Annali italiani di chirurgia最新文献

{"title":"A Novel Ensemble Approach for Rib Fracture Detection and Visualization using CNNs and Grad-CAM.","authors":"Ling Wu, Hongyu Chen, Puxu Li, Kai Yang","doi":"10.62713/aic.3666","DOIUrl":"10.62713/aic.3666","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to develop a reliable and efficient system for predicting and locating rib fractures in medical images using an ensemble of convolutional neural networks (CNNs).</p><p><strong>Methods: </strong>We employed five CNN architectures-Visual Geometry Group Network 16 (VGG16), Densely Connected Convolutional Network 169 (DenseNet169), Inception Version 4 (Inception V4), Efficient Network B7 (EfficientNet-B7), and Residual Network Next 50 layers (ResNeXt-50)-trained on a dataset of 840 grayscale computed tomography (CT) scan images in .jpg format collected from 42 patients at a local hospital. The images were categorized into two groups representing healed and fresh fractures. The ensemble model was designed to improve predictive accuracy and robustness, utilizing techniques like gradient-weighted class activation mapping (Grad-CAM) for visualization of fracture locations.</p><p><strong>Results: </strong>The ensemble model achieved an accuracy of 0.96, area under the curve (AUC) of 0.97, recall of 0.97, and F1 score of 0.96. Grad-CAM visualizations could effectively locate rib fractures, providing crucial assistance in diagnostics.</p><p><strong>Conclusions: </strong>The ensemble model demonstrates high accuracy and robustness in fracture detection, underscoring its potential for enhancing diagnostic processes in clinical settings. Despite limitations such as the small dataset size and lack of diverse demographic representation, the results are promising for future clinical application.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"86-97"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999011","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}

{"title":"Incidence and Outcomes of Low Anterior Resection Syndrome in Patients Undergoing Preventive Ostomy for Laparoscopic Rectal Cancer Surgery.","authors":"Guizhi Luo, Jinhong Lu, Youzhuan Yang, Hongchao Ma","doi":"10.62713/aic.3773","DOIUrl":"10.62713/aic.3773","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the incidence and risk factors of low anterior resection syndrome (LARS) in patients undergoing preventive colostomy following laparoscopic rectal cancer surgery. Additionally, the outcomes of LARS were analyzed to provide evidence for effective prevention and treatment strategies.</p><p><strong>Methods: </strong>The medical records of 143 patients with laparoscopic rectal cancer who underwent preventive ostomy at the Zhujiang Hospital of Southern Medical University between January 2020 and October 2022 were retrospectively reviewed. All patients underwent ostomy reversal within 2 to 6 months post-surgery. The LARS score scale was used to evaluate the occurrence of LARS at 3, 6, and 12months post-surgery. Based on LARS scores, patients were divided into LARS and non-LARS groups. Clinical characteristics, including gender, TNM stage, and other related data, were compared between the two groups. Multivariate logistic regression analysis was conducted to identify risk factors for LARS, and the predictive performance of the regression model was evaluated using the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>The LARS score demonstrated a significant decrease over time after surgery (p < 0.05). LARS was identified in 80 patients (55.94%) at 3 months post-surgery, with no new cases reported after this period. Statistically significant differences between the LARS and non-LARS groups were observed in body mass index (BMI), tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal (p < 0.05). The ROC curve analysis revealed that the logistic regression model predicting LARS had an area under the curve (AUC) of 0.809 (95% CI: 0.735-0.870), with a sensitivity of 76.25% and a specificity of 79.37%. Among the LARS patients 3 months post-surgery, 73.75% (59/80) showed improvement by 12 months. The improvement rate in patients with mild LARS (87.93%) was significantly higher than in those with severe LARS (36.36%) (p < 0.05).</p><p><strong>Conclusions: </strong>The incidence of LARS is relatively high in patients undergoing preventive ostomy after laparoscopic rectal cancer surgery. Key factors associated with LARS include BMI, tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal. Over time, the incidence of LARS decreases, and outcomes improve, especially in patients with mild LARS.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"152-159"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432361","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}

