Annali italiani di chirurgia最新文献

Aim: This study aims to compare the effectiveness of the modified concentric cannula and the conventional concentric cannula for single puncture arthrocentesis (SPA) in terms of irrigation efficiency, procedure duration, and clinician satisfaction.

Methods: The study was conducted on 18 temporomandibular joints (TMJs) of 9 fresh cadavers between June and July 2022. After determining the entry points, 1 mL 10-μM methylene blue solution was injected into the upper joint cavities. For each cadaver, SPA was randomly conducted using a conventional concentric cannula (Group C) on one side and a modified concentric cannula (Group M) on the other side. The primary outcome variables were irrigation efficiency, procedure duration, and clinician satisfaction. All efflux solutions were analyzed using a spectrophotometer to determine irrigation efficiency based on the amount of methylene blue solution removed from the upper joint cavities.

Results: Both cannulas effectively washed the TMJ. However, there were no statistically significant differences in the median absorbance and concentration values between the groups (p = 0.144, p = 0.144). Procedure duration was significantly lower in Group M (p = 0.001). The clinician satisfaction scores were significantly higher in Group M (p = 0.001) than in Group C.

Conclusions: Both cannulas could be used in SPA. However, the modified concentric cannula provides easier procedures, less procedure duration, and higher clinician satisfaction in SPA procedures than conventional concentric cannulas.

Aim: This study aimed to investigate risk factors for early postoperative distant metastasis in patients with medullary thyroid carcinoma (MTC) and to establish a risk prediction model.

Methods: A total of 263 patients diagnosed with MTC after initial surgery at Zhejiang Cancer Hospital between March 2015 and August 2023 were included. The patients were divided into metastasis group (n = 75) and non-metastasis group (n = 188) based on the presence of distant tumor metastasis at 3 months postoperatively. Clinical data, including demographic information, laboratory results, and ultrasound findings, were collected for both groups. The collected data were then randomly assigned into a training set (n = 187) and a validation set (n = 76) at a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for early postoperative distant metastasis. Also, the stepwise backward method was used to determine the predictors of early postoperative distant metastasis, which were utilized for developing a nomogram. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves were adopted to evaluate the performance and predictive value of the model developed.

Results: Multivariate logistic regression analysis revealed that preoperative calcitonin levels and dissection approach were independent factors associated with postoperative distant metastasis. Tumor diameter and number of lesions also showed trends associated with distant metastasis and were therefore included in the predictive model. The final predictors we used to construct the model were age, preoperative carcinoembryonic antigen (CEA), preoperative calcitonin, tumor diameter, number of lesions, and lymph node dissection method. The model demonstrated superior predictive performance, with an area under the curve (AUC) of 0.823 for the training set and 0.763 for the validation set. Calibration curves confirmed good agreement between predicted and observed probabilities. Results from DCA further supported the model's ability to effectively identify individuals at high risk of postoperative distant metastasis on both training and validation sets.

Conclusions: Incorporating readily available clinical variables, the risk prediction model for early postoperative distant metastasis in MTC demonstrated robust discriminatory ability and calibration. Further large-scale prospective studies with external validation are warranted to evaluate the clinical applicability and utility of this model in surgical decision-making.

Aim: To compare the effectiveness and safety of selective arterial perfusion (SAP) combined with core decompression (CD) versus CD alone for treating osteonecrosis of the femoral head (ONFH) at association research circulation osseous (ARCO) stages 1-2.

Methods: Overall, 102 individuals (involving 130 hips) diagnosed with nontraumatic ONFH at ARCO stages 1-2 and admitted into Beijing Jishuitan Hospital Guizhou Hospital (Guizhou Orthopedic Hospital) between January 2021 and December 2023 were enrolled in this retrospective study. They were assigned to two groups based on the treatment protocol: the experimental group (56 patients, 72 hips) treated with SAP combined with CD, and the control group (46 patients, 58 hips) receiving CD only. Both groups were supplemented with conventional treatment: oral aescuven forte (1 tablet/time, 2 times/day for 12 weeks), extracorporeal shock wave therapy (once per week for 4 weeks), nerve block (lateral femoral cutaneous nerve block for visual analogue scale (VAS) >5 points), and rehabilitation training (30 minutes/day, 5 days/week for 12 weeks). All participants were followed up for 12 months, with key outcomes such as effective rate, femoral head collapse rate, lesion size, bone marrow edema grading, VAS score, harris hip score (HHS) score, and complication rate recorded.

