Annali italiani di chirurgia最新文献

{"title":"The Concept of Biological Resectability in Pancreatic Ductal Adenocarcinoma - An Updated Narrative Review.","authors":"Charalampos Lampropoulos, Dimitrios Kehagias, George Papadopoulos, Aggeliki Bellou, Eirini Kehagia, Ioannis Kehagias","doi":"10.62713/aic.4732","DOIUrl":"https://doi.org/10.62713/aic.4732","url":null,"abstract":"<p><p>Resectability in pancreatic ductal adenocarcinoma (PDAC) has traditionally been defined according to tumor-vessel relationship on cross-sectional imaging. However, anatomical criteria alone fail to identify occult systemic disease and do not reliably predict early postoperative recurrence or the likelihood of meaningful oncological benefit from surgery. This structured narrative review evaluated contemporary evidence regarding biological resectability and the emerging role of biomarkers in perioperative decision-making. A literature search was conducted using PubMed/MEDLINE, Embase, and Web of Science, focusing on studies published between January 2017 and March 2026, with inclusion of seminal earlier publications where relevant. Priority was given to consensus statements, clinical practice guidelines, meta-analyses, randomized controlled trials, prospective cohort studies, and large multicentre series. Evidence was qualitatively synthesized and biomarkers were classified according to their level of clinical maturity. Emerging data suggest that many anatomically resectable PDACs exhibit biologically aggressive disease associated with occult metastases, early recurrence, and limited benefit from upfront surgery. Among available biomarkers, carbohydrate antigen 19-9 remains the most clinically established and should be interpreted in the context of biliary status, treatment response, and multidisciplinary assessment. Circulating tumor DNA shows promise for molecular staging and recurrence risk stratification, although prospective interventional validation remains limited. Transcriptomic subtypes, positron emission tomography (PET)-derived biomarkers, radiomics, and hybrid multimodal models provide additional biological insights but remain largely investigational. Biological resectability is increasingly recognized as an important complement to anatomical staging, helping to refine patient selection and treatment sequencing. Nevertheless, prospective validation, assay standardization, and biomarker-guided clinical trials are required before widespread implementation in routine multidisciplinary practice.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1369-1386"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787558","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":"Applications and Research Progress of Biomaterials for Treating Infected Bone Defects.","authors":"Ruixing Shui, Dapeng Li","doi":"10.62713/aic.4702","DOIUrl":"https://doi.org/10.62713/aic.4702","url":null,"abstract":"<p><p>Infected bone defects represent a challenging clinical condition that requires simultaneous infection control and bone structure reconstruction. Traditional antibiotic therapy and bone grafting each have inherent limitations. With advances in regenerative medicine and tissue engineering, biomaterials have garnered increasing attention in this field. This review systematically summarizes the research progress of inorganic biomaterials, polymeric biomaterials, and composite biomaterials in the repair of infected bone defects, covering their antibacterial mechanisms, osteogenic properties, and functional integration strategies. The clinical applications of these materials as adjuncts to established surgical techniques, including the induced membrane technique and bone transport, are also reviewed. Current challenges and future directions, including intelligent responsive materials and immunomodulatory strategies, are discussed to provide insights for the development of next-generation biomaterials for infected bone defect repair.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1358-1368"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787619","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 Early Surgical Debridement on Outcomes in ICU Patients With Sepsis-Associated Intra-Abdominal Infection: A Retrospective Analysis.","authors":"Jiaolong He, Wenjun Li, Haodong Wang","doi":"10.62713/aic.4619","DOIUrl":"https://doi.org/10.62713/aic.4619","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the impact of early surgical debridement, defined as a diagnosis-to-knife time (D-to-K time) ≤12 hours, on intensive care unit (ICU) outcomes in patients with sepsis-associated intra-abdominal infection.