St. Eugenio Hospital

Protein intake plays a critical role in postoperative recovery and wound healing, particularly in procedures such as abdominoplasty. While ERAS protocols emphasize nutritional optimization, evidence in non-bariatric patients undergoing elective body contouring remains limited. To evaluate the effects of early postoperative protein supplementation on wound healing outcomes, complication rates and recovery time in patients undergoing full abdominoplasty. A retrospective, observational cohort study was conducted on 200 non-bariatric patients undergoing standardized full abdominoplasty. Participants were divided into two groups: one receiving daily protein supplementation (≥1.2g/kg/day using whey isolate or hydrolyzed collagen peptides) initiated within 24h postoperatively for at least 14days, and a control group with no supplementation. Outcomes measured included wound dehiscence, seroma formation, surgical site infections (SSI), time to complete healing, and patient satisfaction. Data were analyzed using chi-square tests, t-tests, and multivariate regression models. The supplemented group showed significantly lower wound dehiscence (6% vs. 17%, p = 0.018) and reduced seroma incidence (9% vs. 18%, p = 0.048). Time to complete healing was shorter in the supplemented group (16.8 ± 3.4 days vs. 20.5 ± 4.2days; p < 0.001). While SSI incidence was not significantly different (4% vs. 10%, p = 0.092), a favorable trend was noted. Multivariate regression confirmed protein supplementation as an independent predictor of faster healing (β = -2.94; 95% CI -4.36 to -1.52). Postoperative protein supplementation significantly improves wound healing and reduces complications in patients undergoing abdominoplasty, even outside the bariatric population. These findings support the incorporation of targeted nutritional protocols into routine perioperative care pathways for abdominoplasty. While the study did not formally evaluate an ERAS protocol, its results are consistent with the general principles of enhanced recovery, emphasizing the role of early nutritional support in improving postoperative outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa Collegio Universitario Aspiranti Medici Missionari (CUAMM), the Ethiopian Pediatrics Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian neonatal intensive care unit (NICU)s, identify gaps, and guide targeted interventions. Methods: A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation “Train the Trainers” course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites. Results: The survey showed that most units lacked essential resuscitation equipment. Noninvasive respiratory support mainly relied on homemade continuous positive airway pressure systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas. Conclusions: The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures and promote delivery room and respiratory care.

Abdominoplasty, especially when combined with circumferential liposuction, is a widely performed body contouring procedure with well-established aesthetic and functional benefits. However, postoperative cutaneous sensory loss in the abdominal wall remains a frequent and underexplored complication. This study aimed to prospectively map sensory changes following lipoabdominoplasty and evaluate the influence of Scarpa's fascia preservation on recovery trajectories and quality of life. A prospective single-center study was conducted on 60 patients (mean age 42.7 years; 93.3% female) undergoing 360-degree liposuction and lipoabdominoplasty. Patients were stratified into two groups: Scarpa-preserved (n = 32) and standard dissection with Scarpa removal (n = 28). Sensory testing included Semmes-Weinstein monofilaments, thermal discrimination, and two-point discrimination across 12 abdominal dermatomal zones (T6-L1), assessed preoperatively and at 1, 3, 6, and 12 months. Patient-reported outcomes were measured using standardized questionnaires (SF-36, VAS, and POSAS). Statistical comparisons and multivariate regression were performed to identify predictors of long-term sensory deficits. At 1 month, 93.3% of patients exhibited sensory impairment, most pronounced in the infraumbilical medial (Zone 8), suprapubic (Zone 11), and supraumbilical midline (Zone 5) regions. Recovery progressed steadily: residual deficits persisted in 72.5% at 3 months, 55.0% at 6 months, and 21.7% at 12 months. Tactile, thermal, and spatial discrimination showed parallel patterns of recovery, with near-complete restitution in most cases. Preservation of Scarpa's fascia significantly improved sensory outcomes, with better tactile thresholds (Zones 5 and 8 at 6 months, p < 0.05), faster thermal recovery (Zone 11 at 3 months, p = 0.041), and fewer impaired dermatomes at late follow-up (p < 0.05). Multivariate analysis identified higher BMI, standard dissection (Scarpa removal), and greater resection weight (>1000g) as independent predictors of persistent hypoesthesia. Patient-reported maps correlated strongly with objective findings (r = 0.81, p < 0.001). Quality-of-life scores and scar satisfaction were significantly higher in the Scarpa-preserved group at 12 months. Cutaneous sensory loss is an almost universal early sequela of lipoabdominoplasty but typically resolves within 12 months. Preservation of Scarpa's fascia confers measurable neuroprotective effects, reducing long-term deficits and enhancing patient satisfaction. Incorporating comprehensive sensory evaluation into surgical planning and patient counseling may improve functional and aesthetic outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Despite the preference for transradial access (TRA) in percutaneous coronary interventions (PCI), many operators still use large-bore guiding catheters through the transfemoral approach (TFA), especially in complex cases. This study evaluated the feasibility, safety, and efficacy of the Distal RailTracking (DRT) technique, a sheathless approach via distal radial access (DRA), and investigated its impact on clinical practice. The multicenter SWITCH D-RIL study enrolled patients who required treatment of severely calcified coronary disease by rotational atherectomy, and compared those who underwent PCI before (pre-DRT, n = 97) and after (post-DRT, n = 99) DRT was adopted as the primary approach. Procedural success rates without access site crossover were similar between groups. No significant differences were found in periprocedural complications, in-hospital and 30-day major adverse cardiovascular events, and access- and non-access-related major bleedings. The post-DRT group exhibited a significantly higher use of large-bore guiding catheters (97.1% vs 31.7%). Overall, DRA was used in 90.5% of cases in the post-DRT group, with TFA accounting for 9.5%; the pre-DRT group primarily employed conventional TRA (82.2%), with the remaining cases involving TFA and 1 transbrachial access. The post-DRT group demonstrated increased usage of burrs larger than 1.5 mm (51.4% vs 13.9%) and additional calcium modifying tools (42.9% vs 24.8%). The DRT technique demonstrated feasibility, safety, and efficacy in treating severely calcified coronary disease. This study highlights the reliability of DRA, even when large bore guiding catheters are necessary, emphasizing its potential to provide a safer approach while ensuring radial artery preservation.

