Annali italiani di chirurgia最新文献

{"title":"Association of Preoperative HbA1c and Perioperative Glucose Fluctuation With Coagulation Status and Bleeding Outcomes in Diabetic Women Undergoing Cesarean Section: A Retrospective Cohort Study.","authors":"Yuehui Zhang, Lingxiang Chen","doi":"10.62713/aic.4644","DOIUrl":"https://doi.org/10.62713/aic.4644","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the associations between preoperative glycated hemoglobin (HbA1c) levels and a three-point perioperative glucose coefficient of variation (CV) with perioperative coagulation status and bleeding outcomes in diabetic women undergoing cesarean section.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 150 diabetic women who underwent cesarean section at our institution between October 2022 and December 2025. Preoperative HbA1c was used as an indicator of chronic glycemic control. A three-point perioperative glucose CV, derived from the preoperative glucose value, the highest intraoperative glucose value, and the highest postoperative glucose value, was used as an exploratory marker of short-term perioperative glucose fluctuation. The primary outcome was postpartum hemorrhage (PPH), defined as estimated blood loss (EBL) ≥1000 mL. Secondary outcomes included EBL, escalation of hemostatic interventions, transfusion, and perioperative coagulation parameters, including fibrinogen, platelet count, prothrombin time, international normalized ratio, activated partial thromboplastin time, and D-dimer levels.</p><p><strong>Results: </strong>Among the 150 women, 112 had HbA1c <7.0% and 38 had HbA1c ≥7.0%. Compared with the good glycemic control group, the poor glycemic control group exhibited higher intraoperative and postoperative glucose levels, lower postoperative hemoglobin, platelet count, and fibrinogen levels, and higher international normalized ratio and D-dimer levels. The poor glycemic control group also had higher incidences of perioperative hyperglycemia, PPH, hemostatic escalation, and transfusion. EBL was significantly higher in the poor-control group [630.00 (512.25, 1336.25) mL vs. 492.00 (375.75, 597.50) mL], and the incidence of PPH was also increased (39.47% vs. 3.57%). Univariable logistic regression analysis showed that HbA1c was associated with increased odds of PPH (odds ratio (OR) 4.68, 95% confidence interval (CI) 2.58-8.48), while three-point glucose CV was similarly associated with increased PPH risk (OR 1.19, 95% CI 1.08-1.30). After adjustment for age and body mass index, standardized HbA1c and standardized three-point glucose CV remained associated with PPH (OR 6.86, 95% CI 3.10-15.15; and OR 3.07, 95% CI 1.66-5.67, respectively). Exploratory discrimination analysis demonstrated that the combined model achieved a higher area under the curve than HbA1c alone (0.963 vs. 0.900).</p><p><strong>Conclusions: </strong>Elevated preoperative HbA1c levels and greater perioperative three-point glucose fluctuation were associated with impaired coagulation profiles and an increased risk of perioperative bleeding in diabetic women undergoing cesarean section. Given that the glucose fluctuation metric was derived from only three perioperative measurements and the number of PPH events was relatively limited, these findings should be considered exploratory rather than defi","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1247-1258"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468534","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 a WeChat-Based Follow-Up Approach in Patients Undergoing Minimally Invasive Treatment for Lower Extremity Varicose Veins.","authors":"Yong Wang, Zhong Zhuang","doi":"10.62713/aic.4580","DOIUrl":"https://doi.org/10.62713/aic.4580","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to explore the effectiveness of the WeChat-based digital follow-up approach in patients undergoing minimally invasive surgery for lower extremity varicose veins by evaluating postoperative follow-up compliance, incidence of complications, and patient satisfaction with doctor-patient communication to provide evidence-based improved postoperative follow-up approaches.</p><p><strong>Methods: </strong>This retrospective study enrolled 128 patients who underwent minimally invasive surgery for lower extremity varicose veins between January 2022 and June 2023. According to the postoperative follow-up strategy used, patients were divided into an observation group (n = 66) that received WeChat-based digital follow-up, and a control group (n = 62) that underwent traditional outpatient visits combined with telephone-based follow-up. Patients were followed for 6 months, and postoperative follow-up data were recorded. Adherence with scheduled follow-up, improvements in postoperative symptoms, incidence rate of complications, and patient satisfaction with doctor-patient communication were systematically compared between the two groups.