Table of Content

20 June 2026, Volume 26 Issue 03

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Original Articles and Clinical Research

Clinicopathological features and prognosis of mucinous breast carcinoma

CHAI Jie, WANG Lili, DING Linxiaoxiao, CHEN Tao, WANG Junyan, CAI Yangyang

2026, 26(03):  139-146.  DOI: 10.3969/j.issn.1009-976X.2026.03.001

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Objective To compare the clinicopathological features and long-term prognosis of pure mucinous breast carcinoma （PMuBC） versus mixed mucinous breast carcinoma （MMuBC）, to identify prognostic factors, and to inform individualized treatment strategies. Methods We retrospectively collected clinical and pathological data from 334 patients with mucinous breast carcinoma （MuBC） treated at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between January 2000 and April 2025. The cohort comprised 238 patients with PMuBC （71.3%） and 96 with MMuBC （28.7%）. Clinicopathological characteristics were compared between the two groups. A Cox proportional hazards regression model was used to identify independent prognostic factors, and survival outcomes were assessed using the Kaplan-Meier method with log-rank tests. Results Compared with patients with PMuBC, those with MMuBC had significantly higher rates of HER-2 positivity （11.46% vs. 3.36%, P=0.004）, lymph node involvement （26.04% vs. 9.66%, P<0.001）, clinical stage Ⅲ disease （12.50% vs. 4.62%, P=0.004）, chemotherapy receipt （60.42% vs. 39.50%, P<0.001）, and breast-conserving surgery （53.13% vs. 34.03%, P=0.001）, and a significantly lower rate of sentinel lymph node biopsy （71.88% vs. 84.03%, P=0.011）. The 5-year disease-free survival （DFS） rate did not differ significantly between the two groups （97.5% vs. 94.8%, P=0.061）. However, the 10-year overall survival （OS） rate was significantly higher in the PMuBC group than in the MMuBC group （96.6% vs. 88.5%, P<0.001）. Multivariate Cox regression analysis identified pathological subtype and age as independent prognostic factors for OS; patients with MMuBC had a hazard of death nearly five times that of those with PMuBC （HR=4.722,95%CI：2.019~11.043, P<0.001）. Conclusion PMuBC and MMuBC represent two distinct disease entities with significantly different clinicopathological features and prognoses. MMuBC exhibits greater biological aggressiveness and substantially worse long-term survival, and should be regarded as a high-risk subtype warranting more intensive treatment and closer surveillance. Accurate histological subtyping is essential for prognostic assessment and treatment decision-making in patients with mucinous breast carcinoma.

Prediction model for anastomotic leakage in rectal cancer patients admitted to intensive care after surgery

DONG Chengcheng, LUO Qianxin, ZHANG Xiaofei

2026, 26(03):  147-153.  DOI: 10.3969/j.issn.1009-976X.2026.03.002

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Objective To investigate factors associated with anastomotic leakage in patients with rectal cancer admitted to the intensive care unit （ICU） after surgery and to develop a nomogram-based risk prediction model. Methods Clinical data of postoperative patients with rectal cancer admitted to the ICU were retrospectively analyzed. Patients were grouped according to the occurrence of anastomotic leakage during the index hospitalization. Univariable and multivariable logistic regression analyses were performed to identify candidate predictors, and a nomogram was constructed. Model discrimination, calibration, and clinical utility were assessed using receiver operating characteristic curve analysis, bootstrap calibration with 1 000 resamples, and decision curve analysis, respectively. Results A total of 162 patients were included, of whom 31 developed anastomotic leakage. Age, body mass index （BMI）, vasopressor use, invasive mechanical ventilation, and continuous renal replacement therapy （CRRT） were included in the final prediction model. The model achieved an area under the receiver operating characteristic curve （AUC） of 0.863 （95% CI： 0.785-0.941）. The mean absolute error of the bootstrap-validated calibration curve was 0.024. Decision curve analysis showed that the model provided a higher net benefit across threshold probabilities ranging from 0.10 to 0.60. Conclusion The nomogram showed good discrimination and calibration and may provide a useful tool for risk stratification of anastomotic leakage in postoperative ICU patients with rectal cancer.

