Annali italiani di chirurgia最新文献

{"title":"The Impact of Enteral Nutritional Support on Surgical Complications and Clinical Efficacy in Children With Neuroblastoma With Moderate or High Nutritional Risk.","authors":"Pan Wu, Qin Zhang, Mincui Zheng, Benshan Zhang, Wenyong Kuang, Wanli Li, Haixia Yang","doi":"10.62713/aic.4553","DOIUrl":"https://doi.org/10.62713/aic.4553","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to investigate the association between enteral nutritional support, surgical complication rates, and the nutritional improvement effect in pediatric neuroblastoma (NB) patients.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled 94 neuroblastoma patients (≤14 years old) with moderate or high nutritional risk who underwent treatment at Hunan Children's Hospital between August 2019 and October 2021. Patients were assigned to a control group (n = 45), who received routine dietary guidance, and an experimental group (n = 49), who received enteral nutritional support along with routine dietary guidance. Group assignment indicated clinical decision-making by the treating clinicians, taking into account various parameters such as the children's tolerance to oral intake, the severity of digestive tract symptoms, the Nutrition Screening Tool for Childhood Cancer (SCAN) score, and caregivers' preferences. These clinical considerations were combined with input from caregivers when determining the nutritional protocol. The nutritional status, daily energy intake, and incidence of complications after surgery and chemotherapy were compared between groups.</p><p><strong>Results: </strong>Before treatment, no statistically meaningful variations in all indicators were observed between groups (<i>p</i> > 0.05). After surgery and chemotherapy, the experimental group showed substantially higher levels of physical indicators (mid-upper arm circumference [MUAC], triceps skinfold thickness [TSFT] and biochemical indicators (hemoglobin [Hb] and prealbumin [Pre-Alb]) than the control group (<i>p</i> < 0.05)). After surgery and chemotherapy, the experimental group exhibited substantially higher average daily energy and protein intake levels compared with the control group (<i>p</i> < 0.05). Additionally, the experimental group had significantly lower rates of postoperative complications (4.1% versus 24.4%, risk ratio [RR] = 0.168, 95% confidence interval [CI]: 0.041-0.690) and post-chemotherapy complications (2.0% versus 15.6%, RR = 0.128, 95% CI: 0.017-0.967) than the control group (<i>p</i> < 0.05). No adverse events related to enteral nutritional support occurred in the experimental group during the intervention period.</p><p><strong>Conclusions: </strong>Enteral nutritional support can substantially improve the nutritional status and daily energy intake in neuroblastoma patients with moderate or high nutritional risk. This intervention can further decrease the likelihood of complications after surgery and chemotherapy.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1597-1606"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987853","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":"Preoperative C-Reactive Protein-Albumin-Lymphocyte Index and Related Clinical Factors Associated With Postoperative Complications Following Cholecystectomy in Acute Cholecystitis: A Retrospective Study.","authors":"Huanhuan Chen, Yefeng Yao, Xiangyu Zhang","doi":"10.62713/aic.4683","DOIUrl":"https://doi.org/10.62713/aic.4683","url":null,"abstract":"<p><strong>Aim: </strong>Laparoscopic cholecystectomy (LC) is the primary treatment for acute cholecystitis (AC), although various postoperative complications may still occur. Inflammatory composite indices have gained increasing attention in surgical risk assessment; among them, the C-reactive protein-albumin-lymphocyte (CALLY) index integrates systemic inflammation, immune function, and nutritional status. This study aimed to investigate the association between preoperative CALLY index and postoperative complications in patients with AC undergoing cholecystectomy.</p><p><strong>Methods: </strong>This retrospective cohort study included 330 patients with AC who underwent cholecystectomy at the Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January 2015 and December 2024. Patients were categorized according to the occurrence of postoperative complications. Clinical characteristics, perioperative variables, and preoperative laboratory markers were collected. The CALLY index was calculated using C-reactive protein (CRP), albumin, and lymphocyte count. Between-group comparisons, Spearman correlation analysis, receiver operating characteristic (ROC) curve analysis, and logistic regression analyses were performed to examine the associations of the CALLY index and related clinical factors with postoperative complications and to evaluate their discriminative ability.