{"title":"Effects of Interactive Health Education Combined With Evidence-based Pain Management Nursing on Disease Cognition, Postoperative Pain and Post-traumatic Growth in Patients Undergoing Laparoscopic Salpingectomy.","authors":"Ye Cheng, Weiwei Shao, Lixia Li, Yewei Ding, Xueping Zou","doi":"10.62713/aic.3945","DOIUrl":"https://doi.org/10.62713/aic.3945","url":null,"abstract":"<p><strong>Aim: </strong>Laparoscopic salpingectomy has been widely used in the clinical treatment of benign tubal lesions. This study aims to explore the effects of interactive health education combined with evidence-based pain management nursing on disease cognition, postoperative pain and post-traumatic growth in patients undergoing laparoscopic salpingectomy, in order to provide new insights into clinical nursing for these patients.</p><p><strong>Methods: </strong>In this retrospective study, 360 patients who underwent laparoscopic salpingectomy in our hospital from January 2022 to December 2023 were included. Patients receiving routine care were included in the control group (n = 213) and patients receiving interactive health education combined with evidence-based pain care were classified under the study group (n = 147). General data, disease cognition, postoperative pain and post-traumatic growth of the two groups were collected and compared.</p><p><strong>Results: </strong>The awareness rate regarding pathogenesis, cardinal symptom, surgical and postoperative precautions, prevention of complications, medication management, diet management, sleep management, and review time and project in the study group were all significantly higher than those in the control group (p < 0.05). The numerical rating scale (NRS) scores of the study group were lower than those of the control group at 6 h, 12 h, 24 h and 48 h post-surgery (p < 0.001). Before discharge, all dimensions of the post-traumatic growth inventory (PTGI) scores like relating to others, new possibilities, personal strength, spiritual change, and appreciation of life of the study group patients were significantly higher than those of the control group (p < 0.05). The time to get out of bed, exhaust time, and hospitalization stay of the study group patients were significantly shorter than those of the control group (p < 0.05). The total incidence of complications in the study group was significantly lower than that in the control group (p < 0.05).</p><p><strong>Conclusions: </strong>Interactive health education combined with evidence-based pain management nursing is conducive to improving disease cognition, reducing postoperative pain, enhancing post-traumatic growth, and promoting postoperative recovery in patients undergoing laparoscopic salpingectomy.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"664-672"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075364","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}

{"title":"Investigating Clinical Significance of 3D Single-hole Thoracoscopy Surgery for Mediastinal Tumor Resection With Artificial Pneumothorax.","authors":"Qingpeng Li, Bo Peng, Jiajun Pan, Yongyuan Li, Weimin Qian","doi":"10.62713/aic.3897","DOIUrl":"https://doi.org/10.62713/aic.3897","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to analyze and compare the clinical efficacy and safety between single-hole approach and two-hole video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection.</p><p><strong>Methods: </strong>This study included 62 patients who received VATS mediastinal tumor resection in the Thoracic Department of the Affiliated Hospital of Xuzhou Medical University, between March 2020 and March 2022. Patients were divided into a single-hole VATS group (27 cases) and a two-hole VATS group (35 cases). The two groups were compared for their clinical characteristics (such as age, gender, tumor size, body mass index (BMI), comorbidities, and pathological findings), postoperative outcomes (such as operation time, intraoperative bleeding, transfer to open surgery, drainage volume, extubating time, and hospital stay), postoperative complications, and pain score.</p><p><strong>Results: </strong>There were no significant differences in operation time, introperative bleeding volume, and postoperative complication rates between the two groups (p > 0.05). However, extubating time and hospital stay were significantly shorter in the single-hole VATS group than the two-hole VATS group (p < 0.05). Moreover, drainage volume was decreased in the single-hole VATS group compared to the two-hole VATS group (p < 0.05). The pain score was significantly lower on days 1 and 3 post-surgery in the single-hole VATS group than in the two-hole VATS group (p < 0.05).</p><p><strong>Conclusions: </strong>In conclusion, 3D single-hole VATS mediastinal tumor resection is a safe and feasible option for treating mediastinal tumors compared to the traditional approach. Furthermore, it significantly reduces postoperative pain, lowers drainage duration and volume, as well as extubating time, promotes faster recovery, and reduces hospital stays.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"626-633"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075383","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}

