Annali italiani di chirurgia最新文献

Aim: This study aimed to investigate the application effect of a stereoscopic visualization teaching method combined with a flipped classroom model in the clinical internship of thoracic surgery for undergraduate clinical medicine students.

Methods: Based on teaching methods documented in instructional records, students were retrospectively assigned to a control group (n = 59) and an experimental group (n = 53). The control group employed the flipped classroom teaching model, while the experimental group utilized a three-dimensional visualization approach integrated with the flipped classroom model. Three-dimensional (3D) reconstructed anatomical models of the chest were exclusively used for clinical instruction within the experimental group. Theoretical examinations, case analyses, and clinical practice assessments were adopted to evaluate teaching effectiveness. Teaching satisfaction was measured through a questionnaire survey.

Results: The theoretical scores, case analysis scores, and clinical practice scores of the experimental group were significantly higher than those of the control group (p < 0.001). Satisfaction with teaching content in the experimental group was higher than in the control group, although the difference was not statistically significant (p = 0.347). Satisfaction with teaching methods, teaching effectiveness, learning experience, and overall evaluation in the experimental group was significantly improved compared with the control group (p < 0.001).

Conclusions: Stereoscopic visualization, based on 3D reconstruction combined with a flipped classroom teaching model, has the potential to improve theoretical knowledge, case analysis skills, and clinical practical skills among undergraduate clinical medicine students during thoracic surgery internships. Compared with the flipped classroom alone, the combined teaching model results in higher teaching satisfaction.

Aim: Soft tissue sarcomas are rare, accounting for only 1% of adult malignancies, with liposarcoma being a common subtype. However, mediastinal liposarcomas are extremely uncommon, comprising less than 1% of cases. Dedifferentiated liposarcoma (DDLPS) is a particularly aggressive variant, characterized by a transition from well-differentiated to high-grade non-lipogenic sarcoma. Due to its rarity and often asymptomatic nature until significant progression, mediastinal DDLPS presents a unique diagnostic and therapeutic challenge.

Case presentation: An 83-year-old woman with ischemic heart disease presented with progressive dyspnea over two months. Imaging revealed a giant, well-circumscribed mediastinal mass (21 × 23 × 25 cm), occupying 80% of the thoracic cavity and causing significant pulmonary compression and mediastinal shift. A multidisciplinary tumor board recommended surgical resection.

Results: Initial uniportal video-assisted thoracic surgery exploration confirmed no pleural invasion. This was followed by a posterolateral thoracotomy for complete tumor excision. The patient recovered without complications. Histopathology confirmed DDLPS with complex histological architecture, including both well-differentiated and dedifferentiated sarcomatous components. The patient is disease-free three years postoperatively.

Conclusions: Our case report emphasizes the requirement of a multidisciplinary approach to treat massive chest malignancy. Complete surgical resection remains the gold standard to obtain long-term survival.

Aim: This study aimed to evaluate the safety, clinical efficacy, and economic benefits of day-case endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in a Chinese population, and to compare these indicators between the day-surgery and traditional inpatient models.

Methods: This retrospective cohort study enrolled 80 CRS patients who underwent ESS. Patients were divided into a day-case group (n = 36) and an inpatient group (n = 44). Furthermore, perioperative indicators, hospitalization costs, follow-up costs, subjective symptoms (visual analogue scale [VAS] scores), and objective endoscopic findings (Lund-Kennedy scores) were assessed between the two groups over four weeks post-discharge period.

Results: The day-surgery group demonstrated significantly shorter preoperative waiting times (2.97 ± 0.96 hours vs 18.03 ± 4.47 hours, p < 0.001) and hospital stays (0.52 ± 0.18 days vs 3.64 ± 0.90 days, p < 0.001) compared with the inpatient group. Similarly, hospitalization costs were also lower in the day-case group (11,861.56 ± 3024.71 Yuan vs 29,061.75 ± 4603.45 Yuan, p < 0.001, 1 USD = 7.2 CNY). There were no significant differences in surgical duration, Wong-Baker Faces Pain Score, follow-up costs, or the rate of postoperative adverse events between the two groups. Both groups showed significant and comparable improvements in VAS and Lund-Kennedy scores from baseline through four weeks post-discharge.

Conclusions: Day-case endoscopic sinus surgery is comparable to inpatient surgery in terms of short-term safety and clinical improvement, while significantly shortening hospital stay and reducing hospitalization costs. However, given that this study is a retrospective study and may have selection bias, the above results should still be interpreted with caution.

Aim: This study aims to investigate the therapeutic efficacy of combined anterior-mid-posterior approaches integrated with Enhanced Recovery After Surgery (ERAS) and enhanced management through Internet+ in elderly patients with hip fractures through clinical analysis.

Methods: This study employed a prospective quasi-experimental design. The research protocol was developed in December 2024, and complete clinical data were collected from the time of patient admission. A total of 166 cases of elderly patients with hip fractures who received surgical treatment in Dongying People's Hospital were selected. Patients who underwent surgical treatment from January to February 2025 were assigned to the control group (n = 90), whereas those receiving surgical treatment from March to April 2025 were designated to the intervention group (n = 76). Conventional diagnosis and treatment approaches were applied to the control group, while the anterior-middle-posterior approach strengthened with ERAS and Internet+ was applied to the intervention group. Between-group comparative analyses were performed for preoperative waiting time, incidence of complications at 3 months after discharge, quality-of-life scores, functional recovery scores, satisfaction, and self-care ability at 1 and 3 months after discharge.