</p><p><strong>Results: </strong>The observation group had significantly higher follow-up compliance rate (96.97%), greater postoperative symptom improvements both after 3- and 6-month follow-up (95.45% and 98.48%), doctor-patient communication satisfaction (96.97%), and a lower overall incidence of complications (4.55%) compared to the control group (83.87%, 82.26%, 88.71%, 83.87% and 16.13% respectively); similarly, the recurrence rate was significantly lower in the observation group (3.03%) compared with the control group (12.90%) (all <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>For patients undergoing minimally invasive surgery for lower limb varicose veins, WeChat-based digital follow-up strategies are associated with higher follow-up compliance, earlier detection of postoperative complications, and higher patient overall satisfaction with doctor-patient communication.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1210-1217"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative OCT Microstructural Changes as Predictors of Visual Prognosis Following Epiretinal Membrane Peeling: A Retrospective Study.","authors":"Weifeng Min, Yanchun Zhu, Xinxin Li","doi":"10.62713/aic.4543","DOIUrl":"https://doi.org/10.62713/aic.4543","url":null,"abstract":"<p><strong>Aim: </strong>Idiopathic macular epiretinal membrane (iERM) induces traction and deformation of the macular retina, significantly impairing function and quality of life. This study aimed to evaluate the predictive value of early postoperative optical coherence tomography (OCT) microstructural changes for visual prognosis in patients undergoing vitrectomy with membrane peeling for iERM.</p><p><strong>Methods: </strong>A total of 110 patients diagnosed with iERM at Huzhou Aier Eye Hospital between January 2021 and July 2024 were retrospectively enrolled. According to OCT findings, patients were divided into stage I (n = 38), stage II (n = 52), and stage III (n = 20). All patients underwent 23-gauge minimally invasive vitrectomy combined with indocyanine green staining and peeling of the epiretinal membrane and internal limiting membrane. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), choroidal thickness at 1000 μm from the nasal side of the macular fovea (NFCT), and choroidal thickness at 1000 μm from the temporal side of the macular fovea (TFCT) were assessed before surgery and at 1 and 3 months postoperatively. Repeated-measures analysis of variance was used to compare intergroup differences over time, and multivariate logistic regression was performed to identify indicators associated with a favorable visual prognosis.</p><p><strong>Results: </strong>Significant gradient differences were observed among the three groups in CMT, SFCT, NFCT, TFCT, and BCVA, with stage I patients exhibiting significantly lower values than those in stage II and stage III (all <i>p</i> < 0.05). During postoperative follow-up, OCT parameters and visual acuity improved in all groups, with significantly greater improvement in stage I patients compared with stage II or stage III (all <i>p</i> < 0.05). Repeated-measures analysis demonstrated a significant time × group interaction effect for CMT (F = 2.334, <i>p</i> = 0.032), with a greater rate of CMT reduction in stage I patients. At 6 months postoperatively, 71 patients (64.55%) achieved a favorable visual prognosis. Multivariate logistic regression analysis indicated that lower CMT at 1 month postoperatively (OR = 0.98, 95% CI: 0.97-0.99, <i>p</i> < 0.05) was significantly associated with favorable visual outcomes at 6 months.</p><p><strong>Conclusions: </strong>Postoperative anatomical and functional recovery in iERM patients is stage-dependent. Lower CMT at 1 month after surgery is significantly associated with favorable visual outcomes at 6 months, suggesting its potential value as an early postoperative prognostic indicator. These findings underscore the importance of incorporating early postoperative OCT assessment into clinical follow-up to facilitate individualized prognosis and patient counseling.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1137-1145"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468602","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":"Coronary Artery Bypass Grafting in the Very Elderly (≥80 Years): A Retrospective Comparison of On-Pump and Off-Pump Techniques With Emphasis on Recovery Patterns.","authors":"Mengmeng Tang, Nvwa Jin, Jie Liu, Xin Lv","doi":"10.62713/aic.4473","DOIUrl":"https://doi.org/10.62713/aic.4473","url":null,"abstract":"<p><strong>Aim: </strong>To systematically compare the perioperative safety, early recovery, and mid-term clinical outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in very elderly patients (≥80 years).</p><p><strong>Methods: </strong>This single-center retrospective study enrolled 62 very elderly patients (≥80 years) undergoing isolated CABG from 2012 to 2022, assigned to on-pump (n = 22) or off-pump (n = 40) groups. Baseline characteristics, intraoperative data, and one-year follow-up outcomes were collected and compared. The primary endpoint was 30-day major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, stroke, and myocardial infarction. Secondary endpoints included the individual components of MACCE and key recovery metrics (duration of mechanical ventilation, intensive care unit (ICU) length of stay, and total hospital length of stay).