Annali italiani di chirurgia最新文献

{"title":"Correlation between Preoperative Blood Pressure Variability and Carotid Sinus Reaction after Internal Carotid Artery Stenting.","authors":"Xinxiu Zhao, Zhengyu Tong, Liang Yin, Song Luo, Yuyu Li, Peng Shi, Weidong Qian","doi":"10.62713/aic.3730","DOIUrl":"https://doi.org/10.62713/aic.3730","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the relationship between blood pressure variability (BPV) 24 hours before internal carotid artery stenting and post-procedural carotid sinus reaction (CSR), with an emphasis on identifying BPV indexes that predict the implementation of carotid artery stenting (CAS) and the subtype of CSR.</p><p><strong>Methods: </strong>A total of 105 patients who completed 24-hour ambulatory blood pressure monitoring and underwent CAS from August 2019 to February 2024 in the First Affiliated Hospital of Bengbu Medical College were included in this study. Patients were divided into CSR and non-CSR groups. The CSR group was further divided into three subgroups according to the type of CSR that occurred: namely hypotensive, bradycardic, and mixed types. Prior to stent placement, changes in ambulatory blood pressure were monitored using a fully automated non-invasive portable blood pressure monitor for 24 hours before the procedure, and the individual metrics in BPV were compared.</p><p><strong>Results: </strong>CSR occurred in 69 patients (65.71%) and the remaining 36 patients did not experience CSR (34.29%). Among the patients with CSR, 46 (66.67%) experienced hypotensive CSR, 9 (13.04%) had bradycardic CSR, and 14 (20.29%) mixed-type CSR. The age, history of hypertension, coronary artery disease, and history of smoking were significantly higher in the CSR group than in the non-CSR group (p = 0.007, p = 0.002, p = 0.046, p = 0.007, respectively). Age, hypertension, and history of smoking were the risk factors for CSR. A statistically significant difference in triglyceride levels was found between the three subgroups of CSR (p < 0.05); however, triglycerides had no significant effect on the type of CSR subgroups (all p > 0.05). A series of preoperative BPV indexes, like the maximum systolic blood pressure (SBP), SBP's max-min difference, mean, standard deviation (SD), coefficient of variation (CV), and degree of variability (SV) of the 24-hour SBP, were significantly correlated with the occurrence of CSR (p < 0.05). Further analysis revealed that SBP's max-min difference, SD, CV, and SV of 24-hour SBP were independent predictors of CSR. The bradycardic CSR was significantly correlated with the maximum diastolic blood pressure (DBP), minimum DBP, and 24-hour mean DBP, when compared to the hypotensive CSR (p < 0.05). The mixed-type CSR was significantly correlated with the maximum DBP and minimum DBP, when compared to the bradycardic CSR (p < 0.05).</p><p><strong>Conclusions: </strong>The indexes of BPV 24 hours before internal carotid artery stenting correlate with the occurrence and types of CSR. Therefore, BPV can be used as a predictor of the occurrence and specific type of CSR after internal carotid artery stenting.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"179-187"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432356","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":"Conservative Management of Gastric Twist and Leak Post Band Removal and Sleeve Gastrectomy.","authors":"Mohammad N Nofal, Ali J Yousef, Mohammad Salah, Saad H Samarah","doi":"10.62713/aic.3742","DOIUrl":"https://doi.org/10.62713/aic.3742","url":null,"abstract":"<p><strong>Aim: </strong>Gastric twist is a rare, however, troublesome complication of laparoscopic sleeve gastrectomy. This report describes a case complicated by perforation and leak in addition to twist. The patient was managed conservatively and successfully.</p><p><strong>Case presentation: </strong>A 29-year-old female patient with a body mass index (BMI) of 41.3 kg/m2 (111 kg/1.64 m), who underwent gastric band insertion six years ago, recently experienced postprandial vomiting. Endoscopic examination revealed grade A esophagitis, minor antral gastropathy, and mild bulbar duodenitis. Her BMI was calculated at 33.1 kg/m2 (89 kg/1.64 m). One week later, she had a laparoscopic band removal and sleeve gastrectomy using an endo GIA Tri-stapler. Both the surgical and postoperative periods proceeded without complications, and she was discharged home the next day after surgery. The patient was readmitted after two weeks due to an organo-axial gastric volvulus, which was managed with stent placement. Six weeks following, a stomach leak and peri splenic fluid collection were diagnosed. A 12 mm Ovesco clip was employed to seal a perforation situated 35 cm from the incisors. Subsequently, a MEGA bariatric stent was placed.</p><p><strong>Results: </strong>Two months after the removal of the MEGA stent, the patient had recovered completely and was in good health.