Nevin Manimala

Ann Ital Chir. 2024;95(6):1125-1133. doi: 10.62713/aic.3556.

ABSTRACT

AIM: Colorectal cancer (CRC) ranks as the second most diagnosed and third most deadly cancer worldwide. Despite advances in early diagnosis and treatment, CRC remains a leading cause of cancer-related deaths. Up to 30% of CRC patients are diagnosed during emergency department visits, leading to surgical procedures that may not adhere to oncological principles due to complications like obstruction, bleeding, or perforation. This study aims to compare postoperative complications and long-term oncological outcomes between emergent and elective colon cancer surgeries.

METHODS: Retrospective analysis was performed on patients who underwent surgery for colonic adenocarcinoma from January 2018 to December 2021. Patients included were those diagnosed with colonic adenocarcinoma, excluding those under 18 years old or with other pathological results. Patients were examined under the elective and emergent surgery groups. The study investigated demographic data, tumor localization, operation type, postoperative complications, and long-term oncological outcomes. A Cox proportional hazard model was used to perform multivariate analysis in order to identify prognostic variables for overall survival (OS) and disease-free survival (DFS).

RESULTS: A total of 318 patients were included, with 62 undergoing emergent surgery and 256 undergoing elective surgery. Patient demographics were similar between the groups. The emergent surgery group had a significantly lower OS rate at 50 months compared to the elective surgery group (51% vs. 62%, p = 0.002). DFS at 50 months was also lower for the emergent surgery group compared to the elective surgery group (43% vs. 59%), but this difference did not reach statistical significance (p = 0.202). Independent poor prognostic factors included stage N, stage M, tumor diameter, neural invasion, and emergent surgery status.

CONCLUSIONS: Emergency surgery for colon cancer is associated with poor long-term outcomes due to shorter OS and DFS, highlighting the need for increased awareness and screening to reduce emergency colon cancer surgery.

PMID:39723516 | DOI:10.62713/aic.3556

Ann Ital Chir. 2024;95(6):1178-1185. doi: 10.62713/aic.3639.

ABSTRACT

AIM: Colorectal cancer (CRC) primarily arises from a combination of genetic, environmental, and dietary factors. Compared to traditional open surgery, minimally invasive laparoscopic surgery offers several advantages in managing CRC. This study investigates the factors influencing dynamic intestinal obstruction following laparoscopic colorectal radical surgery.

METHODS: We collected clinical data from 218 CRC patients who underwent laparoscopic radical surgery at the People’s Hospital of Xinjiang Uygur Autonomous Region, China between January 2022 and December 2023. The patients were followed up for 30 days post-surgery, and those who developed dynamic intestinal obstruction were placed in the complication group, while those who did not were included in the control group. The quality of life for all patients was assessed using Quality of Life Score (QoL) measures. The incidence of postoperative dynamic intestinal obstruction was calculated. Baseline and clinical data were collected using a standardized patient data form, and risk factors for postoperative dynamic intestinal obstruction were analyzed.

RESULTS: Postoperative evaluation revealed that 42 out of 218 patients developed dynamic intestinal obstruction, with an incidence rate of 19.27%. Univariate analysis revealed no statistically significant differences between the complication and control groups in terms of gender, age, body mass index (BMI), education level, Quality of Life Score tumor location, degree of differentiation, tumor diameter, surgery duration, presence of hypertension, history of diabetes, hyperlipidemia (HLP), smoking or alcoholism history, or postoperative abdominal infection (p > 0.05). Furthermore, factors such as tumor stage, preoperative hypoproteinemia, history of abdominal surgery, preoperative intestinal obstruction, and lymph node metastasis were identified as risk factors for postoperative dynamic intestinal obstruction. Logistic regression analysis further indicated that tumor stage, preoperative hypoproteinemia, history of abdominal surgery, preoperative intestinal obstruction, and presence of lymph node metastasis were all independent risk factors for dynamic intestinal obstruction after surgery (Odds Ratio (OR) >1, p < 0.05).

CONCLUSIONS: Dynamic intestinal obstruction following laparoscopic radical surgery for CRC is significantly correlated with factors such as tumor stage, preoperative hypoproteinemia, history of abdominal surgery, preoperative intestinal obstruction, and lymph node metastasis.

PMID:39723509 | DOI:10.62713/aic.3639

Ann Ital Chir. 2024;95(6):1206-1212. doi: 10.62713/aic.3650.