</p><p><strong>Results: </strong>Among the 330 patients, 83 (25.2%) experienced postoperative complications. Patients with complications were older and had higher rates of diabetes, gallbladder wall thickness ≥5 mm, and a history of previous cholecystitis (all <i>p</i> < 0.001). Preoperative CRP levels were elevated, whereas albumin, lymphocyte counts, and CALLY index values were lower in the complication group (all <i>p</i> < 0.001). ROC analysis demonstrated that the CALLY index had favorable predictive ability (area under the curve [AUC] = 0.720). Multivariate analysis identified age, diabetes, gallbladder wall thickness, history of cholecystitis, American Society of Anesthesiologists Physical Status (ASA-PS) classification, the 2018 Tokyo Guidelines (TG18) grade, and CALLY index as independent predictors of postoperative complications (all <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Preoperative CALLY index is associated with the occurrence of postoperative complications in patients with AC undergoing cholecystectomy. CALLY index may serve as a supplementary preoperative marker for identifying patients with a higher risk of postoperative complications. However, further prospective multicenter studies are needed to validate its clinical applicability.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1727-1737"},"PeriodicalIF":0.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987832","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":"Effect of PDCA Cycle-Based Orthopedic Rehabilitation Nursing on Perioperative Pain and Functional Recovery in Patients With Femoral Fractures.","authors":"Zhiyong Cui, Xin Song, Huipeng Zhou, Peng Zhao, Yanda Li, Yanyang Guo","doi":"10.62713/aic.4648","DOIUrl":"https://doi.org/10.62713/aic.4648","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the effects of orthopedic rehabilitation nursing based on the Plan-Do-Check-Act (PDCA) cycle model on perioperative pain and postoperative functional recovery in patients undergoing surgical treatment for femoral fractures.</p><p><strong>Methods: </strong>This retrospective single-center study included 120 patients who underwent surgical treatment for femoral fractures at The 964th Hospital of Chinese People's Liberation Army Joint Logistics Support Force between May 2023 and May 2025. Based on the nursing interventions documented in medical records, patients were assigned to a control group (n = 58) and a study group (n = 62). The control group received routine perioperative orthopedic nursing care, while the study group received PDCA cycle-based orthopedic rehabilitation nursing. Clinical outcomes compared between the two groups included time to first ambulation, length of hospital stay, perioperative pain intensity assessed using the numerical rating scale (NRS), comfort level evaluated using the general comfort questionnaire (GCQ), hip joint function assessed using the Harris Hip Score (HHS) and Functional Independence Measure (FIM), and quality of life and health-promoting lifestyle level assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Health-Promoting Lifestyle Profile II (HPLP-II).</p><p><strong>Results: </strong>Compared with the control group, the study group demonstrated a significantly shorter time to first ambulation and reduced length of hospital stay (<i>p</i> < 0.001). Following the nursing intervention, both groups showed lower NRS scores and higher GCQ scores compared with baseline values. Furthermore, post-intervention NRS scores were significantly lower, and GCQ scores were significantly higher in the study group than the control group (<i>p</i> < 0.001). HHS and FIM scores improved in both groups after nursing compared with pre-nursing values, with significantly greater post-intervention scores observed in the study group (<i>p</i> < 0.001). Similarly, WHOQOL-BREF and HPLP-II scores increased in both groups compared with pre-nursing values, and the study group achieved significantly higher BREF and HPLP-II scores than the control group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>PDCA cycle-based orthopedic rehabilitation nursing was associated with reduced perioperative pain, improved patient comfort, earlier postoperative ambulation, and enhanced functional recovery in patients with femoral fractures. However, given the retrospective single-center design and potential selection bias, the findings should be interpreted cautiously. Prospective multicenter, randomized controlled studies with larger sample sizes are warranted to validate these observations.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1405-1412"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787404","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 Scenario-Based Teaching Centered on Gynecological Laparoscopic Surgical Procedures on Clinical Decision-Making Ability and Operative Standardization Among Resident Physicians.","authors":"Xin Zhao, Qi Zhao","doi":"10.62713/aic.4614","DOIUrl":"https://doi.org/10.62713/aic.4614","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;Scenario-based teaching has demonstrated potential in medical education, but its application to comprehensive gynecological laparoscopic training remains limited. This study aimed to evaluate the impact of scenario-based teaching centered on the complete gynecological laparoscopic surgical procedure on resident physicians' clinical decision-making ability, operative standardization, and training satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study included 47 resident physicians