</p><p><strong>Conclusions: </strong>Gastric twist after sleeve gastrectomy is a rare condition; a high index of suspicion is required for diagnosis. Prioritize conservative treatment to prevent the risk of revisional surgery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"14-18"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999000","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 Application of a New Model for Disease Classification in Minimally Invasive Treatment of Concomitant Cholecystolithiasis and Choledocholithiasis.","authors":"Yiwei Liu, Yusha Xiao, Pengpeng Liu, Jianwei Lan, Dekun Song, Longhui Xie, Quanyan Liu","doi":"10.62713/aic.3771","DOIUrl":"https://doi.org/10.62713/aic.3771","url":null,"abstract":"<p><strong>Aim: </strong>There is no consensus regarding the minimally invasive treatment method for concomitant cholecystolithiasis and choledocholithiasis. Therefore, this study aimed to develop a universal classification system for minimally invasive surgeries, thereby supporting development of consensus in guidelines for diagnosing choledocholithiasis.</p><p><strong>Methods: </strong>This retrospective study included 1044 consecutive patients with concomitant cholecystolithiasis and choledocholithiasis who underwent different minimally invasive surgical treatments at the Zhongnan Hospital of Wuhan University, China, between January 2014 and April 2021. To identify the key factors influencing the choice of different minimally invasive surgical procedures, clinical data for all hospitalized patients were analyzed. The patients were followed up through outpatient visits or telephonic calls at 1 week, 6 weeks, 3 months, 6 months, and 1 year or immediately if symptoms developed following discharge from the hospital. This information was integrated in the form of a new disease classification model, and the optimal treatment approaches were screened.</p><p><strong>Results: </strong>A significant correlation was observed between the choice of minimally invasive surgical procedures and the concomitant common bile duct (CBD) (p < 0.001), stone size (p < 0.001), or stone number (p < 0.001). A new clinical classification model was developed for patients with concomitant gallbladder (GB) and CBD stones based on the CBD diameter, stone sizes, and stone numbers, and the patients were sorted into Type I, II, III, and Ⅳ, respectively. Three invasive surgical methods were performed in patients with type I patients, revealing the laparoscopic cholecystectomy + Laparoscopic Transcystic Common Bile Duct Exploration (LC + LTCBDE) method as a preferred option for these patients. Furthermore, five surgical methods were performed on patients with type II CBD stones, demonstrating LC + LTCBDE as the viable option for these patients. Additionally, among the four minimally invasive surgical methods applied in patients with type III, the LC + laparoscopic choledochotomy for common bile duct exploration (LCCBDE) + Duodenoscope or LC + LCCBDE + primary closure demonstrated favorable results in this group of patients. Among the three methods applied in type IV patients, LC + laparoscopic choledocholithotomy and T-tube drainage (LCTD) were found to be more favorable.</p><p><strong>Conclusions: </strong>In summary, this novel and simple clinical classification system, which is based on CBD diameter, stone sizes, and stone numbers, can assist clinicians in selecting a minimally invasive treatment approach for managing concomitant GB and CBD stones.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"244-260"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432366","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":"Predictive Value of Systemic Immune-Inflammation Index Combined with Distal Ureteral Diameter Ratio for Early Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux.","authors":"Xiangxiang Chen, Weihua Zheng, Xiaoyu Tang, Yan Chen, Fang Chen, Xiujun Yang","doi":"10.62713/aic.3916","DOIUrl":"https://doi.org/10.62713/aic.3916","url":null,"abstract":"<p><strong>Aim: </strong>To investigate predictive value of the systemic immune-inflammation index (SII) combined with the distal ureteral diameter ratio (UDR) for early breakthrough urinary tract infection (BT-UTI) in children with primary vesicoureteral reflux (VUR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 150 VUR patients admitted to ShangHai Children's Hospital from January 2021 to December 2023. Patients were divided into the early BT-UTI group (n = 52) and the non-earlyBT-UTI group (n = 98) based on whether early BT-UTI occurred. Univariate and binary logistics regression analyses were performed to identify factors influencing early BT-UTI in VUR children. Pearson correlation analysis was used to assess the relationship between variables, and receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of SII combined with UDR for early BT-UTI in VUR children.</p><p><strong>Results: </strong>Comparisons of age, gender, body mass index (BMI), neutrophils (NEU), lymphocytes (LYM), red blood cells (RBC), white blood cells (WBC), comorbidities, length of hospital stay, and caregiver education level showed no statistically significant differences (p > 0.05). Differences in reflux grade, UDR, SII, and platelets (PLT) between the groups were statistically significant (p < 0.05). According to Pearson linear correlation analysis, SII was negatively correlated with LYM, and positively correlated with PLT and NEU (r = 0.366 and 0.839, respectively; p < 0.05). UDR was unrelated to NEU and LYM, and positively correlated with PLT (r = 0.280, p < 0.05), and SII was positively correlated with UDR (r = 0.162, p < 0.05). Binary logistic regression analysis indicated that UDR and SII were factors influencing early BT-UTI in VUR children (OR = 1.171 and 5.306, respectively; 95% confidence interval (CI) = 1.099-1.249 and 2.841-9.912, respectively; p < 0.05). The combined variables had an area under the curve (AUC) of 0.832 with a standard error of 0.032 (95% CI: 0.768-0.895), Youden index = 0.53, sensitivity of 90.4%, and specificity of 62.2%. The combined index had an AUC closest to 1, indicating the highest predictive value.