Annali italiani di chirurgia最新文献

{"title":"Sex Differences in Presentation, Management, and Prognosis of Surgically Treated Oral Tongue Carcinoma: A Retrospective Cohort Study.","authors":"Saleh Saleh Elbalka, Ahmed Mahmoud Shoman, Ahmed Mohamed Farid, Mansour Elmoatasembellah, Mohamed Elmetwally, Mohamed Abdelkhalek","doi":"10.62713/aic.4736","DOIUrl":"https://doi.org/10.62713/aic.4736","url":null,"abstract":"<p><strong>Aim: </strong>Tongue carcinoma is an aggressive subtype of oral cavity cancer. Sex-related differences in disease presentation and prognosis remain incompletely understood.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with histologically confirmed oral tongue squamous cell carcinoma treated at Oncology Center Mansoura University (OCMU) in Egypt between 2007 and 2025. Baseline clinicopathological characteristics, recurrence, and overall survival were analyzed by sex. Survival was assessed using Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards regression.</p><p><strong>Results: </strong>Of 151 patients identified, 41 were excluded because of missing or indeterminate vital status, leaving 110 patients in the final analytic cohort (52 males and 58 females). Males had a significantly higher smoking prevalence than females (13/49 [26.5%] vs 2/55 [3.6%]; <i>p</i> = 0.001), but age, body mass index (BMI), T stage, nodal status, depth of invasion, histologic grade, and other adverse pathological features were broadly similar between sexes. Overall survival did not differ significantly by sex (log-rank <i>p</i> = 0.785). In univariate Cox analysis, advanced T stage, nodal positivity, and perineural invasion were associated with worse survival, but in a parsimonious multivariable model, only nodal positivity and advanced T stage remained significant.</p><p><strong>Conclusions: </strong>In this Egyptian cohort of oral tongue squamous cell carcinoma (SCC) patients, sex differences in presentation and outcome were minimal. Smoking exposure was substantially higher in men, but sex itself was not associated with survival after adjustment. Tumor burden, particularly nodal involvement and advanced T stage, was the main determinant of prognosis.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1892-1902"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219845","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":"Modified LIFT via a Lateral Approach Versus Standard LIFT for Transsphincteric Anal Fistula: A Prospective Randomized Study.","authors":"Tuğberk Tok, Yusuf Sevim","doi":"10.62713/aic.4784","DOIUrl":"10.62713/aic.4784","url":null,"abstract":"<p><strong>Aim: </strong>To compare the early clinical outcomes of modified ligation of the intersphincteric fistula tract (LIFT) via a lateral approach with those of standard LIFT in patients with magnetic resonance imaging (MRI)-confirmed transsphincteric anal fistula.</p><p><strong>Methods: </strong>This single-center prospective randomized study included adult patients with transsphincteric anal fistula who were treated between January and May 2024 and were followed through August 2024. Among 96 patients assessed for eligibility, 46 met the eligibility criteria, and 40 consenting patients were randomized at a 1:1 ratio to standard LIFT or modified LIFT via a lateral approach. Follow-up was performed at postoperative weeks 1, 4, 8, and 12. The primary outcome was wound healing time. Secondary outcomes included early recurrence or persistence, postoperative pain assessed using the visual analog scale (VAS), and continence evaluated using the Cleveland Clinic Fecal Incontinence Scale.</p><p><strong>Results: </strong>A total of 40 patients were analyzed, with 20 patients in each group. Baseline demographic and available clinical characteristics were comparable between the groups. The median wound healing time was significantly shorter in the modified LIFT group than in the standard LIFT group (13 [interquartile range, 10-17] days vs. 29.5 [26-32] days; <i>p</i> < 0.001). No early recurrence or persistence was observed in the modified LIFT group by week 12. In the standard LIFT group, recurrence/persistence was observed in 3 of the 20 patients (15.0%) at week 8 and in 6 of the 20 patients (30.0%) at week 12 (Fisher exact test at week 12; <i>p</i> = 0.020). The median VAS pain scores were low and comparable in the standard LIFT versus modified LIFT groups at week 1 (0.90 vs. 0.95; <i>p</i> = 0.942) and week 4 (0.00 vs. 0.00; <i>p</i> = 0.115). No case of fecal incontinence was noted in either group during follow-up.