</p><p><strong>Results: </strong>No statistically significant differences were observed between the two groups in perioperative mortality, incidence of major adverse cardiac and cerebrovascular events (including stroke and myocardial infarction), or one-year survival rates (<i>p</i> > 0.05). The off-pump group had significantly shorter median durations of postoperative mechanical ventilation (15 hours vs. 20.5 hours, <i>p</i> = 0.014) and ICU stay (3 days vs. 5 days, <i>p</i> = 0.007) compared to the on-pump group. However, there were no statistically significant differences in median total postoperative hospitalization (14 days vs. 15 days, <i>p</i> = 0.525) or in the time from ICU transfer to discharge (10 days vs. 9.5 days, <i>p</i> = 0.318). Analysis of postoperative complications revealed a high incidence of severe pulmonary inflammation, with no statistically significant difference between the groups. New-onset postoperative stroke was identified as a leading cause of early and mid-term mortality in this population.</p><p><strong>Conclusions: </strong>In this exploratory retrospective analysis of selected very elderly patients, both on-pump and off-pump CABG demonstrated comparable survival and major adverse event outcomes. Although the off-pump group exhibited a statistically significant signal toward faster early physiological recovery (shorter ventilation and ICU stay), this observation warrants cautious interpretation due to baseline imbalances and should be considered hypothesis-generating rather than definitive. These preliminary findings highlight the need for future risk stratification tools and integrated care pathways, rather than prescribing a specific surgical technique based on recovery speed alone.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1279-1291"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468601","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":"Single Stent-Assisted Coiling for the Treatment of Complex, Acute-Angled Wide-Necked Intracranial Bifurcation Aneurysms Using the Bulging Technique with the Neuroform Atlas Stent.","authors":"Heng Ni, Xin Gu, Congguo Yin, Wenqing Xia, Linbo Zhao, Huan Huang","doi":"10.62713/aic.4545","DOIUrl":"https://doi.org/10.62713/aic.4545","url":null,"abstract":"<p><strong>Aim: </strong>Protecting both bifurcation branches with a single device is challenging when the neck of an intracranial aneurysm is centered at a bifurcation and forms an acute angle. This study aimed to evaluate the efficacy of the bulging technique using a single Neuroform Atlas stent to protect two branches in complex, acute-angled, wide-necked bifurcation aneurysms (WNBAs).</p><p><strong>Methods: </strong>We retrospectively reviewed patients with complex, acute-angled WNBAs who underwent single stent-assisted coiling using the bulging technique with a Neuroform Atlas stent between August 2020 and July 2024. Technical feasibility, procedure-related complications, and angiographic and functional outcomes were evaluated.</p><p><strong>Results: </strong>A total of 52 eligible patients were enrolled, including 22 (42.3%) with acutely ruptured aneurysms. The bulging technique was successfully implemented in all cases. Initial angiographic assessment demonstrated complete occlusion in 33 (63.5%) cases, neck remnants in 14 (26.9%) cases, and residual aneurysms in 5 (9.6%) cases. Angiographic follow-up was available for 48 (92.3%) patients, with a median follow-up duration of 6.4 months. Follow-up angiography demonstrated complete occlusion in 42 (87.5%) patients and neck remnants in 6 (12.5%) patients. Procedure-related complications occurred in 2 (3.8%) patients and consisted of ischemic events. Favorable functional outcomes (modified Rankin Scale score, 0-2) were achieved in 48 (92.3%) patients during follow-up. No cases of permanent procedure-related morbidity or mortality were observed.</p><p><strong>Conclusions: </strong>The bulging technique using a single Neuroform Atlas stent appears to be a feasible and safe treatment for complex, acute-angled WNBAs, with satisfactory short-term angiographic and clinical outcomes. However, further studies with longer follow-up durations are warranted to establish its long-term efficacy.