Factors associated with delayed extubation after liver transplantation and short-term outcomes

DING Yu, LIN Qian, ZENG Yitao, ZHANG Kelin, ZHAO Haixuan

2026, 26(03):  154-160.  DOI: 10.3969/j.issn.1009-976X.2026.03.003

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Objective To investigate factors associated with delayed extubation after liver transplantation and its relationship with short-term outcomes. Methods This single-center retrospective cohort study included patients who underwent liver transplantation between January 2021 and December 2023. Delayed extubation was defined as a total endotracheal tube retention time of >24 h. Baseline characteristics and perioperative variables were collected. The primary outcome was ICU length of stay, and the secondary outcome was respiratory tract infection. Logistic regression was used to identify factors associated with delayed extubation, and negative binomial regression was used to assess the association between delayed extubation and ICU length of stay. Results A total of 180 patients were included, of whom 108 patients （60.0%） experienced delayed extubation and 72 （40.0%） did not. Compared with the non-delayed extubation group, the delayed extubation group had greater transfusion volume and longer operation time （both P<0.001）. Multivariable logistic regression showed that operation time was independently associated with delayed extubation; for every 100-min increase in operation time, the risk of delayed extubation increased （OR=2.21, 95%CI： 1.34~3.66, P=0.002）. For the primary outcome, ICU length of stay was longer in the delayed extubation group than in the non-delayed extubation group [9.0（7.0,13.0） d vs. 6.0（5.0,8.0） d, P<0.001]. Negative binomial regression showed that delayed extubation was independently associated with a longer ICU stay（IRR=1.36, 95%CI： 1.11~1.66, P=0.003）. For the secondary outcome, respiratory tract infection occurred in 15.7% of patients in the delayed extubation group and 6.9% in the non-delayed extubation group, with no statistically significant difference （P=0.104）. Conclusion Longer operation time was associated with delayed extubation, and delayed extubation was associated with longer ICU stay, whereas no statistically significant association was observed with respiratory tract infection.

Effect of planned behavior theory-based exercise training combined with liver-gallbladder rehabilitation exercises on postoperative recovery in patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma

PAN Yinzhen, LIN Muzhen, MA Jing

2026, 26(03):  161-166.  DOI: 10.3969/j.issn.1009-976X.2026.03.004

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Objective To investigate the effects of planned behavior theory （TPB）-based exercise training combined with liver-gallbladder rehabilitation exercises on postoperative recovery in patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma. Methods A total of 69 patients who underwent laparoscopic hepatectomy at a tertiary hospital in Guangdong between October 2021 and July 2023 were enrolled and randomly assigned using a random number table to an observation group （n=35） or a control group （n=34）. The control group received routine postoperative rehabilitation care, while the observation group received additional structured TPB-based exercise training combined with liver-gallbladder rehabilitation exercises. The intervention lasted 4 weeks. Primary outcomes （exercise adherence and General Self-Efficacy Scale （GSES） score） and secondary outcomes （Herth Hope Index, HHI）, Hamilton Anxiety Rating Scale （HAMA） score, Hamilton Depression Rating Scale （HAMD） score, liver function, and Visual Analogue Scale （VAS） pain score） were assessed before and 4 weeks after the intervention. Postoperative gastrointestinal recovery times and incidence of complications during the intervention period were also recorded. Results After the intervention, the observation group demonstrated significantly higher exercise adherence scores （all dimension scores and the total score）, GSES scores, and HHI scores, and significantly lower HAMD, HAMA, and VAS scores, as well as shorter bowel sound recovery and flatus time than the control group （P<0.05）. No significant between group difference was found in complication rate （P>0.05）. Conclusion TPB-based exercise training combined with liver-gallbladder rehabilitation exercises effectively improves exercise adherence, self-efficacy, and hope levels, alleviates negative emotions and pain, and promotes gastrointestinal recovery in patients after laparoscopic hepatectomy for hepatocellular carcinoma. No significant difference in complication rates was observed during the 4 week follow up period, suggesting good short term safety. This regimen has positive implications for postoperative rehabilitation; however, its long term safety and clinical benefits require further evaluation.

