Annali italiani di chirurgia最新文献

{"title":"Progress of Digital Technologies in the Perioperative Management of Postoperative Delirium Among Older Adults.","authors":"Yao Lin, Tianmin Lu, Chunlan Liu, Xiuyun Wu, Haiyan Jiang, Mingli Zhu, Weiying Dai","doi":"10.62713/aic.4800","DOIUrl":"10.62713/aic.4800","url":null,"abstract":"<p><p>Postoperative delirium (POD) is one of the most common and severe complications among older adults, and is closely associated with poor outcomes, increased healthcare costs, and long-term cognitive decline. With the rapid growth of the global aging population and the continuous emergence of new geriatric surgical procedures, the prevention and management of POD have become a major challenge. Traditional risk assessment tools have inherent limitations in clinical practice and are insufficient to meet the growing demands of precision medicine. In recent years, digital technologies have shown tremendous potential in perioperative management; innovations such as machine learning-based predictive models, wearable sensors, electroencephalogram (EEG) monitoring, and large language models are increasingly being adopted for POD risk identification. This review comprehensively summarizes research advances in digital technology for POD risk identification and their role in clinical decision support for older adults, with the aim of providing evidence-based insights and implementation guidance for clinical practice.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1561-1574"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987808","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 Nomogram Model Based on Preoperative Coagulation-Fibrinolysis Biomarkers for Predicting Postoperative Hemorrhage After Pancreaticoduodenectomy: A Retrospective Study With Internal Validation.","authors":"Yiling Hu, Weifeng Shen, Dongmei Tang, Hui Zhou","doi":"10.62713/aic.4617","DOIUrl":"https://doi.org/10.62713/aic.4617","url":null,"abstract":"<p><strong>Aim: </strong>Post-pancreaticoduodenectomy hemorrhage (PPH) remains a life-threatening complication. However, conventional coagulation assays fail to capture the dynamic hemostatic disturbances preceding overt bleeding. This study aimed to evaluate whether preoperative coagulation-fibrinolysis biomarkers could improve PPH risk stratification and support the development of an interpretable predictive model.</p><p><strong>Methods: </strong>We retrospectively analyzed 315 adults who underwent elective pancreaticoduodenectomy, randomly allocated to a training cohort (n = 220) and an internal validation cohort (n = 95). Preoperative variables included routine coagulation indices and molecular markers, including thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), and D-dimer. Multivariable logistic regression was used to identify independent predictors and construct a predictive nomogram. Model performance was assessed in terms of discrimination (area under the curve [AUC]), calibration (Brier score and Hosmer-Lemeshow goodness-of-fit test), and decision curve analysis (DCA).</p><p><strong>Results: </strong>In the training cohort, patients who developed PPH exhibited significantly higher levels of TAT, PIC, and D-dimer, and lower fibrinogen (FIB). Multivariable analysis identified four independent predictors: FIB (odds ratio (OR) = 0.46), PIC (OR = 1.79), D-dimer (OR = 1.59), and TAT (OR = 1.15). The nomogram demonstrated good discrimination, with an AUC of 0.81 in the training cohort and 0.75 in the validation cohort. Calibration performance was acceptable, with Brier scores of 0.11 (training) and 0.15 (validation). Although the Hosmer-Lemeshow test indicated no statistically significant lack of fit (<i>p</i> > 0.05 in both cohorts), visual inspection of the validation calibration curve suggested moderate deviations in the intermediate-risk range, likely reflecting the limited sample size. Shapley Additive exPlanations‌ (SHAP) analysis identified PIC as the most influential predictor in the model output.</p><p><strong>Conclusions: </strong>Preoperative coagulation-fibrinolysis \"process markers\" may provide additional information for assessing PPH risk. The four-marker nomogram (PIC, TAT, D-dimer, and FIB) offers an interpretable framework for perioperative risk stratification and demonstrates satisfactory overall performance. However, external validation in larger, independent cohorts is warranted to confirm model generalizability and calibration stability.