Results: There was a statistically significant difference in preoperative waiting time between the two groups (p < 0.001). At 3 months after discharge, the complication rate in the intervention group was significantly lower than that in the control group (13.16% [10/76] vs 31.11% [28/90]; χ² = 13.284, p < 0.05). At 1 month and 3 months post-discharge, the intervention group demonstrated significantly higher quality of life scores, functional recovery scores, and self-care abilities compared to the control group (all p < 0.05). Additionally, the overall satisfaction of patients in the intervention group was significantly higher than that of the control group.

Conclusions: Enhanced with the ERAS concept and Internet+, the anterior-middle-posterior approach shortens preoperative waiting time, reduces complication incidence, improves quality of life, accelerates recovery of hip joint function, and enhances satisfaction levels in elderly patients with hip fractures, showing the potential for clinical applications.

Clinical trial registration: Chinese Clinical Trial Registry (ChiCTR2500095730).

Aim: Videomics, the application of deep learning (DL) to endoscopic video, enables real-time tissue segmentation and anatomical recognition. Within endoscopic endonasal approaches, these methods may improve intraoperative visualization, tumor delineation, and surgical precision. Despite growing interest, its translation into routine clinical practice is still limited and not yet fully characterized. This systematic review aimed to synthesize current evidence on DL-based segmentation in endoscopic endonasal surgery, focusing on model architectures, segmentation targets, and reported outcomes.

Methods: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic search of PubMed, Scopus, and Web of Science was performed on 12 January 2025, and updated on 5 June 2025. Studies published between 2018 and 2025 were included, as no eligible studies were available prior to 2018. Studies were included if they involved human endoscopic endonasal procedures and applied DL techniques to endoscopic video for segmentation purposes. Data extraction included sample size, image resolution, annotated datasets, DL architectures, segmentation targets, and model performance metrics. Study quality was assessed using the Newcastle-Ottawa Scale, and descriptive statistics were used to summarize findings.

Results: Out of 223 screened articles, 28 studies met the inclusion criteria, encompassing 154,989 patients and 1,028,440 annotated images. The most common segmentation targets included nasal polyps (25%), nasopharyngeal carcinoma (21.4%), and pituitary adenomas (7.14%). ResNet and YOLO architectures were each used in 5 studies (17.9%), while transformer-based models such as Swin Transformer, NasVLM, and NaMA-Mamba were increasingly utilized in recent years. Performance metrics were high across studies: area under the receiver operating characteristic curve (AUC-ROC) ranged from 87.4% to 99.2%, mean intersection over union [IoU] (mIoU) from 61.2% to 81.7%, and mean average precision (mAP) [0.50] from 53.4% to 94.9%. Inference times varied from 0.14 ms to 100 ms per image. However, only 35.7% of studies reported segmentation tools, and dataset heterogeneity was common.

Conclusions: DL-based videomics demonstrates high segmentation accuracy across various pathologies and anatomical targets in endoscopic endonasal surgery. Models such as Swin Transformer and YOLO show potential for real-time surgical support. However, translation into clinical practice remains limited by dataset heterogeneity and variability in reporting.

Aim: Intracerebral hemorrhage (ICH) is a critical neurological condition often associated with severe disability and reduced quality of life. Effective postoperative nursing interventions are essential for promoting functional recovery. This study aimed to evaluate the impact of individualized evidence-based nursing guided by the Plan-Do-Check-Act (PDCA) cycle on postoperative functional recovery and quality of life in patients with ICH.

Methods: A total of 152 patients with ICH admitted to Gansu Provincial Hospital of TCM between March 2022 and March 2025 were included and divided into a control group (n = 79) and a study group (n = 73) according to different nursing strategies. The control group received routine nursing care, while the study group received individualized evidence-based nursing guided by the PDCA cycle. Psychological status (Self-Rating Anxiety Scale [SAS], Self-Rating Depression Scale [SDS]), neurological function (National Institutes of Health Stroke Scale [NIHSS]), motor function (Fugl-Meyer Assessment [FMA]), activities of daily living (Barthel Index [BI]), self-management ability, and quality of life (Generic Quality of Life Inventory-74 [GQOLI-74]) were evaluated before and after the intervention.

Results: There were no significant differences in baseline characteristics between the two groups (p > 0.05). Prior to intervention, no significant differences existed between the two groups in SAS, SDS, NIHSS, FMA, BI, self-management ability, or GQOLI-74 scores (all p > 0.05). Post-intervention, the study group exhibited significantly lower SAS and SDS scores than the control group (p < 0.001). NIHSS scores were significantly lower than the control group, while FMA and BI scores were significantly higher than the control group (all p < 0.001). Additionally, post-intervention self-management ability and GQOLI-74 scores in the study group were significantly higher than the control group (all p ≤ 0.001).

Conclusions: The PDCA cycle-guided individualized evidence-based nursing approach significantly promotes neurological and motor recovery, improves psychological well-being, enhances self-management abilities, and optimizes overall quality of life in patients following ICH. This structured and patient-centered nursing model demonstrates significant clinical value and warrants broader clinical implementation.