</p><p><strong>Conclusions: </strong>In selected patients with transsphincteric anal fistula, compared with standard LIFT, modified LIFT via a lateral approach was associated with faster early wound healing and a lower rate of early recurrence/persistence within 12 weeks, without an observed increase in postoperative pain or fecal incontinence. Larger studies with longer follow-up are warranted before definitive conclusions can be drawn regarding long-term recurrence.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT07603635.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1813-1821"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219823","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 Evaluation of Acute Ischemic Stroke Patients After Mechanical Thrombectomy Incorporating Imaging, Inflammatory, and Rehabilitation Aspects.","authors":"Shanshan Mu, Hong Li, Yan Wang, Zemin Liu, Yang Wang, Bangqing Liu, Chunxiao Wan","doi":"10.62713/aic.4672","DOIUrl":"https://doi.org/10.62713/aic.4672","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to perform a prognostic evaluation for patients with acute ischemic stroke after mechanical thrombectomy (MT) incorporating imaging, inflammatory, and rehabilitation aspects.</p><p><strong>Methods: </strong>A retrospective cohort analysis of patients with acute ischemic stroke (AIS) after mechanical thrombectomy (MT) was conducted, systematically evaluating baseline demographics, neuroimaging features, hematological inflammatory indices, and time to start rehabilitation. Prognostic correlations were examined using multivariate logistic regression, with poor functional outcome defined as 90-day modified Rankin Scale (mRS) >2. Model discrimination was assessed via receiver operating characteristic (ROC) analysis of the composite prediction framework.</p><p><strong>Results: </strong>The analytical cohort comprised 144 subjects. Five independent predictors of unfavorable outcomes emerged: pre-existing hypertension (adjusted Odds Ratio [aOR] 6.48, 95% Confidence Interval [CI] 1.03-40.80), lower baseline Alberta Stroke Program Early CT Score (ASPECTS) (aOR 0.18, 95% CI 0.06-0.49), elevated NLR (aOR 1.27, 95% CI 1.11-1.46), extended onset-to-reperfusion time (OTR) (per minute aOR 1.01, 95% CI 1.01-1.02), and delayed starting rehabilitation (aOR 2.30, 95% CI 1.52-3.46). The multivariable model demonstrated excellent discriminative capacity (area under the curve [AUC] 0.964, 95% CI 0.940-0.988).</p><p><strong>Conclusions: </strong>Beyond successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3), functional outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy were independently influenced by factors across the three core domains of our prognostic framework: imaging (baseline ASPECTS), inflammation (elevated neutrophil-to-lymphocyte ratio, NLR), and rehabilitation (delayed starting rehabilitation). Additional significant clinical variables included pre-existing hypertension and longer onset-to-reperfusion time (OTR). These findings support the potential value of a multidimensional prognostic assessment integrating imaging, inflammatory, and rehabilitation aspects in patients with acute ischemic stroke after mechanical thrombectomy.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1785-1793"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219840","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":"Training the Next Generation of Future Surgical Residents: A Scoping Review and Proposal for an Undergraduate Curriculum From the Italian Polispecialistic Society of Young Surgeons.","authors":"Gianmario Edoardo Poto, Marianna Peruffo, Manfredi Giuseppe Anzaldi, Andrea Castaldi, Gianmarco Elia, Giulia Misasi, Giulia Rovero, Martina Lenzi, Elisa Bassan, Francesca Gigola, Domenico Soriero, Giosuè Giordano Incognito, Gennaro Melone, Roberto Cirillo, Marco Angrisani, Maria Rosaria Mastrangeli, Alessandro Coppola, Michele Maruccia, Gaetano Gallo, Arcangelo Picciariello, Alessandro Pasculli, Ludovico Carbone","doi":"10.62713/aic.4796","DOIUrl":"10.62713/aic.4796","url":null,"abstract":"<p><strong>Aim: </strong>The transition from medical school to surgical residency is marked by a persistent gap between theoretical instruction and clinical readiness. In Italy, variability in training programs across centers creates persistent gaps in residents' medical education. Scientific societies are asked to identify current training gaps and define the core competencies required for effective surgical training. We propose an undergraduate curriculum to support last-year medical students in Italy.</p><p><strong>Methods: </strong>A scoping review of the literature focusing on structured surgical curricula for undergraduate medical students was conducted. A suggested \"curriculum\" was introduced at the 2025 Congress of the Italian Polispecialistic Society of Young Surgeons (SPIGC) in Bari, Italy.