</p><p><strong>Methods: </strong>This single-center retrospective cohort study consecutively enrolled patients with sepsis-associated intra-abdominal infection who were admitted to the ICU and underwent surgical debridement between 1 January 2021 and 31 January 2025. Patients were stratified into an early surgery group (D-to-K time ≤12 hours, <i>n</i> = 65) and a delayed surgery group (D-to-K time >12 hours, <i>n</i> = 87). Baseline characteristics, ICU length of stay, duration of organ support, incidence of complications, mortality and other clinical outcomes were compared between the two groups. Multivariate logistic regression analysis was performed to evaluate the independent effect of early surgery on 28-day mortality.</p><p><strong>Results: </strong>The delayed surgery group demonstrated a higher prevalence of preoperative septic shock (66.7% vs. 33.8%) and diffuse peritonitis (50.6% vs. 32.3%), as well as a higher proportion of open surgical procedures (90.8% vs. 76.9%) compared with the early surgery group. The early surgery group exhibited significantly shorter ICU length of stay, total duration of mechanical ventilation, and duration of vasoactive drug use. The incidences of ICU-acquired weakness (ICU-AW), acute kidney injury (AKI), and 28-day ICU mortality were significantly lower in the early surgery group. Surgical timing and preoperative septic shock were significantly associated with mortality. After adjustment for preoperative septic shock, early surgery remained an independent protective factor for 28-day mortality.</p><p><strong>Conclusions: </strong>In patients with sepsis-associated intra-abdominal infection, early surgical intervention (D-to-K time ≤12 hours) is associated with improved ICU outcomes, including shorter organ support duration, lower complication rates, and reduced 28-day mortality.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1508-1516"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787367","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":"Prophylactic Low-Dose Dexamethasone for Postoperative Pulmonary Complications in Type B Aortic Dissection: A Retrospective Cohort Study.","authors":"Dexing Zheng, Xiaoling Huang, Yin Xu, Wenjun Zhao, Caihua Chen, Hui Wang","doi":"10.62713/aic.4673","DOIUrl":"https://doi.org/10.62713/aic.4673","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the impact of prophylactic low-dose glucocorticoids on the incidence of postoperative pulmonary complications (PPCs) and perioperative recovery parameters in patients undergoing surgery for type B aortic dissection.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 240 patients who underwent type B aortic dissection (TBAD) surgery at Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University from January 2023 to December 2025. Patients were divided into an intervention group (n = 118) receiving a single dose of dexamethasone (5 mg intravenously) after anesthesia induction and a control group (n = 122) receiving standard care. To minimize selection bias, propensity score matching (PSM) was performed using 1:1 nearest neighbor matching with a caliper of 0.2 times the standard deviation of the propensity score. Covariates included age, sex, body mass index, diabetes, smoking history, preoperative C-reactive protein, preoperative PaO₂/FiO₂ ratio, operative time, intraoperative blood transfusion volume, and surgical procedure (thoracic endovascular aortic repair [TEVAR] vs. open surgery). After matching, 93 well-balanced pairs were obtained. The primary outcome was the incidence of PPCs within 30 days postoperatively. Secondary outcomes included the duration of mechanical ventilation, intensive care unit (ICU) and hospital length of stay, as well as postoperative inflammatory markers (C-reactive protein [CRP], white blood cell [WBC]) and oxygenation (PaO₂/FiO₂ ratio) at 24 hours.</p><p><strong>Results: </strong>After PSM, baseline characteristics were well balanced between groups, with all standardized mean differences <0.1. The intervention group showed a significantly lower incidence of PPCs compared to the control group (20.43% vs. 34.41%, <i>p</i> = 0.033). The intervention was also associated with significantly shorter mechanical ventilation duration (<i>p</i> = 0.008), ICU stay (<i>p</i> = 0.003), and total hospital stay (<i>p</i> = 0.009). Additionally, the intervention group demonstrated significantly lower postoperative CRP and WBC levels and a higher PaO₂/FiO₂ ratio at 24 hours (all <i>p</i> < 0.001). No significant differences were observed in safety outcomes including new-onset infection, wound healing impairment, or hyperglycemia.