ABSTRACT

AIM: This study had two aims: to analyze surgical patients with mediastinal cysts and masses according to clinical, histopathological, and surgical types; and compare the impact of the coronavirus disease 2019 (COVID-19) pandemic on these cases.

METHODS: A retrospective analysis was conducted on 132 patients who had undergone surgical intervention for mediastinal cysts and masses. Demographic, clinical, and histopathologic data were recorded. Patients were divided into two groups based on their preference for video-assisted thoracoscopic surgery (VATS) and other surgical methods. Patients who had undergone surgery during and before the COVID-19 pandemic were also compared.

RESULTS: Lesions were detected incidentally in 56 patients (42.4%). The lesions were most commonly located in the anterior mediastinum (n = 86, 65.2%), while the most common pathology was found to be thymoma (n = 47, 35.6%). VATS was the most preferred method of operation (n = 36, 27.3%). The duration of hospital stay was observed to be statistically significantly shorter in patients who underwent VATS (p = 0.016). After the COVID-19 pandemic, the incidental incidence of mediastinal cysts and masses was significantly higher (p = 0.005).

CONCLUSIONS: The incidental detection rate of operated mediastinal cysts and masses increased after the COVID-19 pandemic. It is suggested that this study act a starting point for investigating the impact of the pandemic on mediastinal cysts and masses.

PMID:39723507 | DOI:10.62713/aic.3650

Ann Ital Chir. 2024;95(6):1221-1230. doi: 10.62713/aic.3657.

ABSTRACT

AIM: This study is aims to compare the clinical efficacy and safety of percutaneous kyphoplasty (PKP) and percutaneous pedicle screw fixation (PPSF) in managing osteoporotic vertebral compression fractures (OVCFs) among middle-aged and elderly individuals.

METHODS: A total of 142 patients aged 55-65 years were selected retrospectively from the Department of Orthopedics of our hospital from June 2021 to June 2023 and classified into PKP (n = 68) and PPSF (n = 74) groups. General data of patients were collected, and related perioperative indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), Activities of Daily Living (ADL) scores, changes in Cobb angle of the fractured vertebrae, vertebral compression rate, as well as postoperative complications were compared between the two groups.

RESULTS: The PKP group showed shorter operation duration, reduced intraoperative blood loss, shorter hospital stay, and earlier compared to the PPSF group (p < 0.001). In comparison with the PPSF group, the PKP group endured much reduced pain, with improvements in spinal function and quality of life. On postoperative day 1, the PPSF group demonstrated superior restoration of vertebral height and deformity correction in relative to the other group (p < 0.05), with no significant difference in preoperative Cobb angle and vertebral compression rate (p > 0.05). The incidence of complications showed no significant differences between the two groups (p > 0.05).

CONCLUSIONS: The advantages of PKP lie in its ability to effectively relieve pain, improve spinal function, and enhance the quality of life. PPSF, meanwhile, is well-suited for the recovery of vertebral height and the correction of deformity in the early stage.

PMID:39723505 | DOI:10.62713/aic.3657

Ann Ital Chir. 2024;95(6):1085-1094. doi: 10.62713/aic.3695.

ABSTRACT

AIM: This study aims to compare the efficacy of modified single-incision surgery with that of traditional modified Ravitch surgery for the repair of pectus excavatum in pediatric patients.

METHODS: In this retrospective study, we included patients who underwent surgical correction for sternal depression from January 2015 to December 2020 across four major medical centers. Patients were categorized into two specific groups on the basis of the surgical technique employed: the modified single-incision surgery group, which comprised patients treated using the novel single-incision approach, and the traditional modified Ravitch surgery group, which included patients who received the conventional Ravitch surgery with multiple incisions. This study only included patients in the age range of 10 to 18 years, diagnosed with moderate to severe pectus excavatum, and lacked remarkable comorbid conditions that could influence surgical outcomes. Comprehensive data on preoperative characteristics, intraoperative variables, and postoperative results were collected for analysis.