</p><p><strong>Results: </strong>The SPIGC curriculum includes seven domains: (1) soft skills: communication, informed consent, and interdisciplinary collaboration; (2) clinical and diagnostic skills: outpatient clinic management and perioperative care; (3) hygiene, prevention, healthcare systems; (4) technical skills; (5) emergency and trauma surgery; (6) perioperative management, integrating Enhanced Recovery After Surgery (ERAS) protocols, nutritional assessment, and infections; (7) evidence-based medicine and recommendations. The SPIGC curriculum highlights the importance of simulation labs, hands-on workshops, and online learning, while providing clear pathways for fellowships or masters. It also introduces artificial intelligence (AI) systems as a modern learning tool, while highlighting the importance of their safe and responsible use.</p><p><strong>Conclusions: </strong>The SPIGC curriculum may provide a structured plan to improve surgical education for medical students in Italy and to align it with international standards. Its acceptability and impact on training quality and patient outcomes remain to be evaluated through future consensus and prospective studies.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1773-1784"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219623","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":"Imaging Manifestations and Clinical Analysis of 12 Cases of Anorectal Malignant Melanoma.","authors":"Lisong Chen, Jingru Dai, Linying Ma, Chunlan Deng, Feng Chen, Ping Zhu","doi":"10.62713/aic.4863","DOIUrl":"https://doi.org/10.62713/aic.4863","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features and clinical characteristics of primary anorectal malignant melanoma (ARMM).</p><p><strong>Methods: </strong>This retrospective analysis was conducted on the clinical, imaging and pathological data of 12 patients with pathologically confirmed ARMM admitted to The First Affiliated Hospital, Zhejiang University School of Medicine between March 2021 and December 2024, and the relevant literature was reviewed and summarized.</p><p><strong>Results: </strong>All patients underwent CT and MRI examinations. Among the 12 patients, 5 were male and 7 were female; their ages ranged from 37 to 78 years, with a median age of 65 years. The clinical manifestations were diverse, with bloody stool being the most common (58.3%), followed by anal pain (16.7%) and polypoid vegetation prolapsing from the anus (16.7%). Typical anal pigmentation with pruritus was rare (8.3%). Gross pathological examination revealed a polypoid tumor in 7 cases and an ulcerative or infiltrative growth pattern in 5 cases. Immunohistochemical staining results showed that 12 cases were positive for human melanoma black-45 (HMB-45) and Melan-A, and 9 cases were positive for S-100. On imaging, plain CT scan showed that the tumors were predominantly isodense or slightly hyperdense, with a maximum diameter of approximately 2-5 cm. The enhancement patterns varied, but the tumors predominantly demonstrated marked heterogeneous enhancement. On MRI, most lesions were isointense on T1WI (10/12); 11/12 lesions were slightly hyperintense on T2WI, and hyperintense on diffusion-weighted images (DWI). After enhancement, most tumors exhibited marked heterogeneous enhancement.</p><p><strong>Conclusions: </strong>Most of the ARMM lesions in this group demonstrated atypical MRI signal characteristics, making diagnosis challenging. When an anorectal tumor exhibits iso- or hypointensity on T1WI and hyperintensity on T2WI, ARMM should be considered in the differential diagnosis. The CT manifestations lack specificity, and clinical symptoms may mimic those of benign lesions. ARMM may show involvement of the perirectal fat plane on imaging and regional lymph node metastasis and generally shows limited sensitivity to radiotherapy and chemotherapy, contributing to low therapeutic efficacy and poor prognosis. The definitive diagnosis of ARMM depends on histopathological examination, with immunohistochemical staining for S-100, HMB-45 and Melan-A can provide supportive information for the diagnosis of ARMM.