</p><p><strong>Conclusions: </strong>Prophylactic low-dose glucocorticoids were associated with a lower incidence of PPCs and improved perioperative recovery in patients undergoing TBAD surgery, including shorter ventilation time and the length of hospital stay, attenuated inflammatory response, and better oxygenation. These findings suggest potential clinical benefits with a favorable safety profile, but causality cannot be inferred due to the retrospective design. Therefore, prospective multicenter studies are warranted to validate these results.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1490-1497"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787623","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":"Influencing Factors of Air Bubble-Induced Pressure Difference in Drainage Tubes: An <i>In Vitro</i> Study.","authors":"Ling Jin, Yuqing Shi, Yihan Chai, Yushu Sun, Yiyin Zhang, Qijiang Mao","doi":"10.62713/aic.4799","DOIUrl":"https://doi.org/10.62713/aic.4799","url":null,"abstract":"<p><strong>Aim: </strong>This study evaluated the effect of the presence of air bubbles in a drainage tube on its pressure difference and analyzed the relationship between air bubble volume, tube diameter, drainage fluid viscosity, and pressure difference. Accordingly, it provides a theoretical basis for optimizing drainage treatment and preventing obstruction in clinical practice.</p><p><strong>Methods: </strong>A custom-designed experimental device was used to measure the pressure difference in medical-grade silicone drainage tubes. Tubes with various diameters (3 and 6 mm), air bubble volumes (0, 0.1, 0.2, and 0.3 mL), and drainage fluids (low and high viscosities) were used. The pressure difference between the two ends of each drainage tube was measured using a pressure sensor and calculated. A rotational viscometer was used to measure the viscosity of each drainage fluid. Differences in the pressure difference under different conditions of air bubbles, air bubble volumes, tube diameters, and drainage fluid viscosities were compared.</p><p><strong>Results: </strong>The presence of air bubbles in each drainage tube significantly increased the pressure difference, with the pressure difference being higher compared to that under the bubble-free condition (0.591 ± 0.069 vs. 0.830 ± 0.039 kPa, <i>p</i> < 0.01). In addition, the pressure difference progressively increased with increasing air bubble volume, with the maximum increase occurring at a bubble volume of 0.3 mL (0.951 ± 0.039 kPa). The pressure difference was negatively correlated with the tube diameter, with higher pressure difference observed at smaller diameters, and the differences between the values of the different diameter groups were statistically significant (<i>p</i> < 0.01). The pressure difference was positively correlated with the viscosity of the drainage fluid, with a higher pressure difference observed at a higher viscosity. The enhancing effect of air bubbles on the pressure difference was more pronounced in more viscous fluids (<i>p</i> < 0.0001).</p><p><strong>Conclusions: </strong>This study showed that the presence of air bubbles in a drainage tube significantly increases the outflow pressure difference, and this effect is enhanced by increasing the bubble volume, decreasing the tube diameter, and increasing the drainage fluid viscosity. These findings reveal that the hydrodynamic factors associated with air bubbles can theoretically contribute to a poor outflow. Therefore, they provide a preliminary <i>in vitro</i> basis for exploring the rational selection of drainage tube diameter, early detection of air bubble-related obstructions, and development of targeted interventions in future clinical practice.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1452-1462"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787461","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 Systematic Review and Meta-Analysis on 30-Day Readmission Rates After Endovascular Abdominal Aortic Aneurysm Repair and Open Repair.","authors":"Christina Bachert, Jasmin Epple, Rejane Golbach, Andreas Hoene, Sebastian Debus, Reinhart T Grundmann","doi":"10.62713/aic.4536","DOIUrl":"10.62713/aic.4536","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) are established treatments for abdominal aortic aneurysm (AAA). This meta-analysis evaluated 30-day readmission, patient characteristics, postoperative complications, and length of stay after EVAR and OAR, and explored whether 30-day readmission may serve as a surrogate marker of healthcare quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature search of Embase, PubMed, Web of Science, and Cochrane databases was conducted from 1 January 2010 through 31 December 2024. Observational studies reporting 30-day readmission after elective EVAR and OAR were included. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled proportions and comparative effect estimates were calculated using random-effect models. Heterogeneity was assessed using the I&lt;sup&gt;2&lt;/sup&gt; statistic. Meta-analyses and meta-regression models evaluated associations between patient comorbidities, length of stay (LOS), postoperative complications, and 30-day readmission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-nine studies reported outcomes after EVAR (578,744 patients) and OAR (228,683 patients). In procedure-specific pooled analyses, 30-day readmission rates were 8% after EVAR and 13% after OAR. LOS was shorter after EVAR than after OAR (mean 4.2 vs. 7.4 days; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). No significant association was observed between length of stay and 30-day readmission for either OAR (effect estimate 0.0004, 95% CI [-0.0256-0.0265]; &lt;i&gt;p&lt;/i&gt; = 0.973) or EVAR (effect estimate 0.0113, 95% CI [-0.0036-0.0262]; &lt;i&gt;p&lt;/i&gt; = 0.136). Comorbidities including arterial hypertension, congestive heart failure, chronic kidney disease, and chronic obstructive pulmonary disease were significant predictors of readmission after both procedures. Study-level meta-regression suggested that postoperative stroke (EVAR), graft-related and cardiac complications, including myocardial infarction (EVAR and OAR), were significantly associated with higher 30-day readmission rates. Sensitivity analyses confirmed the stability of the pooled estimates, and no significant publication bias was detected. Data on 90-day readmission were too heterogeneous for pooled analysis. In direct comparative studies, random-effects meta-analysis showed no significant difference in 30-day readmission between EVAR and OAR (Odds Ratio [OR] 0.91, 95% CI [0.82-1.01]; I&lt;sup&gt;2&lt;/sup&gt; = 93.8%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;EVAR was associated with lower pooled 30-day readmission rates and shorter hospital stays than OAR. However, direct comparative meta-analysis indicated no significant difference in 30-day readmission rates between procedures. At the study level, readmission was linked to patient comorbidity and postoperative complications, whereas no significant association was observed between length of stay and readmi","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1317-1333"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787595","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 the Unwelcome Return: Insights From a Cohort of Postoperative Haemorrhoid Patients.","authors":"Abdulrahman Alotaibi, Syeda Nafeesa Hashim, Marwah Nasir Ahmad, Maryam Muhammad Rehmatullah, Jumana Hussain Timraz, Nada Yasser Metwali, Bassam Musleh Bin Laswad, Abdullah Almuttawa, Sohayb Faleh, Wail Tashkandi","doi":"10.62713/aic.4656","DOIUrl":"https://doi.org/10.62713/aic.4656","url":null,"abstract":"<p><strong>Aim: </strong>Recurrence after haemorrhoid surgery is a clinical concern, but the factors associated with recurrence have not yet been fully elucidated. In particular, the effects of external haemorrhoids and postoperative complications on long-term outcomes have not been clearly defined. This study aimed to identify the factors associated with haemorrhoid recurrence and recurrence-free survival following haemorrhoid surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included patients who underwent elective haemorrhoid surgery between January 2021 and December 2023 at Dr. Soliman Fakeeh Hospital. We grouped the participants according to their recurrence status. Continuous variables were compared using the Mann-Whitney U test, while categorical variables were analysed using chi-square or Fisher's exact tests, as appropriate. We assessed recurrence-free survival using Kaplan-Meier analysis with log-rank tests. Independent predictors of recurrence were identified using Cox proportional hazards regression analysis.