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1300-1307"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Study the Correlation Between the Anatomical Variation of Bronchial Vessels Identified by Preoperative Three-Dimensional CT Reconstruction and the Clinical Outcome After Complex Segmentectomy.","authors":"Chenhui Ma, Jianguang Pan, Ning Liu","doi":"10.62713/aic.4552","DOIUrl":"https://doi.org/10.62713/aic.4552","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;All enrolled patients with non-small cell lung cancer (NSCLC) undergoing complex pulmonary segmentectomy received standardized preoperative three-dimensional (3D) computed tomography (CT) reconstruction. This study aimed to classify bronchovascular anatomical variations identified on preoperative 3D CT reconstruction and to examine their associations with postoperative complications (POCs), exploratory technical surrogate measures, and short-term postoperative rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;From May 2022 to June 2025, a total of 170 patients with primary NSCLC who underwent thoracoscopic complex segmentectomy were included. All patients underwent preoperative thin-slice CT scanning and 3D reconstruction (Mimics 21.0). Anatomical variation patterns were identified by radiologists using a double-blind approach. Based on the presence of bronchovascular variations, patients were assigned to a variation group (n = 108) and a non-variation group (n = 62). POCs (defined as Clavien-Dindo grade II or higher), exploratory technical surrogate measures (minimum surgical margin distance and intersegmental plane integrity score), pathological indices (lymphatic invasion rate), and postoperative recovery parameters (pulmonary function and quality of life) were retrospectively extracted from medical records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall incidence of POCs was significantly higher in the variation group compared with the non-variation group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), with a notable increase in persistent air leakage and pulmonary infections. For exploratory technical surrogate measures, the variation group showed a shorter minimum surgical margin distance, higher intersegmental plane integrity scores, and more frequent intraoperative plan adjustments (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). Pathological evaluation revealed a higher rate of lymphatic invasion in the variation group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), while no marked inter-group differences were observed in the number of positive lymph nodes (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). In terms of postoperative recovery, patients in the variation group experienced a longer hospital stay, greater decline in 6-minute walking distance from baseline, and lower Short-Form 36 (SF-36) role-physical scores at 3 months postoperatively (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). All patients underwent standardized preoperative 3D CT reconstruction for anatomical assessment and surgical planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Bronchovascular anatomical variations identified through standardized preoperative 3D CT reconstruction were associated with higher rates of persistent air leakage (PAL), a higher rate of lymphatic invasion, pulmonary infection, less favorable exploratory technical surrogate measures, and delayed short-term postoperative functional recovery. Because all patients underwent 3D CT reconstruction, these findings should be interpreted as associations related to anatomical variation rather than evidence that 3D CT indepe","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1153-1161"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468586","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":"Pre- and Postoperative Nutritional Deficiencies in Patients Undergoing Bariatric Surgery: A Retrospective Cohort Study.","authors":"Mohammed R Algethami, Wisam Jamal","doi":"10.62713/aic.4499","DOIUrl":"https://doi.org/10.62713/aic.4499","url":null,"abstract":"<p><strong>Aim: </strong>To assess the changes in biochemical indicators of nutritional deficiencies before and after bariatric surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 480 adult patients who underwent bariatric surgery between June 2016 and June 2019 at a tertiary care center in Saudi Arabia. Demographic data, comorbidities, and pre- and postoperative biochemical parameters, including hemoglobin, iron profile, Vitamin D, Vitamin B12, albumin, calcium, and parathyroid hormone levels, were extracted from the medical records. These biochemical parameters were used to assess micronutrient status and identify clinically relevant nutritional deficiencies based on established laboratory thresholds. Paired <i>t</i>- and McNemar tests were used to compare the pre- and postoperative values. Statistical significance was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>We found a high prevalence of pre- and postoperative nutritional deficiencies among patients. The mean hemoglobin decreased from 13.09 to 12.34 g/dL (mean difference -0.75 g/dL; 95% CI -0.89 to -0.61; <i>p</i> < 0.001). We observed a significant association between ferritin and gender pre- and postoperatively, which was lower in women than in men preoperatively and decreased in both sexes postoperatively. The prevalence of 25-hydroxyvitamin D deficiency was 88.0% preoperatively and 72.7% postoperatively in patients with available laboratory data.