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1880-1891"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219889","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 a Multidimensional Intraoperative Pressure Injury Prevention Protocol on Postoperative Pressure Injuries Incidence in Elderly Patients Undergoing Internal Fixation for Hip Fracture.","authors":"Jiashun Lu, Yulei Hou, Kaixi Yu","doi":"10.62713/aic.4561","DOIUrl":"https://doi.org/10.62713/aic.4561","url":null,"abstract":"<p><strong>Aim: </strong>To retrospectively analyze the comparative effectiveness of a multidimensional intraoperative pressure injury prevention protocol versus routine nursing care in elderly patients undergoing internal fixation for hip fracture, by comparing the incidence of postoperative pressure injuries, patient satisfaction, and clinical outcomes, to provide evidence-based reference for clinical nursing decision-making.</p><p><strong>Methods: </strong>A retrospective analysis was conducted by reviewing the medical records of elderly patients who underwent internal fixation for hip fracture during the same period. Based on the actual nursing protocol implemented clinically, patients were categorized into two groups: an observation group, which received the multidimensional intraoperative pressure injury prevention protocol (n = 96), and a conventional group, which received standard pressure injury care (n = 104). The pressure injury incidence on postoperative day 7, hospitalization duration, and medical expenses constituted the primary endpoints; the secondary measures included inflammatory factors (C-reactive protein [CRP], Interleukin-6 [IL-6]), oxidative stress indexes (Malondialdehyde [MDA], Superoxide dismutase [SOD]), and functional recovery parameters (hip joint mobility, muscle strength).</p><p><strong>Results: </strong>The 7-day incidence of postoperative pressure injuries was lower in the observation group than in the conventional group (<i>p</i> < 0.05). Shorter hospital stays, and lower medical expenses were observed in the observation group (<i>p</i> < 0.05), while patient satisfaction was also evaluated as a secondary clinical outcome. At 72 h post-operation, CRP, IL-6, and MDA were significantly reduced, while SOD activity was significantly elevated in the observation group compared with the conventional group (<i>p</i> < 0.05); no significant intergroup differences in these indicators were observed at 24 h post-operation (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>The multidimensional intraoperative pressure injury prevention protocol, which integrates preoperative accurate assessment and intraoperative dynamic mechanical intervention, is associated with a significantly lower incidence of postoperative pressure injuries, shorter length of hospital stay, and lower medical costs in elderly patients with hip fractures undergoing internal fixation.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1864-1871"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219805","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":"Safety and Short-Term Clinical Outcomes of Robot-Assisted Lobectomy Based on the Tubeless Concept for Early-Stage Lung Cancer: A Retrospective Cohort Study.","authors":"Zhenlin Jiang, Jianhua Yan, Zuxin Dong, Junting Chen","doi":"10.62713/aic.4714","DOIUrl":"https://doi.org/10.62713/aic.4714","url":null,"abstract":"<p><strong>Aim: </strong>The Tubeless comprehensive management model minimizes iatrogenic trauma by avoiding endotracheal intubation, chest tube placement, and urinary catheterization, while the robot-assisted thoracoscopic surgery system offers precise surgical manipulation and high-definition visualization. However, clinical evidence supporting the combination of these two approaches in early-stage lung cancer surgery remains limited. This study aimed to evaluate the short-term safety and clinical benefits of robot-assisted lobectomy based on the Tubeless concept in patients with early-stage lung cancer.</p><p><strong>Methods: </strong>A total of 120 patients with early-stage non-small cell lung cancer who underwent robot-assisted lobectomy in our department between January 2022 and May 2025 were retrospectively analyzed. According to the perioperative management approach, patients were divided into the Tubeless group (n = 50), which received spontaneous breathing anesthesia without indwelling chest tubes or urinary catheters, and the traditional group (n = 70), which received double-lumen endotracheal intubation with indwelling chest tubes and urinary catheters. Baseline characteristics, intraoperative parameters, postoperative pain scores, postoperative complications, length of hospital stay, patient satisfaction, and 30-day readmission rates were compared between the two groups.