</p><p><strong>Results: </strong>A total of 529 patients were included, with a cumulative recurrence incidence of 4.3% (n = 23). Patients who developed recurrence were younger than those who did not (median age: 33 vs. 37 years, <i>p</i> = 0.025). There were also higher incidences of external haemorrhoids (30.4% vs. 14.0%, <i>p</i> = 0.030) and postoperative complications in the recurrence group (43.5% vs. 11.9%, <i>p</i> < 0.001). Kaplan-Meier analysis demonstrated significantly lower recurrence-free survival among patients who developed postoperative complications (log-rank <i>p</i> = 0.005). Patients with external haemorrhoids showed a trend towards lower recurrence-free survival, but the difference did not reach statistical significance (log-rank <i>p</i> = 0.151). In our multivariable Cox regression analysis, postoperative complications remained independently associated with recurrence risk (hazard ratio [HR] 4.63, 95% confidence interval [CI]: 1.68-12.80, <i>p</i> = 0.003). The association between external haemorrhoids and recurrence risk demonstrated borderline significance (HR 2.55, 95% CI: 0.99-6.60, <i>p</i> = 0.053).</p><p><strong>Conclusions: </strong>Postoperative complications were independently associated with earlier recurrence and poorer recurrence-free survival following haemorrhoid surgery. There was a trend towards increased recurrence risk in patients with external haemorrhoids, but the association did not remain statistically significant after adjustment. These findings may help identify patients at higher risk of recurrence and support more individualised postoperative follow-up strategies.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1463-1470"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787542","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 Analysis of Clinical Manifestations of Gasless Endoscopic Surgery via Transaxillary and Subclavicular Approaches in Unilateral cN0 Thyroid Cancer.","authors":"Xiaoshi Li, Anke Jiang, Qinglin Hu","doi":"10.62713/aic.4680","DOIUrl":"https://doi.org/10.62713/aic.4680","url":null,"abstract":"<p><strong>Aim: </strong>To compare the clinical efficacy and safety of gasless endoscopic radical thyroidectomy via the transaxillary approach versus the subclavicular approach for unilateral cN0 thyroid cancer.</p><p><strong>Methods: </strong>A total of 415 patients with unilateral cN0 thyroid cancer admitted between January 2022 and May 2025 were retrospectively included. After propensity score matching (PSM), patients were divided into Group A (gasless endoscopic radical thyroidectomy via the transaxillary approach, <i>n</i> = 57) and Group B (gasless endoscopic radical thyroidectomy via the subclavicular approach, <i>n</i> = 57). The clinical outcomes of these two approaches were compared.</p><p><strong>Results: </strong>Group B had significantly shorter operative time, lower postoperative drainage volume, and a higher rate of complete central compartment exposure than Group A (<i>p</i> < 0.05). Repeated-measures analysis of variance (ANOVA) showed significant main effects of time, group, and time-by-group interaction for interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), incision pain scores, parathyroid hormone (PTH), and Quality of Life Questionnaire-Core 30 (QLQ-C30) scores (<i>p</i> < 0.05). Group B had a lower total complication rate and higher aesthetic satisfaction scores at 1 and 3 months postoperatively than Group A (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Gasless endoscopic radical thyroidectomy via the subclavicular approach demonstrated potential short-term advantages over the transaxillary approach, including shorter operative time, improved central compartment exposure, attenuated inflammatory response, milder early postoperative pain, and more favorable trends in PTH levels and early quality-of-life recovery. However, given the limited 3-month follow-up period, the absence of significant differences in clinical hypocalcemia rates, and the lack of long-term oncological outcomes, these findings should be interpreted with caution.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1433-1442"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787568","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":"Unveiling Systemic Barriers to High-Grade Glioma Management in Non-Tertiary Centers: A Case Report and Analysis of Resource-Limited Care Challenges.","authors":"Saad Misfer Alqahtani","doi":"10.62713/aic.4749","DOIUrl":"https://doi.org/10.62713/aic.4749","url":null,"abstract":"<p><strong>Aim: </strong>High-grade gliomas (HGGs) are among the most aggressive brain tumors, including gliosarcoma. This report aims to present a case of gliosarcoma managed in a general non-tertiary hospital and to highlight the systemic barriers that delayed diagnosis and treatment.