RESULTS: The modified single-incision surgery group showed significantly lower mean blood loss, mean operating time, mean hospital stay, postoperative drainage rate, postoperative mean Haller index and mean Haller index after bar removal compared to the traditional modified Ravitch surgery group (p < 0.05). Furthermore, the surgical outcomes were significantly better in the modified single-incision surgery group (p = 0.010) than in the traditional modified Ravitch surgery group. The modified single-incision surgery group also had a significantly lower incidence of postoperative complications, including pneumothorax, pleural effusion, pulmonary infection, bar rejection, and bar flipping and displacement (p < 0.05), than the traditional modified Ravitch surgery group. The modified single-incision surgery group showed significantly greater improvement in sternal depression depth compared to the traditional modified Ravitch surgery group (p = 0.031). Corrected symmetry was significantly better in the modified single-incision surgery group (p = 0.037). The overall satisfaction of patients in the modified single-incision surgery group was significantly higher than that in the traditional modified Ravitch surgery group (p = 0.011).

CONCLUSIONS: The modified single-incision procedure for the treatment of pectus excavatum offers considerable advantages over the traditional modified Ravitch surgery. The findings of this study suggest that the modified single-incision procedure is a safe and effective alternative for the correction of pectus excavatum.

PMID:39723504 | DOI:10.62713/aic.3695

Ann Ital Chir. 2024;95(6):1213-1220. doi: 10.62713/aic.3725.

ABSTRACT

AIM: To explore the effectiveness and safety of Osborne’s ligament suspension and ulnar nerve anterior transposition (OLSUNAT) in conjunction with transcutaneous electrical nerve stimulation (TENS) for managing cubital tunnel syndrome (CTS).

METHODS: A total of 116 individuals diagnosed with CTS who underwent OLSUNAT in our hospital between October 2020 and December 2023 were retrospectively selected. They were divided into a treatment group (62 cases) and a control group (54 cases) based on whether they received subsequent TENS. Observation indicators included pain level, numbness, ulnar nerve conduction velocity, strength of the abductor of the little finger, two-point discrimination, elbow range of motion, fine motor activities of the upper limb and hand, SF-36 scores, and incidence of complications.

RESULTS: No significant differences in baseline characteristics were identified between the treatment and control groups (p > 0.05). After treatment, both groups showed remarkable improvements in pain level, numbness, motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV), strength of the abductor of the little finger, two-point discrimination, elbow range of motion, Simple Test for Evaluating Hand Function (STEF) score, and SF-36 scores compared to before treatment (p < 0.05). However, the treatment group showed greater progress than the control group (p < 0.05). Although the overall incidence of complications in the treatment group was slightly lower than in the control group, this difference did not reach statistical significance (p > 0.05).

CONCLUSIONS: OLSUNAT combined with TENS offers significant advantages in managing CTS, effectively alleviating symptoms, promoting nerve and elbow function recovery, and improving patients’ quality of life while demonstrating high safety. However, further extensive and long-term studies are needed to confirm its sustained efficacy and safety.

PMID:39723501 | DOI:10.62713/aic.3725

Ann Ital Chir. 2024;95(6):1163-1169. doi: 10.62713/aic.3805.

ABSTRACT

AIM: This study aimed to explore the application effect of comfort nursing based on evidence-based concept in radial artery puncture hemostasis of patients after coronary intervention.

METHODS: This interventional study included the clinical data of 180 patients who underwent percutaneous radial coronary intervention in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from July 2024 to September 2024. All patients were treated with radial artery hemostasis device after operation. Patients were divided into two groups based on the single and even number of admission date. Patients admitted with single number were included in the control group (routine nursing, n = 94), and patients admitted with even number were included in the study group (comfort nursing based on evidence-based concept, n = 86). The post-surgical discomfort, postoperative complications, and patient satisfaction levels were comparatively analyzed between the two experimental groups.

RESULTS: The hemostasis was successfully achieved in both groups of patients, with a success rate of 100%. Compared to the control group, visual analogue scale (VAS) scores were significantly reduced in the study group at 2 and 4 hours after the procedure (p < 0.05). Post-surgery, the study group experienced reduced rates of subcutaneous ecchymosis, swelling of palms and forearms, and reduced complication rate compared to the control group (p < 0.05). Furthermore, patients in the study group exhibited higher mission content, service attitude, nursing quality, nursing approach score, and nursing satisfaction score than those in the control group, and the differences between the two groups were statistically significant (p < 0.001).

CONCLUSIONS: Using comfort nursing based on the evidence-based concept during radial artery puncture hemostasis in patients after the coronary intervention effectively relieves patients’ pain, reduces postoperative complications and improves nursing care satisfaction.