Chronic myeloid leukemia (CML) persists due to leukemic stem cells, notably the CD26+ subset. We investigated correlations between circulating CD26+ leukemic stem cells (LSCs) and BCR::ABL1 transcripts in an extracellular vesicle–enriched secretome (EVES) from plasma samples of 44 CML patients. EVES were characterized and BCR::ABL1 quantified via digital PCR. We observed an inverse correlation between CD26+LSC counts and EVES BCR::ABL1 levels, especially in deep molecular responders (DMR). CD26+LSCs were elevated in patients in treatment-free remission (TFR), while EVES BCR::ABL1 levels were higher in those receiving therapy. These findings suggest distinct dynamics between LSC populations and vesicle-mediated transcript release, with potential implications for CML monitoring and prognosis.

Early relapse in multiple myeloma (MM) is a major predictor of poor prognosis, regardless of cytogenetic risk or treatment intensity. Here we analyzed 1026 MM patients treated across 12 Italian hematology centers. FHR was defined as progression-free survival (PFS) ≤18 months in transplant-eligible (TE) and ≤12 months in non-transplant-eligible (NTE) patients. Logistic regression and ROC analysis were used to identify significant predictors of FHR and build a risk score. FHR status was identified in 175 patients (17%). These patients had significantly shorter PFS (7 vs. 57.5 months) and overall survival (19 months vs. not reached; p < 0.001). FHR status was associated with higher median LDH, lower Hb level, higher creatinine level and lower platelets count. Modified EASIX formula was built by these significant continuous variables, to be tested in a logistic analysis: [(LDH × creatinine)/(Hb × PLT) × 100]. A significantly higher rate of FHR was found with a score > 2.0 (89% vs. 11%, p < 0.001). Multivariate logistic analysis selected the above formula, ECOG PS ≥ 2 and ISS III as factors associated with FHR. Scoring these variables according to OR, three groups of patients were segregated with a rate of FHR patients of 7%, 29.5%, and 63.5%, respectively. Treatment with anti-CD38 monoclonal antibodies was associated with lower FHR frequency. This study proposes a simple, clinically applicable model to identify FHR MM patients early in their disease course. However, very in-depth biological tools, not available in clinical practice, are needed to identify singularly risk of becoming FHR.

A 19-year-old male patient with no significant medical history was the victim of a firearm attack, with penetrating injury to the thoracoabdominal and left popliteal region. A diagnosis of deep vein thrombosis of the popliteal vein was made, which was managed with anticoagulation. Weeks later, this resulted in a sensation of a growing mass in the popliteal fossa, accompanied by palpitations and paresthesias. He was evaluated in an outpatient clinic, where a mass was found in the popliteal region of the leg measuring approximately 4 cm, with an ultrasound diagnosis of popliteal pseudoaneurysm. Surgical treatment was indicated, which consisted of surgical resection of the pseudoaneurysm plus autologous femoropopliteal bypass with a saphenous vein, without surgical complications. Popliteal artery pseudoaneurysms are rare post-traumatic injuries that must be resolved promptly. The type of treatment depends on the size, location, and symptoms, as well as the expertise and experience of each center in open surgery.