</p><p><strong>Conclusions: </strong>A high prevalence of pre- and postoperative nutritional deficiencies was observed among patients undergoing bariatric surgery in Saudi Arabia. Although certain parameters improved after surgery, others remained prevalent or worsened postoperatively. These findings highlight the importance of structured nutritional assessments and regular biochemical monitoring before and after bariatric surgery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1232-1238"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of a Novel Light-Transmitting Ocular Dressing in Children After Bilateral Strabismus Surgery: A Prospective Quasi-Experimental Study.","authors":"Wei Song, Ying Sha, Hang Yin, Ruiheng Zhang, Jin Hou, Yonghong Jiao, Zhangfang Ma, Yue Li","doi":"10.62713/aic.4576","DOIUrl":"10.62713/aic.4576","url":null,"abstract":"<p><strong>Aim: </strong>Nontransparent ocular dressings used after bilateral strabismus surgery deprive children of visual input, often provoking crying, causing premature dressing removal, and increasing caregiver burden. This study evaluated the effectiveness of a self-developed, novel light-transmitting ocular dressing in improving postoperative experience and alleviating caregiver burden.</p><p><strong>Methods: </strong>This prospective quasi-experimental study enrolled 120 children (3-14 years) who underwent bilateral strabismus surgery from August to December 2024. Participants were alternately assigned according to admission week to either a light-transmitting dressing group (<i>n</i> = 60) or a conventional nontransparent dressing group (<i>n</i> = 60). Outcomes included postoperative comfort (visual analogue scale [VAS]), crying/agitation level, caregiver burden (Zarit Caregiver Burden Interview), and unplanned dressing-change rate. Multivariate linear regression was used to evaluate the independent effect of dressing type after adjustment for demographic and surgical covariates.</p><p><strong>Results: </strong>Compared with those in the nontransparent group, children in the light-transmitting group reported significantly better postoperative comfort (VAS: 1.57 ± 0.81 vs 3.58 ± 1.34, <i>p</i> < 0.001) and were more likely to remain calm and cooperative (76.67% vs 33.33%). Caregiver burden scores were significantly lower (30.30 ± 3.12 vs 36.51 ± 4.20, <i>p</i> < 0.001), and the unplanned dressing-change rate was reduced (3.33% vs 18.33%, <i>p</i> < 0.01). After adjustment for demographic and surgical variables (procedure type, number of muscles operated, and operative duration), dressing type remained an independent predictor of comfort (β = -2.04, <i>p</i> < 0.001) and caregiver burden (β = -6.36, <i>p</i> < 0.001). Caregiver education level was balanced between groups and was an independent predictor of caregiver burden (β = -0.80, <i>p</i> = 0.03).</p><p><strong>Conclusions: </strong>The light-transmitting ocular dressing effectively improves comfort after bilateral strabismus surgery in children, reduces crying/agitation and caregiver burden, and lowers the need for unplanned dressing changes. By preserving postoperative visual input, this design offers an effective nonpharmacological strategy to mitigate postoperative psychological stress in children and warrants broader clinical adoption.</p><p><strong>Clinical trial registration: </strong>China Clinical Trial Registry (ChiCTR2600117638).</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1259-1269"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468450","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 Inflammatory and Nutritional Indices as Predictors of Infectious Complications Following Elective Cesarean Section in Patients With Gestational Diabetes Mellitus: A Retrospective Study.","authors":"Xiaoli Zhang, Chen Chen","doi":"10.62713/aic.4544","DOIUrl":"https://doi.org/10.62713/aic.4544","url":null,"abstract":"<p><strong>Aim: </strong>Postoperative infection is a significant complication that may adversely affect maternal recovery following cesarean section. Patients with gestational diabetes mellitus (GDM) may be at increased risk due to metabolic dysregulation and altered immune function. This study aimed to investigate preoperative risk factors for infectious complications following elective cesarean section in patients with GDM, with a focus on readily obtainable inflammatory and nutritional indices.</p><p><strong>Methods: </strong>This retrospective study included 383 patients with GDM who underwent elective cesarean section at Tongxiang Maternity and Child Health Care Hospital between January 2022 and February 2025. Preoperative inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP), as well as nutritional indices, including prognostic nutritional index (PNI) and hemoglobin (Hb), were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative infection, and a risk stratification approach based on inflammatory and nutritional indices was developed.