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1690-1700"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987797","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":"To Explore the Effects of Multidisciplinary Collaborative Nursing on Clinical Outcomes in Patients Undergoing Skull Defect Repair.","authors":"Yifan Chen, Linglin Yao","doi":"10.62713/aic.4697","DOIUrl":"https://doi.org/10.62713/aic.4697","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To explore the effects of the multidisciplinary collaborative nursing model on neurological function, cognitive function, depressive symptoms, and quality of life in patients with cranioplasty (i.e., surgical repair of skull defects).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a single-center retrospective study. A total of 101 patients who underwent skull defect repair at The First People's Hospital of Jiashan from June 2022 to November 2025 were selected as the study population. Patients were divided into two groups based on sequential temporal cohorts: those treated before the implementation of the multidisciplinary collaborative nursing protocol (June 2022 to October 2023) were designated as the control group (n = 54), whereas those treated after its hospital-wide implementation (November 2023 to November 2025) served as the observation group (n = 47). The control group received routine nursing, while the observation group received multidisciplinary collaborative nursing, including multidisciplinary team formation, preoperative psychological counseling and rehabilitation guidance, postoperative rehabilitation training, dynamic assessment of psychological status, and continuous nursing guidance after discharge. Neurological function, cognitive function, anxiety/depression, and self-care ability were assessed using the National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and Activities of Daily Living (ADL), respectively. Quality of life was measured with the General Quality of Life Inventory-74 (GQOLI-74), and postoperative complications were documented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Before the intervention, no significant differences were observed between the two groups in any of the measured indices (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). After the intervention, both groups demonstrated improvement in neurological and cognitive function, as well as reductions in anxiety and depression scores; however, the observation group showed significantly greater improvements compared with the control group. The observation group showed significantly lower NIHSS scores than the control group (&lt;i&gt;p&lt;/i&gt; = 0.02), along with significantly higher MMSE scores (&lt;i&gt;p&lt;/i&gt; &lt; 0.01). Both HADS-A (&lt;i&gt;p&lt;/i&gt; &lt; 0.01) and HADS-D scores (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) were significantly reduced in the observation group compared with the control group. The ADL score of the observation group was also significantly higher than that of the control group (&lt;i&gt;p&lt;/i&gt; = 0.01). Regarding quality of life, the observation group demonstrated significantly higher scores in the psychological (&lt;i&gt;p&lt;/i&gt; &lt; 0.01), social (&lt;i&gt;p&lt;/i&gt; = 0.03), and physical dimensions (&lt;i&gt;p&lt;/i&gt; &lt; 0.01), while no significant difference was found in the material dimension (&lt;i&gt;p&lt;/i&gt; = 0.30). Furthermore, the overall complication rate was significantly lower in the observation group (&lt;i&gt;p&lt;/i&gt; = 0.04).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Multidi","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1607-1614"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987944","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 Value of a Dynamic AFP-LDH Index for Predicting Recurrence After Curative Resection in Hepatocellular Carcinoma.","authors":"Bartu Çetin, Emine Bihter Eniseler, Atike Pınar Erdoğan","doi":"10.62713/aic.4711","DOIUrl":"https://doi.org/10.62713/aic.4711","url":null,"abstract":"<p><strong>Aim: </strong>Although curative resection remains a cornerstone treatment for hepatocellular carcinoma (HCC), recurrence continues to limit durable disease control in a considerable proportion of patients. Improved postoperative risk assessment may facilitate more individualized surveillance and management strategies. Accordingly, we examined the prognostic performance of a dynamic alpha-fetoprotein-lactate dehydrogenase (AFP-LDH) Index in predicting recurrence after curative resection.