</p><p><strong>Conclusions: </strong>UDR combined with SII boasts a high predictive value for early BT-UTI in VUR children.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"345-351"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639393","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":"Chylous Leakage after Endometrial Carcinoma Surgery: A Case Report.","authors":"Shanshan Li, Wenwen Li, An Zhang, Chongyi Yang, Jie Liu","doi":"10.62713/aic.3583","DOIUrl":"https://doi.org/10.62713/aic.3583","url":null,"abstract":"<p><strong>Aim: </strong>This report represents a case of chylous leakage after endometrial carcinoma surgery, providing therapeutic insights into similar cases in future.</p><p><strong>Case presentation: </strong>This report describes a case of chylous leakage after endometrial carcinoma surgery. A 67-year-old woman with a 25-year of menopause was admitted to the hospital due to vaginal bleeding that had persisted for 5 days. She was diagnosed with high-grade serous carcinoma with partial sarcomatoid changes. Subsequently, she received surgical treatment for a malignant endometrial carcinoma, and chylous leakage occurred afterwards. A series of treatments were administered, eventually achieving satisfactory control over the patient's condition.</p><p><strong>Results: </strong>The patient was managed with a multidisciplinary approach, including conservative measures such as bowel rest, total parenteral nutrition, and octreotide to reduce chyle production. Despite initial conservative treatment, chylous leakage persisted, leading to the decision for surgical intervention. Post-surgery, the patient showed significant improvement, with cessation of chylous drainage, and she was eventually discharged with a plan for follow-up care.</p><p><strong>Conclusions: </strong>Chylous leakage after endometrial carcinoma surgery is a serious complication that requires timely diagnosis and comprehensive treatment. This case provides valuable therapeutic insights into treatment plans and ways to improve prognosis of patients grappling with the same condition.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"127-137"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432351","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":"Comparison of Autologous Flap-Supported vs. Stent-Supported Preventive Ileostomy in Laparoscopic Radical Resection of Low Rectal Cancer.","authors":"Xing Liu, Weilin Wang, Meng Li, Lei Gao","doi":"10.62713/aic.3703","DOIUrl":"https://doi.org/10.62713/aic.3703","url":null,"abstract":"<p><strong>Aim: </strong>This study compared the clinical efficacy of preventive ileostomy supported by autologous flaps versus stents in laparoscopic radical resection of low rectal cancer.</p><p><strong>Methods: </strong>Sixty-four patients diagnosed with low rectal cancer who underwent laparoscopic radical resection in Fuyang Women's and Children's Hospital between April 2020 and December 2023 were included in this study. Based on the intraoperative support method, the patients were divided into a control group (n = 30) receiving stent support and a flap support group (n = 34) undergoing autologous flap support. Surgical outcomes, perioperative indicators, and postoperative complications were analyzed and compared between the groups. Patients were followed up for six months to evaluate recovery outcomes.</p><p><strong>Results: </strong>Significant differences were observed in operative time, total duration of surgery, intraoperative blood loss, and hospitalization costs between the two groups (p < 0.05). Postoperative levels of inflammatory markers, including C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT), were elevated at 2, 4, and 6 days after surgery in both groups, while erythrocyte sedimentation rate (ESR) and prealbumin (PA) levels decreased in both groups compared to preoperative levels (p < 0.05). Notably, the flap support group demonstrated significantly lower CRP, IL-6, PCT, and ESR levels and higher PA levels at the same time points compared to the control group at 2, 4, and 6 days after surgery (p < 0.05). The complication rate in the flap support group (2.94%) was significantly lower than in the control group (20.00%) (p < 0.05). During the follow-up period, no cases of permanent fistula were observed in the flap support group, while the control group reported a 13.33% incidence of permanent fistula, indicating a statistically significant difference between the two groups (p < 0.05).