{"title":"Transanal Opening of the Intersphincteric Space to Treat Anal Fistula: A Systematic Review and Meta-Analysis.","authors":"Can Cui, Wei Jin, Jiong Wu, Chang-Peng Han, Ying Li, Lei Jin, Hao-Jie Yang, Zhen-Yi Wang","doi":"10.62713/aic.4148","DOIUrl":"10.62713/aic.4148","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"4-14"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 (p > 0.05). Postoperative VAS scores in the comprehensive intervention group were significantly lower than those in the control group (p < 0.001). Furthermore, the total VSS score in the comprehensive intervention group was significantly superior to that in the control group (p < 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%) (p < 0.01). Subgroup analyses based on scar type (hypertrophic vs. keloid) demonstrated consistent benefits of the intervention, with no significant interaction observed (p > 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.
{"title":"Impact of Comprehensive Postoperative Incisional Analgesia and Scar-Prevention Interventions on Rehabilitation Outcomes in Patients Undergoing Scar Revision Surgery.","authors":"Mingyan Guo, Jinhua Liao","doi":"10.62713/aic.4394","DOIUrl":"https://doi.org/10.62713/aic.4394","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Preoperative baseline characteristics showed no significant differences between the two groups (<i>p</i> > 0.05). Postoperative VAS scores in the comprehensive intervention group were significantly lower than those in the control group (<i>p</i> < 0.001). Furthermore, the total VSS score in the comprehensive intervention group was significantly superior to that in the control group (<i>p</i> < 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%) (<i>p</i> < 0.01). Subgroup analyses based on scar type (hypertrophic vs. keloid) demonstrated consistent benefits of the intervention, with no significant interaction observed (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 1","pages":"134-140"},"PeriodicalIF":0.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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