{"title":"A Retrospective Analysis of Laparoscopic Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Techniques in the Treatment of Unilateral Inguinal Hernias.","authors":"Yahya Ozel, Muhammer Ergenc, Servet Emir, Yalcin Burak Kara","doi":"10.62713/aic.3852","DOIUrl":"https://doi.org/10.62713/aic.3852","url":null,"abstract":"<p><strong>Aim: </strong>Inguinal hernia is a common surgical issue, with laparoscopic techniques such as totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) being widely used. However, there is no clear consensus on the superiority of either method for unilateral primary or recurrent inguinal hernias. This study compares TEP and TAPP, focusing on efficacy, safety, and clinical outcomes.</p><p><strong>Methods: </strong>This study included patients who underwent elective laparoscopic surgery for unilateral inguinal hernias between April 2009 and May 2024. Patients who underwent inguinal hernia repair were divided into two groups according to whether the TAPP or TEP procedure was used. Primary and recurrent cases were analyzed, with data on demographic features such as age, gender, body mass index (BMI), operative duration, hospital stay, and complications compared between the groups.</p><p><strong>Results: </strong>Of the 985 patients, 72.6% underwent TAPP and 27.4% underwent TEP. The median BMI was significantly higher in the TAPP group (24.23 [23.4-25.6] vs. 24.00 [23.06-25.62], p = 0.038). The proportion of recurrent hernias was higher in the TEP group (15.6% vs. 9.0%, p = 0.004). Operative time was significantly longer for TEP compared to TAPP (60.0 [40-80] vs. 35.0 [25-45] minutes, p < 0.001). Although the median hospital stay was the same in both groups (1 [1] vs. 1 [1] days), the TAPP group had a wider range of hospital stays (p < 0.001). Complication rates were higher in the TEP group (11.1% vs. 4.3%, p < 0.001), primarily driven by increased seroma formation. Linear regression analysis revealed a significant association between case volume and operative duration for TEP primary cases (p < 0.001, R2 = 0.380), recurrent TEP cases (p = 0.024, R2 = 0.121), primary TAPP cases (p = 0.017, R2 = 0.009), and recurrent TAPP cases (p = 0.627, R2 = 0.004).</p><p><strong>Conclusions: </strong>Both TAPP and TEP are effective for unilateral inguinal hernia repair; however, TAPP demonstrated shorter operative times, and fewer complications compared to TEP. Case volume significantly influences operative duration, particularly in TEP repairs. Further studies with larger cohorts are warranted to refine surgical approaches and outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"703-712"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075574","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}

{"title":"Well-Differentiated Extraosseous Chondrosarcoma Arising of Gall Bladder: A Detailed Case Report.","authors":"ZhangQiang Wu, QingQu Guo, YuLian Wu","doi":"10.62713/aic.3739","DOIUrl":"https://doi.org/10.62713/aic.3739","url":null,"abstract":"<p><p>This article reports a rare case of extraosseous myxoid chondrosarcoma originating from the gallbladder. The patient, a 50-year-old female, presented with recurrent right upper quadrant abdominal pain for over two months, with worsening symptoms in the month prior to admission. Before hospitalization, enhanced computed tomography (CT) of the upper abdomen performed at a local hospital suggested a malignant gallbladder tumor (gallbladder cancer) with lymphadenopathy near the hepatic portal, as well as chronic cholecystitis with gallstones. Upon admission, whole-abdomen enhanced CT and liver-enhanced magnetic resonance imaging (MRI) confirmed uneven thickening of the gallbladder wall and multiple enlarged lymph nodes in the hepatic portal, further supporting the suspicion of gallbladder cancer. Tumor marker tests revealed elevated levels of carbohydrate antigen 19-9 (CA19-9) and cytokeratin 19 fragment. On 12 March 2020, the patient underwent extended radical resection for gallbladder cancer. The procedure included the removal of the gallbladder, hepatic lobe, right half of the colon, and greater omentum, along with extensive lymphadenectomy of the hepatic portal and posterior of the pancreatic head. Postoperative pathological examination confirmed the diagnosis of extraosseous myxoid chondrosarcoma, with the tumor involving the full thickness of the gallbladder, intrahepatic parenchyma, and the serosa to the muscular layer of the intestinal wall. Hematoxylin and eosin staining results supported this diagnosis. The patient recovered well postoperatively and did not receive any additional antitumor therapies, such as chemotherapy or radiotherapy. During a 36-month follow-up period after surgery, no tumor recurrence or metastasis was observed.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"437-442"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954054","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}