who underwent laparoscopic training in the Department of Obstetrics and Gynecology at Zhoukou Central Hospital between April 2021 and April 2025. Based on the training methods implemented during the teaching phase, participants were assigned to a routine training group (n = 23) or a scenario-based training group (n = 24). The routine training group received conventional theoretical instructions and basic laparoscopic simulation training, whereas the scenario-based teaching group additionally participated in scenario-based simulation teaching modules designed around the complete surgical workflow. Following completion of the training program, participants underwent a comprehensive assessment using a closed-book theoretical examination, the Global Assessment of Laparoscopic Skills (GOALS), structured case-based clinical decision-making scoring, and a teaching satisfaction questionnaire. Differences in theoretical knowledge, operative skills, clinical decision-making ability, and satisfaction were compared between the two groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After training, the theoretical examination scores of the scenario-based teaching group were significantly higher than those of the routine training group (&lt;i&gt;p&lt;/i&gt; = 0.047). In the assessment of laparoscopic operative performance, the scenario-based teaching group significantly outperformed the routine training group across all GOALS dimensions (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy), and total score (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). In terms of clinical decision-making ability, the scenario-based training group achieved higher scores than the routine training group in diagnostic accuracy, surgical plan rationality, and identification of key risk points (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), with particularly marked differences observed in surgical plan rationality and key risk point identification (both &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Regarding training satisfaction, the scenario-based training group reported significantly higher scores across all six dimensions, including content arrangement rationality, applicability of teaching format, participation in practical activities, perceived improvement in decision-making ability, perceived enhancement in operative skills, and overall satisfaction (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Under the conditions of this study, scenario-based teaching centered on the complete gynecological laparos","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1387-1395"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787473","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":"Management of Incidentally Discovered Appendiceal Malignancies: When to Perform Right Hemicolectomy - Case Series and Literature Review.","authors":"Licia Dari, Chiara Barresi, Stefano Pileci, Ivan Lettini, Sara Zofrea, Marco Beggiato, Lorenzo Bono, Guido Mondini, Lavinia Claudia Petrelli, Antonio Bergantino, Luca Panier Suffat","doi":"10.62713/aic.4703","DOIUrl":"10.62713/aic.4703","url":null,"abstract":"<p><strong>Aim: </strong>Appendiceal neoplasms are rare and are most frequently diagnosed incidentally after appendectomy for suspected acute appendicitis. Their optimal management, particularly the indication for completion right hemicolectomy, remains debated due to the absence of standardized guidelines.</p><p><strong>Case presentation: </strong>We present a retrospective case series of four patients who underwent emergency appendectomy for clinical and radiological suspicion of acute appendicitis at Ivrea Hospital between May 2023 and February 2026. Histopathological examination revealed incidental appendiceal malignancies. Clinical, intraoperative, histopathological, and follow-up data were analyzed. A narrative review of the literature was also performed, focusing on current evidence regarding classification, prognostic factors and indications for right hemicolectomy.</p><p><strong>Results: </strong>Among 178 appendectomies performed during the study period, four cases were diagnosed with appendiceal neoplasms: one neuroendocrine tumor (G1), one non-mucinous adenocarcinoma, one goblet cell adenocarcinoma and one mucinous adenocarcinoma. Completion right hemicolectomy was performed in three cases based on histopathological risk factors, while one patient required no further surgical treatment. One patient presented with peritoneal metastatic disease (pT4a pN1a pM1c) and received systemic chemotherapy. At follow-up (6-12 months) no evidence of recurrence was observed.</p><p><strong>Conclusions: </strong>Incidentally discovered appendiceal neoplasms represent a heterogeneous group of rare tumors requiring individualized management. Completion right hemicolectomy should be considered in selected cases based on histological subtype, stage, and risk factors. Multidisciplinary evaluation is essential to guide optimal treatment and follow-up strategies. This case series supports a selective surgical approach and highlights the importance of careful pathological assessment after appendectomy for acute appendicitis.