</p><p><strong>Methods: </strong>Patients who underwent curative resection for HCC between January 2020 and January 2025 were retrospectively analyzed. The AFP-LDH Index was calculated as log₁₀ (postoperative AFP × LDH / preoperative AFP). Survival probabilities were estimated using the Kaplan-Meier method, and the relationship between clinical variables and outcomes was examined with Cox proportional hazards models. Receiver operating characteristic (ROC) analysis was used to identify the optimal cutoff value. Internal validation of the discriminative performance of the AFP-LDH Index was performed using bootstrap resampling (2000 repetitions), and optimism-corrected area under the curve (AUC) estimates with bootstrap-derived 95% confidence intervals were reported.</p><p><strong>Results: </strong>A total of 50 patients were included, with a median follow-up duration of 27.9 months. Recurrence occurred in 26 patients (52.0%). The median RFS was 23 months (95% confidence interval [CI]: 14.5-31.5). ROC analysis identified an optimal AFP-LDH Index cutoff value of >1.67, demonstrating promising discriminative performance (AUC = 0.960). In multivariable analysis, the AFP-LDH Index remained an independent predictor of recurrence (hazard ratio [HR]: 27.24, 95% CI: 5.41-137.14, <i>p</i> < 0.001). ROC analysis demonstrated good discriminative performance for recurrence prediction (AUC = 0.960; 95% CI: 0.863-0.995; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The dynamic AFP-LDH Index was independently associated with recurrence risk after curative resection for HCC. This exploratory composite biomarker demonstrated promising prognostic performance; however, further multicenter validation is required before routine clinical application.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1681-1689"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987820","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":"Blood Loss in Pancreatic Resections: Definitions, Risk Factors and Strategies for Intra- and Postoperative Bleeding Prevention - A Narrative Review.","authors":"Charlotte Thrandorf, Emelie Nébel, Lätitia Dennin, Ulrich Ronellenfitsch, Jörg Kleeff, Artur Rebelo","doi":"10.62713/aic.4860","DOIUrl":"https://doi.org/10.62713/aic.4860","url":null,"abstract":"<p><strong>Aim: </strong>Pancreatic resections are among the most complex procedures in general surgery and are associated with high morbidity. Intraoperative blood loss and post-pancreatectomy hemorrhage (PPH) are clinically relevant yet inconsistently defined and reported, limiting comparability across studies. This narrative review integrates current evidence on definitions, risk factors, and preventive approaches for bleeding in pancreatic surgery.</p><p><strong>Methods: </strong>A selective PubMed literature review was conducted without restrictions on publication date or study design, limited to full-length English-language articles. Multiple targeted searches addressed definitions of blood loss, PPH, patient- and procedure-related risk factors, patient blood management, tranexamic acid, surgical techniques, and perioperative outcomes.</p><p><strong>Results: </strong>Blood loss estimation is highly heterogeneous across studies. Key risk factors for increased blood loss and/or PPH include obesity, antithrombotic therapy, preoperative anemia, vascular resection, and prolonged operative time. Higher intraoperative blood loss correlates with higher reoperation rates, prolonged intensive care unit (ICU) stay, and increased 90-day mortality. While perioperative transfusions are associated with shorter long-term survival in observational studies, causal interpretation remains limited by confounding, suggesting that blood loss and preoperative anemia rather than transfusion itself drive adverse outcomes. Effective preventative approaches include Patient Blood Management (PBM) programs, preoperative intravenous iron supplementation, the artery-first approach, and minimally invasive surgical techniques, which may reduce blood loss and/or transfusion requirements; prophylactic falciform ligament wrapping may reduce the risk of PPH.