{"title":"The Impact of Timing of Percutaneous Coronary Intervention on the Prognosis of Non-ST Segment Elevation Myocardial Infarction Patients.","authors":"Tianzhu Li, Nimin Lu, Yingxue Dong","doi":"10.62713/aic.3339","DOIUrl":"10.62713/aic.3339","url":null,"abstract":"<p><strong>Aim: </strong>To study the effect of timing of percutaneous coronary intervention (PCI) to prognosis of Non-ST segment elevation myocardial infarction (NSTEMI) patients.</p><p><strong>Methods: </strong>295 Patients were derived from our hospital who were diagnosed as NSTEMI and accepted PCI therapy in 24 hours from admission during March 2017 to May 2020. According to results of coronary angiography, patients with NSTEMI were divided into culprit artery occlusion (CO, n = 117) and non-culprit artery occlusion (N-CO, n = 178) two groups and then according to timing of PCI into three categories: <6 h, 6-12 h and 12-24 h from admission. We defined major adverse cardiovascular events (MACE) in 1 year follow.</p><p><strong>Results: </strong>In this study, with earlier time to PCI, the incidence of MACE was lower in NSTEMI patients with CO. The incidence of MACE was higher in the CO group than in the N-CO group (25.8% vs. 36.8%, p = 0.046). The incidence of MACE was 11.8% in T1 (<6 h) group (n = 50), less than 29.4% in T2 (6-12 h) group (n = 30) and 43.4% in T3 (12-24 h) group (n = 215), with a statistically significant difference (p = 0.044). However, this phenomenon does not occur in N-CO group. As the duration of PCI increased, patient survival decreased progressively over the course of follow-up in NSTEMI with CO (p = 0.048).</p><p><strong>Conclusions: </strong>Our study found that early PCI improves the prognosis of NSTEMI patients with culprit artery occlusion.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"339-344"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639437","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}

{"title":"Patient-Specific Rods vs Traditional Rods in Surgical Correction of Adult Spinal Deformities: A Case-Matched Study.","authors":"Luigi Aurelio Nasto, Chiara Paolicelli, Angelo Sieczak, Paolo Ulisse, Alessandro Cattolico, Enrico Pola","doi":"10.62713/aic.3367","DOIUrl":"10.62713/aic.3367","url":null,"abstract":"<p><strong>Aim: </strong>Patient specific pre-contoured rods (PSRs) represent a relatively new technological development aimed at improving surgical outcomes and reducing complications in adult spinal deformity surgery. To date, only a limited number of studies have been published comparing PSRs with traditional spinal rods. In this paper, we compare the surgical, imaging, and clinical outcomes of PSRs and traditional spinal rods in a single-center case-matched study.</p><p><strong>Methods: </strong>Thirty cases of adult spinal deformities (ASD) were retrospectively analysed. These included 10 patients who were operated on using UNiD™ (Adaptive Spine Intelligence, MedTronic, Minneapolis, MN, USA) PSRs and 20 operated on using traditional rods from January 2023 to August 2023. Minimum post-surgical follow-up was 6 months. General demographics and standard radiographic parameters, as well as Scoliosis Research Society (SRS)-22, Oswestry Disability Index (ODI) and Short Form Health Survey (SF-12) Scores, were measured at pre-operative examination and at 6-month follow-up. Follow-up imaging data were compared with software-planned correction goals. Intra-operative data and complications were also recorded.</p><p><strong>Results: </strong>Patients in the two groups were matched in terms of age, body mass index (BMI), sex, type and severity of spinal deformity. The magnitude of the coronal deformity (p = 0.812) and preoperative sagittal imbalance (p = 0.845) were similar between the two groups. The number of fused levels (p = 0.439), osteotomies (p = 0.188), implant density (p = 0.880), and surgery duration (p = 0.299) were similar between the two groups. Sagittal correction goals set during preoperative planning were achieved in the PSRs group, with the exception of pelvic tilt (PT) (p = 0.042). In contrast, PT (p = 0.040), L1-S1 lordosis (p = 0.032) and global tilt (GT) (p = 0.001) remained significantly undercorrected in the control group at 6-month follow-up. Clinical outcomes (ODI and SF-12 Scores) and complication rates were similar between the two groups.</p><p><strong>Conclusions: </strong>The use of PSRs improves the achievement of better post-operative spinopelvic alignment in adult spinal deformity surgery. Moreover, no significant differences were noted in terms of complications, operative times, and clinical outcomes compared to traditional spinal rods at 6-month follow-up.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"116-123"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999048","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}