</p><p><strong>Results: </strong>No significant differences in baseline characteristics were observed between the two groups (<i>p</i> > 0.05). Similarly, no significant differences were observed in intraoperative blood loss, operative time, number of lymph node dissection stations, or total number of lymph nodes dissected (<i>p</i> > 0.05). Visual analogue scale (VAS) scores on postoperative days 1, 2, and 3 were significantly lower in the Tubeless group than in the traditional group (<i>p</i> < 0.05). The overall incidence of postoperative complications was significantly lower in the Tubeless group than in the traditional group (<i>p</i> = 0.04). Total hospital stay and postoperative hospital stay were significantly shorter in the Tubeless group than in the traditional group (<i>p</i> < 0.001). No significant difference was observed in the 30-day readmission rate between the two groups.</p><p><strong>Conclusions: </strong>Robot-assisted lobectomy combined with the Tubeless comprehensive management approach is feasible and is associated with favorable short-term perioperative outcomes in patients with early-stage lung cancer. However, long-term oncologic outcomes, such as recurrence-free and overall survival, require further investigation.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1912-1920"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219877","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":"Association Between Two Anatomical Landmark Measurements and Tibial Osteotomy Thickness in Total Knee Arthroplasty.","authors":"Jinglei Shi, Hui Liu, Pu Liu, Feng Jing, Xu Cai","doi":"10.62713/aic.4635","DOIUrl":"https://doi.org/10.62713/aic.4635","url":null,"abstract":"<p><strong>Aim: </strong>This study preliminarily explores the statistical association between measurements derived from the apex of the tibial tubercle and the most lateral point of the fibular head, as anatomical reference landmarks, and tibial osteotomy thickness in total knee arthroplasty (TKA), while also evaluating the limitations of their predictive value.</p><p><strong>Methods: </strong>We analyzed the computed tomography (CT) scan data from 20 patients in the TKA Group and 30 patients in the Non-surgical Group. Key anatomical measurements were performed: the distance from the tibial tubercle apex to the osteotomy surface in the sagittal plane (tibial tubercle distance [TD]), and the distance from the most lateral point of the fibular head to the osteotomy surface in the coronal plane (fibular head distance [FD]). Statistical analysis was performed using SPSS 22.0 software. The primary aim was to assess the association between these measurements and the tibial osteotomy thickness and to evaluate the strength and limitations of this association for exploratory estimation of tibial osteotomy thickness.</p><p><strong>Results: </strong>Measurements showed good to excellent inter-observer reliability (intraclass correlation coefficient [ICC]: 0.89-0.91). A modest inverse association was observed. The multiple regression model combining both landmarks was significant (F = 3.303, <i>p</i> = 0.041), but demonstrated very limited explanatory power (adjusted R² = 0.041), and neither landmark emerged as an independent significant predictor (normalized tibial tubercle distance [TDJ]: <i>p</i> = 0.078; normalized fibular head distance [FDJ]: <i>p</i> = 0.098). In an exploratory time-series analysis, an Auto Regressive Integrated Moving Average (ARIMA) (0,1,0) model demonstrated a high goodness-of-fit on the historical data (R² = 0.896, Mean Absolute Percentage Error [MAPE] = 1.137%), whereas its near-zero stationary R² suggests that its goodness-of-fit may be attributed more to the intrinsic continuity of the data series rather than the predictive utility of the anatomical landmarks.</p><p><strong>Conclusions: </strong>This study demonstrates a modest inverse association between the measurements derived from the tibial tubercle apex/the most lateral point of the fibular head and the tibial osteotomy thickness. However, linear regression reveals that these variables are weak standalone predictors, and their clinical predictive utility likely depends on integration into multifactorial models.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1794-1801"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219838","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":"Oblique Vertical Component and Dual Anteroposterior Fixation in Sagittal \"L\"-Shaped High Tibial Osteotomy: Technical Considerations and Biomechanical Reasoning.","authors":"Eliseo Javier Firman","doi":"10.62713/aic.4737","DOIUrl":"https://doi.org/10.62713/aic.4737","url":null,"abstract":"<p><strong>Aim: </strong>To describe an oblique vertical modification of the sagittal \"L\"-shaped high tibial osteotomy combined with dual anteroposterior fixation and to present the biomechanical reasoning supporting its potential application.