</p><p><strong>Conclusions: </strong>Systematic preoperative risk assessment, structured PBM protocols, and tailored surgical strategies are necessary to minimize hemorrhagic complications in pancreatic surgery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1549-1560"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987661","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":"Comparative Study of Dual-Modality Endoscopic Surgery in Elderly Patients With Emergency Common Bile Duct Stone Complicated With Gallbladder Stones-Clinical Application Analysis of ERCP Combined With LC Versus LCBDE+LC.","authors":"Xinyuan Wu, Zhiqiang Yu, Jun Shao, Jun Li, Zuofu Liao","doi":"10.62713/aic.4556","DOIUrl":"https://doi.org/10.62713/aic.4556","url":null,"abstract":"<p><strong>Aim: </strong>To compare and analyze the clinical efficacy of two surgical approaches, endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE)+LC, in the treatment of emergency common bile duct stones, providing evidence-based support for individualized clinical surgical selection.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 103 patients with emergency common bile duct stones complicated by gallbladder stones admitted between December 2016 and January 2023. The patients were divided into an ERCP+LC group (n = 56) and an LCBDE+LC group (n = 47). Surgical indicators, postoperative recovery, complications (Clavien-Dindo grade), and mid-term recurrence rates (1 and 1.5 years postoperatively), were compared between the two groups. Age and American Society of Anesthesiologists (ASA) classification were included as covariates in the multivariate Cox regression model, and multivariate logistic regression was performed to adjust for preoperative pancreatitis and evaluate its effects on operative time, postoperative complications and recurrence rate.</p><p><strong>Results: </strong>The ERCP+LC group demonstrated significantly better intraoperative blood loss (15.00 (10.00-25.00) mL) and operative time (64.11 ± 26.64 min) compared to the LCBDE+LC group (30.00 (20.00-42.50) mL and 116.11 ± 29.69 min, respectively), but with higher hospitalization costs (<i>p</i> < 0.001). The LCBDE+LC group showed higher clearance rates for mid-common bile duct stones (n = 41, 87.23%) and sandy stones (n = 38, 80.85%) (<i>p</i> = 0.008; <i>p</i> = 0.010), and due to the preservation of the Oddi sphincter, the mid-term recurrence rates at 1 year and 1.5 years postoperatively were lower than those in the ERCP+LC group, although the differences were not statistically significant. High-risk patients (e.g., those with advanced age combined with severe comorbidities or ASA classification ≥ III) demonstrated comparable safety and perioperative recovery profiles between the two procedures (with identical complication rates of 9.1% and <i>p</i> > 0.05 for recovery time and hospital stay), while the ERCP+LC group exhibited a significantly shorter single-session operative time (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Both approaches are effective treatments. ERCP+LC offers a shorter single-session operative time while maintaining a safety profile comparable to LCBDE+LC, making it a suitable option for high-risk patients sensitive to prolonged surgical stress, while LCBDE+LC offers more thorough stone clearance and better mid-term control of recurrence. Clinical decisions should consider stone characteristics, patient conditions, and hospital technical capabilities to develop individualized treatment strategies.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1615-1623"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987664","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":"Enteric NK/T Cell Lymphoma-induced Recurrent Perforation in the Intestine: A Case Report.","authors":"Jiansen Su, Yixiao Yang, Xinyi Huang, Liang Wen","doi":"10.62713/aic.4662","DOIUrl":"https://doi.org/10.62713/aic.4662","url":null,"abstract":"<p><strong>Aim: </strong>To report a rare case of recurrent intestinal perforation caused by primary intestinal extranodal NK/T-cell lymphoma (ENKTL), analyze the diagnostic challenges of this rare and aggressive malignancy, and raise clinical awareness for its early identification and optimal management in patients with unexplained gastrointestinal perforation.