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1340-1348"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787628","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 Thyroid Function Status on Perioperative Characteristics and Early Postoperative Recovery in Cesarean Section.","authors":"Gangjun Ying, Jie Shen","doi":"10.62713/aic.4655","DOIUrl":"https://doi.org/10.62713/aic.4655","url":null,"abstract":"<p><strong>Aim: </strong>Thyroid dysfunction is common in pregnancy, but its effects on perioperative outcomes in cesarean section remain unclear. This study aimed to investigate the effects of thyroid dysfunction in the third trimester on perioperative hemodynamic stability and early postoperative recovery in women undergoing cesarean section.</p><p><strong>Methods: </strong>Clinical data from women undergoing elective cesarean section at Yuhuan Second People's Hospital between January 2023 and December 2025 were retrospectively collected. Propensity score matching (1:2 nearest neighbor matching, caliper 0.1) was used to balance baseline covariates between groups. After matching, 81 cases were included in the thyroid dysfunction group and 162 cases were categorized in the euthyroid group. Intraoperative hemodynamic parameters (hypotension, hypertension, tachycardia, bradycardia, vasopressor use, and maximum decrease in mean arterial pressure (MAP)), postoperative recovery indicators (pain scores, time to bowel function recovery, onset of lactation, higher Edinburgh Postnatal Depression Scale (EPDS) scores, length of hospital stay, and complications), and neonatal outcomes were compared between the two groups.</p><p><strong>Results: </strong>After matching, baseline data were well-balanced between the two groups (all standardized differences <0.1). Compared to the euthyroid group, the thyroid dysfunction group had significantly higher rates of intraoperative hypotension, tachycardia, bradycardia, and vasopressor use (all <i>p</i> < 0.01), along with a greater maximum decrease in MAP (<i>p</i> < 0.001). Postoperative pain scores, time to first flatus and defecation, time to onset of lactation, EPDS scores, and length of hospital stay were significantly increased in the thyroid dysfunction group compared with the euthyroid group (all <i>p</i> < 0.001). No significant difference was found between groups in intraoperative hypertension (<i>p</i> > 0.05). Subgroup analysis showed that the hypothyroidism subgroup had higher rates of intraoperative hypotension (<i>p</i> = 0.042), and longer time to first flatus (<i>p</i> = 0.004); the hyperthyroidism subgroup had a higher rate of tachycardia (<i>p</i> = 0.017). Regarding neonatal outcomes, the 5-minute Apgar score was slightly lower in the thyroid dysfunction group (<i>p</i> < 0.05), but all scores were within the normal range. Neonatal hyperthyroidism occurred in one infant born to a mother with hyperthyroidism.</p><p><strong>Conclusions: </strong>Thyroid dysfunction was associated with intraoperative hemodynamic instability and delayed early postoperative recovery in cesarean section, with distinct clinical characteristics between hypothyroidism and hyperthyroidism. Perioperative monitoring and management should be enhanced for these patients.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1423-1432"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787477","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 Labetalol With Versus Without Magnesium Sulfate on Intraoperative Blood Pressure Variability During Cesarean Delivery in Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study.","authors":"Caifen Gao, Juanli Lv","doi":"10.62713/aic.4542","DOIUrl":"https://doi.org/10.62713/aic.4542","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to investigate the effects of two medication regimens-labetalol combined with magnesium sulfate versus labetalol alone-on intraoperative blood pressure variability (BPV) and maternal-neonatal outcomes in patients with hypertensive disorders of pregnancy (HDP) undergoing cesarean delivery.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled 170 HDP patients who underwent cesarean delivery at TongXiang Maternity and Child Health Care Hospital between January 2023 and June 2025. Based on perioperative medication regimens, patients were divided into a combination group (labetalol plus magnesium sulfate, n = 86) and a monotherapy group (labetalol alone, n = 84). After propensity score matching (PSM), a cohort of 54 patients was included in each group for analysis. All patients received oral labetalol for preoperative blood pressure control and postoperative management. Patients in the combination group additionally received intravenous magnesium sulfate. The primary outcome measure was the standard deviation of intraoperative systolic blood pressure (SD of systolic blood pressure (SBP)). Secondary outcomes included intraoperative blood pressure target attainment rate, incidence of severe hypertensive events, and maternal-neonatal complications.