CLINICAL TRIAL REGISTRATION: China Clinical Trial Registry: ChiCTR2400087080.

PMID:39723498 | DOI:10.62713/aic.3805

Br J Math Stat Psychol. 2024 Dec 26. doi: 10.1111/bmsp.12379. Online ahead of print.

ABSTRACT

This paper introduces the generalized Hausman test as a novel method for detecting the non-normality of the latent variable distribution of the unidimensional latent trait model for binary data. The test utilizes the pairwise maximum likelihood estimator for the parameters of the latent trait model, which assumes normality of the latent variable, and the maximum likelihood estimator obtained under a semi-non-parametric framework, allowing for a more flexible distribution of the latent variable. The performance of the generalized Hausman test is evaluated through a simulation study and compared with other test statistics available in the literature for testing latent variable distribution fit and an overall goodness-of-fit test statistic. Additionally, three information criteria are used to select the best-fitted model. The simulation results show that the generalized Hausman test outperforms the other tests under most conditions. However, the results obtained from the information criteria are somewhat contradictory under certain conditions, suggesting a need for further investigation and interpretation. The proposed test statistics are used in three datasets.

PMID:39723492 | DOI:10.1111/bmsp.12379

Clin Endosc. 2024 Dec 12. doi: 10.5946/ce.2024.061. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Colonoscopy is widely used as a diagnostic and preventive procedure for colorectal diseases. The most recent guidelines advocate the use of a low-residue diet (LRD) for bowel preparation before colonoscopy. LRD duration varies considerably, with recommended 1-day and multiple-day regimens in clinical practice.

METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched multiple databases for randomized controlled trials (RCTs) and analyzed the outcomes using a fixed-effects model.

RESULTS: Six RCTs with 2,469 subjects were included in this study. The rates of adequate bowel preparation for 1-day and >1-day were 87.2% and 87.1%, respectively. No statistically significant differences were observed between the 1-day and >1-day LRD in adequate bowel preparation (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.76-1.41; p=0.84; I2=0%), polyp detection rate (OR, 0.91; 95% CI, 0.76-1.09; p=0.29; I2=16%), adenoma detection rate (OR, 0.87; 95% CI, 0.71-1.08; p=0.21; I2=0%), and withdrawal time (mean difference, -0.01; 95% CI, -0.25 to 0.24; p=0.97; I2=63%).

CONCLUSIONS: The efficacy of 1-day and multiple-day LRD is comparable in achieving satisfactory bowel preparation, highlighting their similar impact on the detection of polyps and adenomas during colonoscopy.

PMID:39722139 | DOI:10.5946/ce.2024.061

CNS Neurosci Ther. 2024 Dec;30(12):e70185. doi: 10.1111/cns.70185.

ABSTRACT

BACKGROUND: Previous research has demonstrated correlations between the complex types and functions of brain cells and the etiology of glioma. However, the causal relationship between gene expression regulation in specific brain cell types and glioma risk, along with its therapeutic implications, remains underexplored.

METHODS: Utilizing brain cell type-specific cis-expression quantitative trait loci (cis-eQTLs) and glioma genome-wide association study (GWAS) datasets in conjunction with Mendelian randomization (MR) and colocalization analyses, we conducted a systematic investigation to determine whether an association exists between the gene expression of specific brain cell types and the susceptibility to glioma, including its subtypes. Additionally, the potential pathogenicity was explored utilizing mediation and bioinformatics analyses. This exploration ultimately led to the identification of a series of brain cell-specific therapeutic targets.

RESULTS: A total of 110 statistically significant and robust associations were identified through MR analysis, with most genes exhibiting causal effects exclusively in specific brain cell types or glioma subtypes. Bayesian colocalization analysis validated 36 associations involving 26 genes as potential brain cell-specific therapeutic targets. Mediation analysis revealed genes indirectly influencing glioma risk via telomere length. Bioinformatics analysis highlighted the involvement of these genes in glioma pathogenesis pathways and supported their enrichment in specific brain cell types.

CONCLUSIONS: This study, employing an integrated approach, demonstrated the genetic susceptibility between brain cell-specific gene expression and the risk of glioma and its subtypes. Its findings offer novel insights into glioma etiology and underscore potential therapeutic targets specific to brain cell types.

PMID:39722126 | DOI:10.1111/cns.70185