</p><p><strong>Results: </strong>Among the 383 patients, 72 (18.8%) developed postoperative infections. Multivariable analysis identified elevated CRP (odds ratio (OR) = 2.383, 95% confidence interval (CI): 1.669-4.427), decreased PNI (OR = 0.680, 95% CI: 0.507-0.842), decreased hemoglobin (OR = 0.854, 95% CI: 0.746-0.945), and elevated PLR (OR = 1.046, 95% CI: 1.006-1.101) as independent risk factors for postoperative infection (all <i>p</i> < 0.05). Receiver operating characteristic (ROC) analysis demonstrated good discriminative performance of the inflammatory and nutritional indices, with CRP showing the strongest performance. Risk stratification based on the number of these factors (CRP, PLR, PNI, Hb) showed infection rates of 0.0%, 1.4%, 14.1%, 84.2%, and 100.0% for patients with 0, 1, 2, 3, and 4 factors, respectively (trend test <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Preoperative elevation of inflammatory markers (CRP, PLR) and impairment of nutritional status (PNI, Hb) are independent risk factors for post-cesarean infection in patients with GDM. Preoperative risk assessment incorporating these indices may facilitate identification of high-risk patients and support targeted perioperative management strategies.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1292-1299"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468619","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":"Anatomical Feasibility and Morphometric Analysis of Cortical Bone Trajectory Screw Fixation in the Pediatric Lumbar Spine Using Computed Tomography.","authors":"Jun Xuan, Zhi-Guang Zhang, Yi Chen, Jian Chen, Xiang-Yang Wang","doi":"10.62713/aic.4529","DOIUrl":"https://doi.org/10.62713/aic.4529","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;The cortical bone trajectory (CBT) screw fixation technique has been widely adopted in adult spinal surgery due to its minimally invasive nature and biomechanical advantages. However, systematic research on its anatomical feasibility and morphometric parameters in the pediatric lumbar spine remains lacking. This study aimed to evaluate the anatomical feasibility of CBT screw fixation in the pediatric lumbar spine, and to characterize the variations in screw dimensions and insertion angles across different age groups and lumbar levels, providing an individualized reference for pediatric lumbar surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included 80 pediatric patients aged 5-16 years without lumbar pathologies. Participants were stratified into four age groups (5-7, 8-10, 11-13, and 14-16 years, denoted as Groups 1, 2, 3, and 4, respectively), with 20 patients per group and sex-matched distribution (10 males and 10 females per group). Multiplanar reconstruction based on computed tomography (CT) images with 1 mm reconstruction was performed to measure the following parameters at each lumbar level (L1-L5): maximum screw length (MSL), maximum screw diameter (MSD), lateral angle (LA), and cephalad angle (CA). Statistical analysis was conducted using a mixed linear effects model to assess the influence of age, sex, lumbar level, and their interactions on each parameter, supplemented by analysis of variance (ANOVA) and post hoc multiple comparisons with Bonferroni correction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;MSL increased significantly with age and showed a level-specific pattern, generally rising from L1 to L3 and declining at L5. In the mixed-effects model, age group and lumbar level had significant effects on MSL, and a significant Group 4 × female interaction was observed. MSD increased progressively from L1 to L5 and was significantly affected by age group, sex, lumbar level, and age × sex interaction, with a particularly significant Group 2 × female interaction (estimate = 0.459, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). LA generally increased with age and caudal progression of the lumbar level and was significantly influenced by age group, sex, and lumbar level. In contrast, CA decreased progressively from L1 to L5 within each age group and was significantly influenced by age group and lumbar level, whereas the age × sex interaction was not significant. Anatomical feasibility was assessed using a screw diameter threshold of ≥ 4.5 mm. The applicability rate of CBT fixation increased with both age and caudal lumbar level, with lower feasibility mainly observed at upper lumbar levels in younger children. At L1, applicability rates were 50% in Group 1, 70% in Group 2, and 100% in Groups 3 and 4; at L5, applicability reached 100% in all groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The anatomical parameters for CBT screw placement in the pediatric lumbar spine are significantly influenced by age, lumbar level, and sex. This study p","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1172-1181"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468439","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}