</p><p><strong>Methods: </strong>A technical note was developed based on the previously described sagittal \"L\"-shaped high tibial osteotomy (HTO). The proposed modification consists of introducing a slight obliquity (10°-20°) in the vertical osteotomy component posterior to the tibial tubercle while maintaining supplementary parallel anteroposterior fixation. The surgical technique, preoperative planning, indications, and biomechanical reasoning were reviewed and described.</p><p><strong>Results: </strong>The proposed modification was designed to increase the available metaphyseal cancellous contact area without substantially altering the original osteotomy geometry. Based on geometric principles and previously published biomechanical studies evaluating osteotomy configurations, the oblique orientation may theoretically improve contact surface characteristics and facilitate load transfer across the osteotomy interface. Dual anteroposterior fixation is maintained as an adjunct stabilization strategy previously described for this osteotomy configuration.</p><p><strong>Conclusions: </strong>The oblique vertical modification represents a technical refinement of the sagittal \"L\"-shaped high tibial osteotomy. Although its proposed biomechanical advantages remain theoretical and require experimental and clinical validation, the modification may provide a useful geometric framework for increasing metaphyseal contact area while preserving the established principles of sagittal alignment control, posterior tibial slope preservation, and maintenance of patellar height.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1929-1936"},"PeriodicalIF":0.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219861","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":"Development and Validation of a Multivariate Nomogram for Predicting Post-ERCP Pancreatitis: A Retrospective Cohort Study.","authors":"Xiaodong Zhang, Jieyu Zhang, Lu Wang","doi":"10.62713/aic.4758","DOIUrl":"https://doi.org/10.62713/aic.4758","url":null,"abstract":"<p><strong>Aim: </strong>To identify predictors of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and to develop a multivariate prediction model by comprehensively evaluating clinical characteristics, procedure-related factors, and inflammatory biomarkers, including C-reactive protein (CRP)-to-lymphocyte ratio (CLR).</p><p><strong>Methods: </strong>A total of 335 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Zhejiang Jinhua Guangfu Cancer Hospital from December 2022 to December 2025 were retrospectively analyzed. Patients were divided into the PEP group (<i>n</i> = 52) and the non-PEP group (<i>n</i> = 283) according to whether PEP occurred. Demographic characteristics, comorbidities, ERCP-related procedural factors, and preoperative laboratory indices were collected and evaluated. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of PEP. A nomogram was subsequently developed based on the identified independent predictors. The discriminative ability, calibration, and clinical utility of the model were evaluated using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision curve analysis, respectively.</p><p><strong>Results: </strong>Compared with the non-PEP group, patients who developed PEP exhibited significantly higher CLR levels and a higher prevalence of periampullary diverticulum, pancreatic duct cannulation, and pancreatic duct guidewire passage ≥2 times (all <i>p</i> < 0.05). Multivariate logistic regression analysis revealed that a history of acute pancreatitis (odds ratio [OR] = 3.43, 95% confidence interval [CI]: 1.32-8.93), periampullary diverticulum (OR = 4.10, 95% CI: 2.00-8.39), pancreatic duct cannulation (OR = 3.11, 95% CI: 1.46-6.64), and CLR (OR = 1.11, 95% CI: 1.04-1.19) were independent predictors of PEP. The nomogram incorporating these independent predictors demonstrated satisfactory discriminative ability (area under the curve [AUC] = 0.80, 95% CI: 0.73-0.87). The Hosmer-Lemeshow test indicated good model calibration (<i>p</i> = 0.239), and the decision curve analysis showed that the model provided a net clinical benefit within the threshold probability range of 0.2-0.7.</p><p><strong>Conclusions: </strong>The multivariate nomogram incorporating CLR and other independent predictors demonstrated good discriminative ability and calibration, and may serve as a practical tool for facilitating individualized risk assessment and guiding preventive strategies in patients undergoing ERCP.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 10","pages":"1921-1928"},"PeriodicalIF":0.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219869","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}