</p><p><strong>Conclusions: </strong>Preventive ileostomy supported by autologous skin flaps offers advantages in laparoscopic radical resection for low rectal cancer. This approach simplifies the procedure, eliminates the need for secondary stent removal, reduces postoperative complications, and improves overall safety and recovery outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"188-193"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432355","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":"Two-Step Endodontic and Surgical Treatment of Large Periapical Lesions in the Maxilla: A Case Report.","authors":"Bartłomiej Karaś, Artur Pitułaj, Mariusz Szyba, Jacek Matys, Maciej Dobrzyński","doi":"10.62713/aic.3770","DOIUrl":"https://doi.org/10.62713/aic.3770","url":null,"abstract":"<p><p>The aim of this article was to present a two-step procedure for treating two large periapical lesions located near the maxillary sinus. The first lesion measuring 7.1 mm by 6.1 mm by 5.9 mm was located around the apices of both upper right premolars and was perforating the alveolar bone. The second lesion, measuring 13.7 mm by 16.3 mm by 12.5 mm, was located around all the roots of the first upper right molar. The first step of the procedure involved single-session endodontic treatment. The second step involved endodontic microsurgery. To plan the microsurgery, a Cone Beam Computed Tomography image and an intraoral scan were taken, and a surgical guide was printed to enhance the outcome of the surgery. During the surgical procedure, a 3D-printed guide for the window preparation in the alveolar bone was created with a piezosurgery unit. Next, a microsurgical procedure under magnification with a microscope, retro-preparation, and retrofilling with bioceramic material and platelet rich fibrin were placed in the chamber after the apicectomy. A control cone-beam computed tomography (CBCT) taken 8 months after the treatment revealed full healing in the treated areas. Proper planning, novel technologies, biological approach and precise treatment allowed clinicians to successfully heal both periapical lesions.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"286-295"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639446","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":"Efficacy of Open Reduction and Internal Fixation Assisted by Handheld Ultrasound Combined with 3D Printing Technology in Treating Multiple Rib Fractures.","authors":"Jieshi Li, Qianshun Chen, Xunyu Xu, Yimeng Zhuo, Minhui Zhang, Dong Zhou, Zhong Li","doi":"10.62713/aic.3612","DOIUrl":"https://doi.org/10.62713/aic.3612","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the efficacy of open reduction and internal fixation assisted by handheld ultrasound combined with three-dimensional (3D) printing technology in treating multiple rib fractures.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data from 84 patients affected with multiple rib fractures admitted to our hospital between August 2022 and April 2024. After excluding four cases, 80 cases were included in this study. Based on the method of preoperative rib fracture localization, patients were divided into three groups: group A (n = 30), group B (n = 26), and group C (n = 24). Group A received 3D reconstruction of ribs on chest Computed Tomography (CT), group B adopted the examination of handheld ultrasound and 3D reconstruction of ribs on chest CT, and group C received handheld ultrasound, 3D reconstruction of ribs on chest CT, and 3D printing technology. The operation-related indicators (such as incision length, exposure time of surgical field, intraoperative blood loss), pulmonary function [total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in one second/forced vital capacity (FEV1/FVC), residual volume (RV)], quality of life, degree of pain, and incidence of complications were compared among the three groups.</p><p><strong>Results: </strong>Before surgery, there were no significant differences in pulmonary function, quality of life, and degree of pain among the three groups (p > 0.05). However, after surgery, significant differences in the pairwise comparison of TLC, FVC, FEV1/FVC and RV were observed among the three groups (p < 0.001), with group C indicating the highest levels of observational indicators and group A exhibiting the lowest levels. Furthermore, a significant difference was observed in the pairwise comparison of incision length, exposure time of surgical field, and intraoperative blood loss among the three groups (p < 0.001). Group C had the shortest incision length, the lowest exposure time in the surgical field, and the least intraoperative blood loss, while those in group A were the opposite. After surgery, a significant difference was found in the pairwise comparison of the quality of life and degree of pain among the three groups (p < 0.001). Group C had the highest quality of life and the lowest degree of pain, while Group A had the opposite results. Additionally, there was no significant difference in the incidence of complications among the three groups (p > 0.05).</p><p><strong>Conclusions: </strong>The open reduction and internal fixation assisted by handheld ultrasound combined with 3D printing technology revealed effective curative outcomes in treating multiple rib fractures. This method promotes the formulation of an accurate and personalized surgical plan and seems to have high clinical significance.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"98-107"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999022","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":"Impact of Pterygium Excision Combined with Autologous Limbal Stem Cell Transplantation on Microvascular Density, Tear Film Stability, and Corneal Wound Healing.","authors":"Mengxuan He, Na Li, Jingjing Li, Xiaobo Huang","doi":"10.62713/aic.3800","DOIUrl":"https://doi.org/10.62713/aic.3800","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to evaluate the impact of pterygium excision combined with autologous limbal stem cell transplantation on microvascular density, tear film stability, and corneal wound healing in the management of pterygium.