{"title":"Understanding the Current Practice in Chest Tube Management Following Lung Resection-A Canadian National Survey.","authors":"Fabrizio Minervini, Esther Lau, Housne Begum, Yaron Shargall","doi":"10.62713/aic.3535","DOIUrl":"10.62713/aic.3535","url":null,"abstract":"<p><strong>Aim: </strong>Timing of chest tube removal post lung resection is variable in practice and often based on personal experience rather than evidence. The current practice in chest tube management among thoracic surgeons across Canada is so far unknown. Our primary aim was to assess the current status of chest tube removal in Canada in order to uncover potential shortcomings.</p><p><strong>Methods: </strong>An online anonymous survey was emailed to members of Canadian Association of Thoracic Surgeons in order to better understand the status quo of the chest tubes' removal policy in the different departments preparing the grounds for suggesting a future uniformity. Data were collected and analysed with descriptive statistics. A linear regression analysis was performed in order to understand the factors related to chest tube removal.</p><p><strong>Results: </strong>Sixty responses were received (44.4% response rate). Most surgeons place a single chest tube in both open (75%, 45/60) and minimally invasive lobectomies (93.3%, 56/60). Digital drainage systems are used by half of the surgeons surveyed. A quarter of the respondents report removing chest tubes regardless of drainage output. This practice was independent of the surgeons' number of years in practice (p = 0.127), number of lobectomies performed annually (p = 0.877), proportion of lobectomies performed minimally invasively (p = 0.259), whether digital drainage system is used (p = 0.141) and whether the surgeon is aware of the Enhanced Recovery after Surgery (ERAS) guideline (p = 0.374). Of those who remove chest tubes based on fluid output, thresholds vary widely; a significant proportion (86%, 37/43) uses a volume lower than the 450 mL/24 h threshold set out ERAS. Most respondents (77%) were interested in a clinical trial studying chest tube removal independent of drainage volume.</p><p><strong>Conclusions: </strong>This study demonstrated ongoing diverse practice amongst thoracic surgeons in Canada with regards to post-operative chest tube management, indicating a much-needed area of research.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"69-77"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999053","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}

{"title":"Prognostic Impact and Safety of Ketorolac Tromethamine in Tibial Plateau Fracture Patients Undergoing Open Reduction and Internal Fixation.","authors":"Kai Lin, Weiping Zheng, Jinyi Zhu, Xiaoyong Zhang, Xinxiang Jiang, Zhenzhong Ding, Zongyao Duan","doi":"10.62713/aic.3895","DOIUrl":"10.62713/aic.3895","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the postoperative analgesic efficacy and safety of ketorolac tromethamine in tibial plateau fracture (TPF) patients undergoing open reduction and internal fixation (ORIF) surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 194 TPF patients treated at Dongtai People's Hospital between October 2022 and March 2024. Patients meeting the inclusion criteria were divided into two groups: the ketorolac tromethamine group (n = 104), who received ketorolac tromethamine combined with imrecoxib, and the control group (n = 90), who received imrecoxib alone after ORIF. Baseline characteristics, postoperative analgesia (measured using the visual analogue scale (VAS) and Ramsay sedation scores), fracture healing parameters (healing time, alkaline phosphatase (ALP), bone gamma-carboxyglutamate protein (BGP), and collagen type I carboxy-terminal propeptide (PICP), and adverse events were evaluated preoperatively and at hospital discharge.</p><p><strong>Results: </strong>The ketorolac tromethamine group demonstrated significantly lower VAS scores (1 h, p = 0.017; 6 h, p = 0.022) and Ramsay sedation scores (1 h, p = 0.017; 6 h, p = 0.034) after anesthesia recovery compared to the control group. No significant differences between the two groups were observed in fracture healing time, ALP, BGP, or PICP levels (p > 0.05). The incidence of adverse events was comparable between the groups (p > 0.05). Laboratory results, including routine blood tests (neutrophil-to-lymphocyte ratio, p = 0.080; hemoglobin, p = 0.830), liver function tests (alanine aminotransferase (ALT), p = 0.773; aspartate aminotransferase (AST), p = 0.629), and renal function markers (creatinine, p = 0.596; uric acid (UA), p = 0.466; β2-microglobulin, p = 0.605), exhibited no significant differences between the two groups.</p><p><strong>Conclusions: </strong>The combination of ketorolac tromethamine and imrecoxib was more effective than imrecoxib alone in alleviating postoperative pain in TPF patients undergoing ORIF. Ketorolac tromethamine had no significant impact on bone healing, indicating its potential as bone-safe analgesia when combined with imrecoxib.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"329-338"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639415","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}