AIM: Urinary tract infection (UTI) is a frequent early complication after pelvic floor reconstruction. This study examined whether perioperative UTI is associated primarily with the surgical approach or with recurring patient-, disease-, and care-related factors. METHODS: Medical records were retrospectively reviewed for 376 women treated with pelvic floor reconstructive surgery from 2020 through 2025. According to the principal reconstructive procedure, the cohort was divided into three surgical strata: mesh-based sacrospinous fixation accompanied by transobturator tape (TOT) or tension-free vaginal tape (TVT) insertion; combined anterior and posterior colporrhaphy with a midurethral sling; and anterior and posterior colporrhaphy performed without an associated sling procedure. The study endpoint was a symptomatic urinary tract infection confirmed by urine culture during the initial hospital admission. Associations between candidate predictors and infection were estimated separately within each surgical stratum. Stratum-level effect estimates were then integrated using a DerSimonian–Laird random-effects model to obtain pooled odds ratios and 95% confidence intervals. Cross-stratum variability was quantified through Cochran’s Q test and the I2 statistic. RESULTS: Of the 376 women included, 71 experienced a symptomatic, culture-confirmed infection during the perioperative period, producing an overall event rate of 18.9%. The proportion of affected patients varied numerically among the three reconstructive pathways, although no statistically significant difference was observed in the unadjusted comparison. When risk estimates were synthesized across surgical strata, higher odds of infection were observed in postmenopausal women, patients older than 63 years, those with grade III–IV pelvic organ prolapse, women with morbid obesity, patients requiring bladder catheterization for more than 3 days, and those undergoing hysterectomy during the same operation. The principal significant associations showed little or no between-stratum heterogeneity, suggesting a consistent direction of association across surgical approaches, although the limited number of subgroups (k = 3) and instances of non-estimable models restrict definitive conclusions regarding reproducibility; further validation in larger cohorts is warranted. CONCLUSIONS: Perioperative urinary tract infection after pelvic floor reconstructive surgery appears to reflect a multifactorial susceptibility profile, influenced mainly by patient characteristics, prolapse severity, and prolonged catheterization rather than procedure type alone. These findings support individualized risk assessment and reduced unnecessary catheter use. However, differences in baseline characteristics between surgical groups preclude concluding that the procedures carry equivalent infectious risk.
AIM: To compare the clinical, functional, and radiological outcomes of two nucleus pulposus management strategies, limited discectomy and aggressive discectomy, during percutaneous endoscopic lumbar discectomy (PELD), and to investigate the association between the extent of disc removal, postoperative Modic changes, and functional recovery.METHODS: A total of 200 patients with lumbar disc herniation who underwent transforaminal PELD between January 2023 and January 2025 were retrospectively enrolled. Patients were classified into an aggressive discectomy group (n = 88) and a limited discectomy group (n = 112) according to the intraoperative nucleus pulposus removal strategy. Propensity score matching (PSM) at a 1:1 ratio was performed to balance baseline characteristics between the two groups, resulting in 72 matched pairs for analysis. The primary outcome was the incidence of Modic changes at 1 year postoperatively. Secondary outcomes included recurrence, reoperation, complications, modified MacNab outcomes, and recovery of neurological function, pain, lumbar function, and quality of life.RESULTS: A total of 144 patients were included after PSM. Compared with the limited discectomy group, the aggressive discectomy group exhibited a significantly higher incidence of Modic changes at 1 year postoperatively (37.50% vs. 22.22%, p = 0.045). No significant differences were observed between the two groups in the 1-year recurrence rate, reoperation rate, complication rate, or the proportion of patients achieving excellent or good modified MacNab outcomes (all p > 0.05). At 1 month postoperatively, the aggressive discectomy group had higher low-back pain visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores than the limited discectomy group (Holm-adjusted p = 0.012 and p < 0.001, respectively), whereas no significant between-group differences were observed at 6 or 12 months (all Holm-adjusted p > 0.05). Repeated-measures analysis showed significant group-by-time interactions for low-back pain VAS and ODI scores (pinteraction = 0.036 and 0.004, respectively), whereas the trajectories of the other functional outcomes were comparable between the groups (all pinteraction > 0.05).CONCLUSIONS: Among patients undergoing PELD for lumbar disc herniation, aggressive discectomy was associated with a higher incidence of Modic changes at 12 months, whereas no significant between-group difference in recurrence was observed. The association between aggressive discectomy and long-term recurrence requires further investigation.