Antisense lncRNA KRT-AS promotes diabetic cutaneous wound healing by regulating keratin expression

HAN Yuting, YANG Chuan, HU Mengdie

2026, 26(03):  167-175.  DOI: 10.3969/j.issn.1009-976X.2026.03.005

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Objective This study aimed to investigate the effects of antisense long non-coding RNA （lncRNA） KRT-AS on keratin expression and keratinocyte function, and to elucidate its role in diabetic wound healing. Methods Differential lncRNA expression profiles between diabetic and non-diabetic skin were analyzed using microarray. A novel lncRNA, keratin antisense RNA （KRT-AS）, which is transcribed from the opposite strand of keratin genes, was identified and characterized by rapid amplification of cDNA ends. The effects of lncRNA KRT-AS on keratin 14 （Krt14） expression, proliferation, cell cycle, and migration were assessed in keratinocytes. The in vivo effect of lncRNA KRT-AS was evaluated using a diabetic rat wound healing model. RNA stability was assessed using ribonuclease protection assays and α-amanitin treatment. Results LncRNA KRT-AS was the most significantly downregulated lncRNA in diabetic skin. Knockdown of lncRNA KRT-AS in keratinocytes decreased cell proliferation, induced G0/G1 phase cell cycle arrest, inhibited cell migration, and suppressed Krt14 expression. In vivo experiments suggested lncRNA KRT-AS accelerated diabetic wound closure, increased epidermal thickness and upregulated Krt14 expression in diabetic skin. Mechanistically, lncRNA KRT-AS formed an RNA-RNA duplex with Krt14 mRNA, protecting the mRNA from degradation, thereby enhancing the expression level of Krt14 mRNA. Conclusion LncRNA KRT-AS is downregulated in diabetic skin. Overexpression of lncRNA KRT-AS promotes diabetic wound healing by enhancing the stability of Krt14 mRNA in keratinocytes. LncRNA KRT-AS represents a potential therapeutic target for diabetic wound repair.

Simplified tubular retractor-assisted visualized endoscopic surgery of intracerebral hematomas

MA Guangshuo, ZHANG Xiaohui, CAO Jianping, GAO Chao, HOU Wenjiao, LIU Bo, CHANG Bin′ge

2026, 26(03):  176-183.  DOI: 10.3969/j.issn.1009-976X.2026.03.006

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Objective To introduce a simplified tubular retractor for intracerebral hemorrhage surgery and analyze the efficacy of visualized neuroendoscopic hematoma evacuation. Methods Review and analyze the data of neuroendoscopic hematoma evacuation in 32 cases of intracerebral hemorrhage from June 2024 to October 2025. A simple cannula was intraoperatively fabricated using syringes, gloves, and disposable lumbar puncture kits to assist in establishing a visualized channel under neuroendoscopy, followed by direct-view hematoma evacuation. The clinical outcomes were evaluated. Results In this group, 32 patients with cerebral hemorrhage had an average hematoma clearance rate of 80.4%, with 2 cases of obvious hematoma within the fistula and 1 case of secondary craniotomy. Conclusion The self-made simplified tubular retractor-assisted visualized neuroendoscopic hematoma evacuation has certain feasibility and potential application value.

TNS4 expression in lung adenocarcinoma and its association with clinical features

SHEN Tao, XU Shengshan, ZHANG Guowei, LIN Zhichao, WANG Fei, ZHAGN Dongxi, CHEN Zhuowen, KE Yongwen, LU Zhuming

2026, 26(03):  184-189.  DOI: 10.3969/j.issn.1009-976X.2026.03.007

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Objective To investigate the expression level of TNS4 in lung adenocarcinoma （LUAD） tissues and analyze its expression differences across distinct high-risk clinical factors of LUAD. Methods A single-center retrospective study was performed to collect 88 LUAD tissue samples from patients undergoing radical lung cancer surgery and 20 non-cancerous lung tissue samples from patients undergoing pulmonary surgery between January 2021 and December 2021. TNS4 protein expression was detected by immunohistochemistry, and its correlation with clinicopathological features was evaluated by analyzing the differences in positive expression rates among variables, including sex, age, TNM stage, and high-risk factors for pathological recurrence. Results The positive expression rate of TNS4 in LUAD tissues was significantly higher than that in the control group. Male patients exhibited a significantly higher TNS4 positivity rate than female patients （P<0.05）. The TNS4 positivity rate increased with advancing tumor stage, with a significant upward trend in N stage （P<0.05）. Pathologically, cases featuring spread through air spaces or lymphatic vessel invasion showed significantly higher TNS4 expression （P<0.05）. Conclusion TNS4 is highly expressed in LUAD tissues, with higher expression in male patients. TNS4 expression correlates with tumor stage, N stage, spread through air spaces, and lymphatic vessel invasion. These findings suggest that TNS4 may provide novel insights into predicting recurrence and prognosis in LUAD patients.