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 317 patients with pterygium who underwent treatment between January 2021 and January 2024. Patients were divided into a control group (pterygium excision alone, n = 161) and a study group (pterygium excision combined with autologous limbal stem cell transplantation, n = 156) based on the surgical approach. The study compared the surgical efficacy, perioperative outcomes, and corneal healing between the two groups. Preoperative and postoperative changes in conjunctival microvascular density, tear film stability indicators, and ocular comfort scores were also assessed.</p><p><strong>Results: </strong>The effective treatment rate was significantly higher in the study group compared to the control group (p < 0.05). Postoperative uncorrected visual acuity, vertical corneal curvature, and horizontal corneal curvature were significantly better in the study group, whereas corneal astigmatism was lower than in the control group (p < 0.05). The postoperative levels of pigment epithelial derived factor (PEDF) were higher in the study group, while levels of vascular endothelial growth factor (VEGF) and microvascular density (MVD) were lower than in the control group (p < 0.05). Corneal healing scores on postoperative days 1, 3, and 7 were lower in the study group than in the control group, and the time resolution of corneal wound congestion and corneal epithelial coverage was significantly shorter compared to the control group (p < 0.05). Tear film stability, as indicated by the Schirmer I test (SIt) and tear breakup time (BUT), was improved in the study group than that in the control group (p < 0.05). Postoperative ocular comfort scores were lower in the study group compared to the control group (p < 0.05). No significant difference in postoperative complication rates was observed between the groups (p > 0.05).</p><p><strong>Conclusions: </strong>Pterygium excision combined with autologous limbal stem cell transplantation effectively inhibits angiogenesis, improves visual function, enhances tear film stability, and accelerates corneal wound healing, making it a superior treatment option for pterygium.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"47-54"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999025","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":"Predicting Risk Factors Affecting the Efficacy of Flexible Ureteral Holmium Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Ureteral Calculi Based on Decision Tree Model.","authors":"Ben Wu, Li Wu, Hao He, Xiaogui Ding, Tong Bao, Rui Zhou","doi":"10.62713/aic.3702","DOIUrl":"https://doi.org/10.62713/aic.3702","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the efficacy of flexible ureteroscopic lithotripsy (FURL) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral calculi based on decision tree model.</p><p><strong>Methods: </strong>A total of 600 patients with ureteral calculi, including 289 treated with FURL and 311 cases with ESWL in Anqing Municipal Hospital from June 2021 to August 2023, were selected as study subjects. Perioperative indicators and stone clearance rate of the two groups were compared, and the preoperative and postoperative (24 and 72 hours) changes of serum creatinine, cystatin C (Cys-C) and microalbumin were observed. The complications during and 7 days after treatment, the influence of perioperative indexes, total stone removal rate and renal function indexes were analyzed using decision tree method, and a complication risk prediction model was constructed.</p><p><strong>Results: </strong>The operation time, length of hospital stays and postoperative hematuria time in FURL group were shorter than those in ESWL group (p < 0.001), and the usage of painkillers was less frequent in FURL group than in ESWL group (p = 0.002). The total stone removal rate in the FURL group was higher than that in the ESWL group (p < 0.001). Serum creatinine, urinary microalbumin and Cys-C in both groups were lower before surgery than at 24 h and 72 h after surgery (p < 0.05). Serum creatinine, urinary microalbumin and Cys-C in FURL group were lower than those in the ESWL group at 24 and 72 h after operation (p < 0.001). The overall complication rate in the FURL group was lower than that in the ESWL group (p = 0.028). Decision tree model analysis showed that four explanatory variables, including preoperative creatinine, urinary microalbumin, Cys-C and surgical method were identified by screening. The risk statistic of the model was 0.027, and the accuracy, sensitivity and specificity of the model in predicting postoperative complications in patients with ureteral calculi were 97.33%, 97.73% and 97.30%, respectively.</p><p><strong>Conclusions: </strong>FURL has significant advantages over ESWL in the treatment of ureteral calculi, and has less impact on renal function and fewer complications. Preoperative creatinine, urinary microalbumin, Cys-C and surgical methods may adversely influence the occurrence of postoperative complications. These identified factors can be employed to build a decision tree model for predicting the occurrence of postoperative complications.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"78-85"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999049","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}