AIM: To investigate the factors associated with hyperopic shift (HS) after phacoemulsification (PE) combined with intraocular lens (IOL) implantation in patients with primary angle-closure glaucoma (PACG).METHODS: A total of 167 eyes with PACG that underwent PE+IOL were retrospectively included. Postoperative refractive prediction error (RPE) was calculated as the actual postoperative spherical equivalent minus the Barrett-predicted postoperative spherical equivalent. HS (RPE >+0.50 D) was the primary outcome. Group comparisons and univariable logistic regression were performed, followed by receiver operating characteristic (ROC) analyses of selected variables and multivariable logistic regression to identify independent factors.RESULTS: Postoperative HS occurred in 54 eyes (32.3%). ROC curve analysis showed that axial length/corneal radius (AL/CR) ratio, anterior chamber depth (ACD), and white-to-white distance (WTW) showed moderate discriminative ability for postoperative HS, with areas under the curve (AUCs) of 0.779, 0.764, and 0.730, respectively. Multivariable logistic regression analysis showed that higher relative lens position (RLP), AL/CR, and WTW were associated with a lower likelihood of postoperative HS, whereas capsular tension ring (CTR) implantation was associated with a higher likelihood of postoperative HS.CONCLUSIONS: Lower RLP, AL/CR, and WTW values and CTR implantation were independently associated with postoperative HS. ROC analyses showed that AL/CR, ACD, and WTW had discriminative ability for HS.
AIM: The transition from medical school to surgical residency is marked by a persistent gap between theoretical instruction and clinical readiness. In Italy, variability in training programs across centers creates persistent gaps in residents’ medical education. Scientific societies are asked to identify current training gaps and define the core competencies required for effective surgical training. We propose an undergraduate curriculum to support last-year medical students in Italy.METHODS: A scoping review of the literature focusing on structured surgical curricula for undergraduate medical students was conducted. A suggested “curriculum” was introduced at the 2025 Congress of the Italian Polispecialistic Society of Young Surgeons (SPIGC) in Bari, Italy.RESULTS: The SPIGC curriculum includes seven domains: (1) soft skills: communication, informed consent, and interdisciplinary collaboration; (2) clinical and diagnostic skills: outpatient clinic management and perioperative care; (3) hygiene, prevention, healthcare systems; (4) technical skills; (5) emergency and trauma surgery; (6) perioperative management, integrating Enhanced Recovery After Surgery (ERAS) protocols, nutritional assessment, and infections; (7) evidence-based medicine and recommendations. The SPIGC curriculum highlights the importance of simulation labs, hands-on workshops, and online learning, while providing clear pathways for fellowships or masters. It also introduces artificial intelligence (AI) systems as a modern learning tool, while highlighting the importance of their safe and responsible use.CONCLUSIONS: The SPIGC curriculum may provide a structured plan to improve surgical education for medical students in Italy and to align it with international standards. Its acceptability and impact on training quality and patient outcomes remain to be evaluated through future consensus and prospective studies.
AIM: We aimed to perform a prognostic evaluation for patients with acute ischemic stroke after mechanical thrombectomy (MT) incorporating imaging, inflammatory, and rehabilitation aspects.METHODS: A retrospective cohort analysis of patients with acute ischemic stroke (AIS) after mechanical thrombectomy (MT) was conducted, systematically evaluating baseline demographics, neuroimaging features, hematological inflammatory indices, and time to start rehabilitation. Prognostic correlations were examined using multivariate logistic regression, with poor functional outcome defined as 90-day modified Rankin Scale (mRS) >2. Model discrimination was assessed via receiver operating characteristic (ROC) analysis of the composite prediction framework.RESULTS: The analytical cohort comprised 144 subjects. Five independent predictors of unfavorable outcomes emerged: pre-existing hypertension (adjusted Odds Ratio [aOR] 6.48, 95% Confidence Interval [CI] 1.03–40.80), lower baseline Alberta Stroke Program Early CT Score (ASPECTS) (aOR 0.18, 95% CI 0.06–0.49), elevated NLR (aOR 1.27, 95% CI 1.11–1.46), extended onset-to-reperfusion time (OTR) (per minute aOR 1.01, 95% CI 1.01–1.02), and delayed starting rehabilitation (aOR 2.30, 95% CI 1.52–3.46). The multivariable model demonstrated excellent discriminative capacity (area under the curve [AUC] 0.964, 95% CI 0.940–0.988).CONCLUSIONS: Beyond successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3), functional outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy were independently influenced by factors across the three core domains of our prognostic framework: imaging (baseline ASPECTS), inflammation (elevated neutrophil-to-lymphocyte ratio, NLR), and rehabilitation (delayed starting rehabilitation). Additional significant clinical variables included pre-existing hypertension and longer onset-to-reperfusion time (OTR). These findings support the potential value of a multidimensional prognostic assessment integrating imaging, inflammatory, and rehabilitation aspects in patients with acute ischemic stroke after mechanical thrombectomy.