Results: No statistically significant differences in baseline data (age, gender, disease duration, ARCO staging, etiology, etc.) were identified between the two groups (p > 0.05), indicating their comparability. Twelve months after treatment, the effective rate of the experimental group (91.7%) proved higher than that of the control group (63.8%), whereas the femoral head collapse rate in the experimental group (5.6%) was lower in comparison to that of the control group (19.0%). After treatment, the experimental group also showed more significant improvements in lesion size, bone marrow edema (BME) grading improvement rate, VAS score, and HHS score. The complication rates of the two groups were similar (7.1% vs. 6.5%, p > 0.05).

Conclusions: At 12 months of follow-up, compared with CD alone, SAP combined with CD demonstrated better clinical performance in nontraumatic ONFH patients at ARCO stages 1-2, accompanied by a higher effective rate, lower femoral head collapse rate, more significant reductions in lesion size and improved hip joint function, while maintaining a comparable safety profile. This combined regimen provides a valuable option for hip-preservation treatment in early-stage ONFH, with potential clinical implications for optimizing minimally invasive intervention strategies.

Gastric cancer is one of the most prevalent malignant tumors worldwide. Sporadic gastric cancer accounts for more than 80% of all gastric cancer cases, and its pronounced heterogeneity underlies the substantial variability in clinical outcomes and the complexity of treatment strategies. The breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are core regulators of the DNA damage homologous recombination repair (HRR) pathway, and their pathogenic mutations are closely associated with hereditary breast and ovarian cancer syndrome. Recent evidence has shown that BRCA1/2 mutations also exist in some sporadic gastric cancer patients and may profoundly affect tumor biological behavior, clinical prognosis, and treatment response. This article systematically reviews the latest research progress on BRCA1/2 mutations in sporadic gastric cancer, focusing on their incidence and molecular characteristics, their impact on patients' postoperative prognosis, and their potential value as novel biomarkers for guiding individualized therapy, thereby providing a theoretical basis for clinical risk stratification and tailored treatment strategies.

Aim: To develop and validate a nomogram for predicting the risk of poor healing after great saphenous vein stripping in patients with venous varicose ulcers, based on preoperative iron metabolism markers and other clinical indicators.

Methods: Clinical data from 278 patients with venous varicose ulcers who underwent great saphenous vein stripping at Wujin Hospital Affiliated with Jiangsu University between July 2022 and January 2025 were retrospectively analyzed. Patients were randomly divided to a training set (n = 166) and a validation set (n = 112) at a 6:4 ratio. Based on the ulcer healing status at 6 months postoperatively, patients were categorized into a poor healing group and a good healing group. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative poor healing, and a nomogram prediction model was developed based on these factors. Internal validation of model performance was conducted using the Bootstrap resampling method. Model discrimination, calibration, and clinical utility were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively.

Results: The overall incidence of postoperative poor healing was 40.29% (112/278). Multivariate logistic regression analysis revealed that diabetes (odds ratio [OR] = 3.01, 95% confidence interval [CI]: 1.38-6.57), increased soluble transferrin receptor (sTfR) (OR = 1.78, 95% CI: 1.17-2.70), decreased albumin (OR = 0.92, 95% CI: 0.85-0.99), and elevated C-reactive protein (CRP) (OR = 1.05, 95% CI: 1.02-1.08) were independent risk factors for postoperative poor healing (all p < 0.05). The nomogram model based on these factors yielded an area under the curve (AUC) of 0.75 (95% CI: 0.68-0.83) in the training set and 0.74 (95% CI: 0.64-0.83) in the validation set. Calibration curves demonstrated good agreement between predicted and observed probabilities. Decision curve analysis indicated a favorable clinical net benefit of the model.

Conclusions: The prediction model developed in this study effectively assesses the risk of poor healing after great saphenous vein stripping in patients with venous varicose ulcers, facilitating early identification of high-risk patients and supporting targeted clinical interventions.

Aim: Primary open-angle glaucoma (POAG) is one of the leading contributors to irreversible blindness. This study evaluated the impact of individualized nursing interventions in patients with POAG undergoing trabeculectomy.

Methods: This retrospective analysis included 94 cases of POAG (94 eyes) undergoing primary trabeculectomy at the Department of Ophthalmology in Binzhou Medical University Hospital between January 2021 and December 2021. Based on the type of postoperative nursing care received, patients were allocated to either an individualized nursing group (n = 54), which received individualized nursing care, or a control group (n = 40), which received standard care. Individualized care comprised preoperative psychological assessment, tailored education, visual function rehabilitation, structured complication monitoring, lifestyle counseling, and remote follow-up support. Assessments were conducted at 1 week and at 1, 6, 12, 24, and 36 months postoperatively. Key outcomes included intraocular pressure (IOP), use of antiglaucoma medication, length of hospital stay, postoperative complications, and cumulative surgical success.