</p><p><strong>Results: </strong>After PSM, baseline characteristics were balanced between the two groups. The combination group exhibited a significantly lower intraoperative SD of SBP compared to the monotherapy group (<i>p</i> < 0.001), along with a higher intraoperative blood pressure target attainment rate (<i>p</i> < 0.001) and a lower incidence of severe hypertensive events (<i>p</i> = 0.030). Regarding maternal-neonatal outcomes, the combination group had significantly higher 1‑minute and 5‑minute Apgar scores (<i>p</i> = 0.035 and <i>p</i> = 0.036, respectively) and a lower rate of admission to the neonatal intensive care unit (NICU) (<i>p</i> = 0.002). There were no significant differences between the groups in the incidence of adverse drug events such as hypotension or bradycardia.</p><p><strong>Conclusions: </strong>For HDP patients undergoing cesarean delivery, the perioperative application of a combined regimen of labetalol and magnesium sulfate, compared with labetalol alone, was associated with more stable intraoperative blood pressure, reduced variability under surgical stress, and improved early neonatal outcomes. This combined regimen provides valuable clinical reference for optimizing perioperative blood pressure management during cesarean delivery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1471-1479"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787547","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 the Systemic Immune-Inflammation Index Combined With the Prognostic Nutritional Index for Flap-Related Complications Following Flap Repair in Patients With Stage Ⅲ and Ⅳ Pressure Injuries.","authors":"Sanshun Zhou, Linjun Wu, Dongqiang Xie","doi":"10.62713/aic.4634","DOIUrl":"https://doi.org/10.62713/aic.4634","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the combined predictive value of systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) for postoperative flap-related complications in patients with stage Ⅲ and Ⅳ pressure injuries undergoing flap repair.</p><p><strong>Methods: </strong>A single-center retrospective cohort study was conducted. A total of 242 patients with stage Ⅲ and Ⅳ pressure injuries who underwent flap repair between January 2020 and December 2024 were enrolled. Based on postoperative flap-related complications, patients were divided into a non-complication group (n = 181) and a complication group (n = 61). Preoperative clinical data and laboratory parameters were collected, and SII and PNI were calculated. Independent risk factors were identified using univariate and multivariate logistic regression analyses, and a nomogram prediction model was subsequently developed. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive performance of the model.</p><p><strong>Results: </strong>Multivariate analysis demonstrated that PNI (odds ratio (OR) = 0.851, 95% CI: 0.793-0.913), SII (OR = 1.307, 95% CI: 1.143-1.494), and intraoperative blood loss (OR = 2.150, 95% CI: 1.141-4.052) were independent predictors of postoperative flap-related complications. The area under the curve (AUC) of the prediction model based on these three variables was 0.88 (95% CI: 0.83-0.93). The calibration curve demonstrated good agreement between predicted and observed outcomes (Hosmer-Lemeshow test, <i>p</i> = 0.335).</p><p><strong>Conclusions: </strong>Elevated preoperative SII, reduced preoperative PNI, and increased intraoperative blood loss are independent risk factors for flap-related complications following flap repair in patients with stage Ⅲ and Ⅳ pressure injuries. The prediction model based on these three factors demonstrates good discrimination and calibration, which may facilitate perioperative risk assessment and provide a basis for individualized clinical interventions.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1443-1451"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787551","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":"Independent Predictors and a Nomogram for Postoperative Urethral Stricture After TURP in Elderly Patients: A Real-World Study.","authors":"Yuping Wu, Di Dai, Hui Jin, Gang Cheng, Liyu Shen, Haifeng Chen, Hongzhang Chen, Lihua Zhang","doi":"10.62713/aic.4668","DOIUrl":"https://doi.org/10.62713/aic.4668","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;Postoperative urethral stricture is an important complication after transurethral resection of the prostate (TURP). This study aimed to identify independent predictors of urethral stricture within 3 months after TURP in elderly patients and to develop a nomogram for predicting this complication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study consecutively included 300 elderly patients who underwent transurethral resection of the prostate at Deqing County People's Hospital between June 2024 and November 2025. Patients were divided into a stricture group and a non-stricture group according to whether a urethral stricture occurred within 3 months after surgery. Demographic, clinical, and laboratory data were collected, and the controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and neutrophil-to-lymphocyte ratio (NLR) were calculated. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of postoperative urethral stricture. A nomogram was subsequently constructed with variables of statistical significance. Model discrimination was assessed using the receiver operating characteristic (ROC) curve, and internal validation was performed by bootstrap resampling. Model performance was further evaluated using calibration and decision curve analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 300 elderly patients included in the final cohort, 84 were identified as having urethral stricture within 3 months after TURP. Multivariate logistic regression analysis showed that a higher CONUT score was an independent risk factor for postoperative urethral stricture (odds ratio [OR] = 2.41, 95% confidence interval [CI]: 1.43-4.04). Higher fasting glucose (OR = 1.56, 95% CI: 1.11-2.21), lower body mass index (BMI) (OR = 0.80, 95% CI: 0.70-0.91), alcohol use (OR = 3.02, 95% CI: 1.33-6.88), acute urinary retention (OR = 2.15, 95% CI: 1.07-4.31), longer catheterization duration (OR = 1.34, 95% CI: 1.03-1.74), and longer operative time (OR = 1.04, 95% CI: 1.02-1.07) were also independently associated with an increased risk of postoperative urethral stricture. The nomogram based on these variables demonstrated good discriminative ability, with an area under the curve (AUC) of 0.836 (95% CI: 0.789-0.882), a sensitivity of 76.2%, and a specificity of 75.0%. After 1000 bootstrap resamples for internal validation, the optimism-corrected AUC was 0.810 (95% CI: 0.731-0.878). Calibration analysis showed good agreement between predicted and observed probabilities, and decision curve analysis indicated that the model provided a certain net benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preoperative CONUT score, fasting glucose, BMI, alcohol use, acute urinary retention, catheterization duration, and operative time were associated with postoperative urethral stricture in elderly patients undergoing TURP. The nomogram based on these variables showed good discriminative","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1480-1489"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787510","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":"Risk Factors of Postoperative Atelectasis and the Preventive Effect of a Risk-Stratified Nursing Model in Elderly Patients With Severe Polytrauma.","authors":"Na Zhu, Fang Gu, Liting Zou","doi":"10.62713/aic.4507","DOIUrl":"https://doi.org/10.62713/aic.4507","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the incidence and independent risk factors for postoperative atelectasis in elderly patients with severe polytrauma, and to evaluate the preventive effect of a risk-stratified nursing model developed based on these factors.</p><p><strong>Methods: </strong>This retrospective study comprised two components. The first component included 108 elderly patients with severe polytrauma who underwent surgery between March 2021 and March 2024. Based on postoperative atelectasis, patients were categorized into an atelectasis group (n = 31) and a non-atelectasis group (n = 77). Baseline characteristics, injury- and surgery-related variables, and preoperative laboratory parameters were collected from both groups. Univariable analysis and multivariate logistic regression were performed to identify independent risk factors and to estimate their odds ratios (ORs) with 95% confidence intervals (CIs). The combined predictive performance of these factors was evaluated using receiver operating characteristic (ROC) curve analysis. The second component was an intervention analysis to evaluate the effectiveness of a stratified nursing protocol established based on the derived risk scoring system. Using a before-after design, the incidence of postoperative atelectasis was retrospectively analyzed in a subsequent cohort of 48 elderly patients with severe polytrauma who received this nursing intervention between June 2024 and June 2025.</p><p><strong>Results: </strong>The incidence of postoperative atelectasis in elderly patients with severe polytrauma was 28.70% (31/108). Multivariate logistic regression analysis identified advanced age (>75 years), elevated body mass index (BMI) (>24 kg/m²), concomitant pulmonary injury, substantial blood loss volume (≥3000 mL), prolonged time from injury to surgery (≥6 h), and extended operative time (≥2 h) as independent risk factors (all <i>p</i> < 0.05). The combined predictive model incorporating these factors yielded an area under the curve (AUC) of 0.924 (95% CI: 0.876-0.971), with a sensitivity of 83.9% and specificity of 87.0%. A risk-scoring system derived from regression coefficients stratified patients into low- (0-2 points), moderate- (3-4 points), and high-risk (≥5 points) groups. Implementation of the corresponding risk-stratified nursing model was associated with a reduction in postoperative atelectasis incidence to 10.42% (5/48) in the subsequent intervention cohort.</p><p><strong>Conclusions: </strong>Postoperative atelectasis is common among elderly patients with severe polytrauma and is influenced by multiple clinical factors. A risk-stratified nursing model based on identified independent predictors demonstrates potential to reduce the incidence of atelectasis in clinical practice and warrants further validation.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1498-1507"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787600","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}