</p><p><strong>Case presentation: </strong>A 53-year-old female was diagnosed with two intra-axial brain lesions and was managed in a general non-tertiary hospital. One lesion was excised and identified as gliosarcoma. Pathological analysis concluded that the excised lesion was World Health Organization (WHO) grade 4 gliosarcoma, isocitrate dehydrogenase (IDH)-wild type, with glial and spindle sarcomatous components, <i>P53</i> mutation, C228T (c.-124C>T) variant of the telomerase reverse transcriptase (<i>TERT</i>) promoter, and hypermethylated O-6-methylguanine-DNA methyltransferase (<i>MGMT</i>) promoter status. The final diagnosis was concluded as gliosarcoma, WHO grade 4, IDH-wild type.</p><p><strong>Results: </strong>Despite the detailed histopathological and molecular findings, there were delays in radiological imaging, surgical treatment, and possible adjuvant therapy because of several systemic barriers, including initial family opposition and resource-limited conditions. The case also shows the challenges of managing high-grade gliomas in non-tertiary settings and the impact of delayed referral and treatment.</p><p><strong>Conclusions: </strong>This report highlights the limitations of care in resource-limited settings and the need for stronger referral systems and better access to timely imaging, surgery, and adjuvant treatment to improve outcomes for patients with HGGs. It also suggests that future WHO guidelines for central nervous system tumors may consider adding diagnostic and prognostic parameters relevant to resource-limited settings, rather than relying only on histological entities or using the term \"Not Otherwise Specified\" when molecular classification is not achievable.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1349-1357"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787576","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 Staged and Concomitant Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Cohort Study.","authors":"Tong Tan, Zitao Li, Enjun Zhu, Yongqiang Lai","doi":"10.62713/aic.4593","DOIUrl":"https://doi.org/10.62713/aic.4593","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to compare the clinical outcomes of concomitant versus staged percutaneous coronary intervention (PCI) in patients with severe aortic valve disease and significant coronary artery stenosis undergoing transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods: </strong>We retrospectively analyzed 180 patients with severe aortic valve disease and significant coronary artery stenosis who underwent TAVR with PCI during the same hospitalization. Patients were treated using either a concomitant strategy (PCI and TAVR performed on the same day) or a staged strategy (procedures performed on different days). Procedural success, valve hemodynamics, and perioperative complications were compared between strategies.</p><p><strong>Results: </strong>Overall procedural success was achieved in 168 of 180 patients (93.3%), without a significant difference between the concomitant and staged groups (92.2% vs. 97.4%, <i>p</i> = 0.467). Transvalvular pressure gradients decreased markedly after TAVR in both groups, from 81.7 (66.3, 99.6) mmHg to 20.0 (12.7, 24.8) mmHg in the concomitant group and from 75.2 (63.2, 97.8) mmHg to 14.9 (8.4, 27.3) mmHg in the staged group (both <i>p</i> < 0.001). Perioperative mortality occurred in 6 (4.3%) patients in the concomitant group and in none of the staged group (<i>p</i> = 0.343). Rates of permanent pacemaker implantation (1.4% vs. 0%), myocardial infarction (0.7% vs. 2.6%), major bleeding (2.1% vs. 0%), stroke (5.0% vs. 0%), and acute kidney injury (13.5% vs. 12.8%) were infrequent in both groups (all <i>p</i>-values > 0.05).</p><p><strong>Conclusions: </strong>In this cohort, both concomitant and staged PCI strategies achieve high procedural success, and no statistically significant differences in early clinical outcomes are observed between the two strategies. Nevertheless, the definitive optimal timing of PCI remains to be elucidated by future large-scale studies with extended follow-up.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 8","pages":"1413-1422"},"PeriodicalIF":0.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787246","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}