Results: The individualized nursing group exhibited markedly shorter hospital stays (p = 0.007), lower IOP at 24 and 36 months (all p < 0.05), and fewer antiglaucoma medications at early time points (1 week and 1 month; all p < 0.05). Overall complications occurred less frequently in the individualized nursing group (p = 0.020). Kaplan-Meier analysis demonstrated a significantly higher cumulative surgical success rate in the individualized nursing group (p = 0.019). Multivariable Cox regression identified individualized nursing as an independent predictor of reduced surgical failure (hazard ratio (HR) = 0.519, p = 0.023).

Conclusions: Individualized nursing interventions significantly improve postoperative outcomes following trabeculectomy in POAG patients. Integrating individualized nursing care into routine clinical practice may enhance surgical success and reduce postoperative complications.

Aim: To analyze the influencing factors of postoperative delirium (POD) after intraspinal anesthesia in elderly patients undergoing femoral neck fracture (FNF) surgery and to construct a prediction model for early identification of high-risk patients.

Methods: This retrospective study included 407 elderly patients who underwent FNF surgery under spinal anesthesia from January 2020 to January 2024 as the modeling cohort; and another 82 patients who underwent similar surgery under spinal anesthesia between February 2024 and February 2025, according to the same inclusion and exclusion criteria, as an independent time-limited external validation cohort. Data were collected from the hospital's electronic medical records. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POD. A nomogram prediction model was constructed and validated internally and externally.

Results: The incidence of POD was 16.95% (69/407). Independent risk factors identified were age >80 years (odds ratio (OR) = 2.25, 95% CI: 1.25-4.05, p = 0.007), diabetes (OR = 1.91, 95% CI: 1.03-3.56, p = 0.041), preoperative hemoglobin <90 g/L (OR = 2.11, 95% CI: 1.14-3.90, p = 0.017), preoperative albumin <30 g/L (OR = 3.76, 95% CI: 1.95-7.25, p < 0.001), preoperative waiting time ≥3 days (OR = 2.62, 95% CI: 1.40-4.90, p = 0.003), American Society of Anesthesiologists (ASA) grade ≥III (OR = 2.12, 95% CI: 1.08-4.17, p = 0.029), postoperative hypoxemia (OR = 2.22, 95% CI: 1.22-4.05, p = 0.009), and postoperative visual analog scale (VAS) score ≥4 (OR = 2.55, 95% CI: 1.39-4.68, p = 0.002). The nomogram exhibited strong discriminative ability (area under the curve (AUC) = 0.79 for internal, 0.85 for external validation) and satisfactory calibration (Hosmer-Lemeshow p > 0.05).

Conclusions: This study identified independent risk factors for POD after intraspinal anesthesia in elderly FNF patients and established a nomogram with excellent predictive ability, offering a reliable tool for early detection of high-risk cases and facilitating implementation of targeted preventive measures.

Aim: To investigate the predictive value of intraoperative glucose variability (GV) for chronic postsurgical pain (CPSP) in patients undergoing arthroscopic rotator cuff repair (ARCR).

Methods: A retrospective study was conducted on 211 ARCR patients admitted to Tongxiang First People's Hospital from January 2021 to December 2024. Patients were divided into CPSP group (n = 35) and non-CPSP group (n = 176). Influencing factors were analyzed with univariate and binary logistic regression. The predictive value of these factors for CPSP in ARCR patients was evaluated with receiver operating characteristic (ROC) curve analysis. Shoulder joint indicators of patients with different levels of intraoperative GV were compared before and after treatment. GV was expressed as the ratio of the standard deviation to the mean value of intraoperative blood glucose.

Results: There were no statistically significant differences (p > 0.05) in age, sex, body mass index (BMI), surgery time, intraoperative blood loss, length of hospital stay, tear location, tear area, glycated hemoglobin (HbA1c), fasting blood glucose and full-thickness tear between the groups. However, there were statistically significant differences (p < 0.05) in the number of torn tendons, shoulder acromioplasty, coefficient of variance (CV), largest amplitude of glycemic excursions (LAGE), and preoperative pain. Binary logistic regression analysis revealed that the number of torn tendons, LAGE, and CV were influencing factors for CPSP in ARCR patients (p < 0.05). The area under the ROC curve for CV was 0.864, standard error 0.027 (95% CI: 0.812-0.916, p < 0.001), with a Youden index of 0.62, sensitivity of 91.43%, and specificity of 70.45%. Post-treatment Constant-Murley Score (CMS) and American Shoulder and Elbow Surgeons Score (ASES) scores were significantly better in patients with CV ≤0.18 compared to CV >0.18 (p < 0.001).

Conclusions: Intraoperative GV has predictive value for CPSP in ARCR patients.