</p><p><strong>Case presentation: </strong>A 31-year-old female presented with 3 days of persistent hypogastric abdominal pain and a 1-day history of high fever up to 39 ℃. She had undergone emergency surgery for jejunal perforation 20 months prior, with a postoperative pathological diagnosis of Epstein-Barr virus (EBV)-associated T- and NK-cell lymphoproliferative disorders. Multiple follow-up colonoscopies and bone marrow aspiration examinations failed to confirm the diagnosis of ENKTL, due to negative immunohistochemical staining of cluster of differentiation (CD)56 and EBV-encoded small RNA (EBER) in biopsy specimens. Abdominal contrast-enhanced computed tomography on this admission confirmed intestinal perforation, and emergency partial ileectomy was performed. Histopathological examination of the resected specimen showed diffuse full-thickness intestinal infiltration of atypical lymphoid cells, with positive immunohistochemical staining for CD2, CD3, CD56, T‑cell intracellular antigen‑1 (TIA-1) and EBER, and a Ki-67 proliferation index of approximately 70%. The final diagnosis of ENKTL (Ann Arbor stage IVA) was confirmed, and the patient received systemic chemotherapy with a regimen of methotrexate, etoposide, dexamethasone and pegaspargase after surgery.</p><p><strong>Results: </strong>The patient's general condition improved significantly after combined surgical intervention and systemic chemotherapy. During the 26-month continuous follow-up, the patient remained in good general condition, with no recurrence of abdominal pain, intestinal perforation, disease progression, or severe treatment-related adverse events.</p><p><strong>Conclusions: </strong>Primary intestinal ENKTL is a rare and highly aggressive subtype of non-Hodgkin lymphoma, whose non-specific clinical and imaging manifestations pose major challenges for early diagnosis, which may lead to delayed treatment and unfavorable prognosis. This disease should be included in the core differential diagnosis for young patients, especially Asian populations, presenting with unexplained gastrointestinal perforation. Repeated deep tissue biopsy, EBER detection combined with comprehensive imaging evaluation are essential for early definitive diagnosis, and timely surgical intervention combined with standardized systemic chemotherapy can effectively improve the clinical outcomes of affected patients.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1544-1548"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987748","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":"Postoperative C-Reactive Protein-to-Albumin Ratio Predicts Anastomotic Leakage After Elective Right Hemicolectomy for Colon Cancer.","authors":"İsmail Ege Subaşı, Ahmet Topcu, Furkan Saydın","doi":"10.62713/aic.4761","DOIUrl":"10.62713/aic.4761","url":null,"abstract":"<p><strong>Aim: </strong>Anastomotic leakage (AL) is a life-threatening complication of colorectal surgery carrying significant risks of postoperative morbidity and mortality. Timely identification of patients at elevated risk for AL is critical for optimizing surgical outcomes. This study aimed to evaluate factors associated with AL and to assess the predictive utility of the postoperative day 3 C-reactive protein-to-albumin ratio (CAR) in patients undergoing elective right hemicolectomy for colon cancer.</p><p><strong>Methods: </strong>This retrospective observational cohort study included patients who underwent elective right hemicolectomy with primary ileocolic anastomosis for colon cancer at Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital (January 2020 to January 2025). Patients undergoing emergency surgery, multivisceral resection, diverting stoma formation, or with incomplete data were excluded. ROC curve analysis and limited univariable logistic regression were used to evaluate the predictive performance of postoperative day 3 CAR.</p><p><strong>Results: </strong>A total of 194 patients were included, and AL developed in 14 patients (7.2%). No significant differences were observed between groups regarding age, body mass index, operative duration, surgical technique, or comorbidities, confirming the homogeneity of the study population. Early enteral feeding was initiated significantly later in patients with AL (3.36 ± 0.74 vs. 2.83 ± 0.76 days, <i>p</i> = 0.021). Postoperative day 3 C-reactive protein (CRP) levels were significantly higher in the AL group (451.3 [398.7-534.2] mg/L vs. 98.4 [71.2-138.6] mg/L, <i>p</i> < 0.001), whereas serum albumin levels were significantly lower (2.30 ± 0.16 g/dL vs. 3.09 ± 0.34 g/dL, <i>p</i> < 0.001). The postoperative day 3 CAR was markedly elevated in patients with AL compared with those without leakage (196.4 [168.2-248.7] vs. 32.1 [22.4-45.8], <i>p</i> < 0.001). Receiver operating characteristic (ROC) curve analysis demonstrated strong predictive performance for CAR, with an area under the curve (AUC) of 0.91 (95% CI: 0.84-0.98, <i>p</i> < 0.001). The optimal cutoff value was 148.7, yielding a sensitivity of 85.7% and specificity of 88.3%. In limited univariable logistic regression analysis, postoperative day 3 CAR remained significantly associated with AL (odds ratio [OR]: 6.84, 95% CI: 3.11-11.52, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>On postoperative day 3, CAR demonstrated strong discriminatory performance for anastomotic leakage after elective right hemicolectomy in this retrospective cohort. The high negative predictive value (98.8%) suggests potential utility as a rule-out tool for early postoperative risk stratification; however, these findings require prospective multicenter validation before any clinical implementation can be considered.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1701-1707"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987848","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 Rare Case of Spontaneous Transvaginal Intestinal Evisceration.","authors":"Fabio Cavallo, Raffaele Basile, Salvatore De Maria, Antonio Coppola, Augusto Campi, Francesco Bianco, Giuseppe Siciliano","doi":"10.62713/aic.4558","DOIUrl":"https://doi.org/10.62713/aic.4558","url":null,"abstract":"","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1529-1532"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987610","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":"Clinical Efficacy Comparison of Bilaterally Threaded Elastic Locking Intramedullary Nailing Versus Minimally Invasive Percutaneous Locking Plate Fixation in Treating Midshaft Clavicle Fractures.","authors":"Zhongyi Pan, Feicheng Qi, Junwei Gao, Yansong Chen","doi":"10.62713/aic.4484","DOIUrl":"https://doi.org/10.62713/aic.4484","url":null,"abstract":"<p><strong>Aim: </strong>Midshaft clavicle fractures are a common form of upper extremity injury, with various treatment modalities available to stabilize displaced midshaft clavicular fractures. However, the optimal surgical method remains a matter of controversy. This study aimed to compare the clinical efficacy of bilaterally threaded elastic locking intramedullary nailing (BTELIN) versus minimally invasive percutaneous locking plate (MIPLP) fixation in treating midshaft clavicle fractures.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on 110 patients with midshaft clavicle fractures treated between May 2021 and April 2024. Fifty-two patients received BTELIN fixation (Group A), while 58 patients underwent MIPLP fixation (Group B). Perioperative indicators (operative time, intraoperative blood loss, and hospital stay), fracture healing time, visual analog scale (VAS) for pain, Constant-Murley Shoulder Score, Disabilities of the Arm, Shoulder and Hand (DASH) score, shoulder range of motion (ROM), and postoperative complications were compared between the two groups.</p><p><strong>Results: </strong>Compared with Group B, Group A exhibited significantly shorter operative time, less intraoperative blood loss, shorter hospital stay, and faster fracture healing time (<i>p</i> < 0.001). At 1 and 6 months postoperatively, VAS and DASH scores in Group A were significantly lower than those in Group B (<i>p</i> < 0.001), while Constant-Murley scores were significantly higher (<i>p</i> < 0.001). By 12 months postoperatively, there were no statistically significant differences in VAS or Constant-Murley scores between the two groups (<i>p</i> > 0.05); however, the DASH score in Group A remained significantly better than that in Group B (<i>p</i> < 0.05). Regarding shoulder ROM, Group A demonstrated superior movement in all directions at 3 months postoperatively (<i>p</i> < 0.001). At 12 months postoperatively, Group A maintained an advantage in external rotation and internal rotation (<i>p</i> < 0.05). There was no statistically significant difference in the incidence of various complications between the two groups (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>Both BTELIN and MIPLP are effective methods for treating midshaft clavicle fractures. BTELIN offers several advantages in terms of minimal invasiveness, promotion of fracture healing, accelerated early functional recovery, and, in particular, preservation of shoulder rotation function. Therefore, BTELIN may represent a promising surgical option.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1708-1717"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987659","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}