Effectiveness and safety of forearm arteriovenous fistula created by radial artery deviation and reimplantation： long-term results

LI Yonghui, ZHANG Rui, LIAO Weitang, YANG Zhihui, ZHENG Junmeng

2026, 26(03):  190-194.  DOI: 10.3969/j.issn.1009-976X.2026.03.008

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Objective To evaluate the safety and effectiveness of forearm arteriovenous fistula （AVF） created by radial artery deviation and reimplantation（RADAR）. Methods From June 2019 to October 2019, those patients accepted the forearm arteriovenous fistula created by RADAR were included, and their clinical and follow-up data were retrospectively collected and analyzed. Results A total of 5 patients were involved with a median age of 54 years. The preoperative ultrasound revealed that the median diameters of the radial artery and cephalic vein were 2.5 mm and 2.0 mm, respectively. The procedure was completed with a median operation time of 100 minutes （range： 80~140） and a median blood loss of 10 ml （range： 5~20）. Postoperatively, all 5 patients achieved technical success with a robust thrill, and no hand ischemia occurred. Two patients manifested with transient swollen hand. One patient with a history of heart failure experienced temporary chest tightness and shortness of breath, and recovered well after hemodialysis. At the one-month visit, 4 patients showed well-matured arteriovenous fistulas, while one patient had inadequate maturation and underwent balloon dilatation. During a median follow-up of 4 years （range： 1~6）, one patient died of septic shock at 5 years postoperatively, and another died of hepatocellular carcinoma at 4 years, both with patent fistulas prior to death. Among the 3 surviving patients, 2 maintained fistula patency, and one developed fistula failure at 1 year after surgery, requiring conversion to a prosthetic graft arteriovenous fistula. Conclusion RADAR to create AVF is safe with a high patency rate during the long-term follow-up period.

Case Report

Severe acute pancreatitis complicated with guillain barre syndrome： a case report with literature review

ZHUANG Suyuan, CHENG Huihua, ZHANG Kelin, ZHOU Ting, HE Qing

2026, 26(03):  195-200.  DOI: 10.3969/j.issn.1009-976X.2026.03.009

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Severe acute pancreatitis is a disease caused by local inflammation, necrosis and infection of the pancreas caused by a variety of causes,accompanied by systemic inflammatory response and persistent organ failure. Guillain Barre syndrome （GBS） is a type of immune-mediated acute inflammatory peripheral neuropathy. It has an acute onset and usually reaches its peak in about 2 weeks. Clinically, symmetrical flaccid limb paralysis, facial nerve paralysis, peripheral sensory impairment,and “protein-cell” separation in cerebrospinal fluid are common. GBS is common after infection,and it has also been reported to be combined with other diseases. This article reports a rare case of a 42-year-old male patient with severe necrotizing pancreatitis complicated by Guillain Barre syndrome. After comprehensive treatment by a multidisciplinary team （MDT）,the patient′s pancreatitis-related symptoms and neurological symptoms were improved to some extent. For patients with central nervous system symptoms,clinical practice needs to be more vigilant to consider the possibility of Guillain Barre syndrome,achieve early identification and intervention,and improve the patient′s prognosis.

Review

Avoiding cement leakage and vertebral recollapse after percutaneous vertebroplasty： advances in optimization strategies

HAN Wenguang, FU Bifeng, XUE Jingjing, ZHANG Xiaoyu, WU Si, LIU Aifeng, ZHU Wenhui, ZHANG Xiaoqing

2026, 26(03):  201-207.  DOI: 10.3969/j.issn.1009-976X.2026.03.010

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Percutaneous vertebroplasty （PVP） for osteoporotic vertebral compression fractures （OVCFs） provides immediate pain relief and mechanical support. However, complications such as bone cement leakage, re-collapse of the treated vertebra, and adjacent vertebral fractures remain clinical challenges that limit long-term efficacy. This review focuses on the prevention and management of post-PVP complications, systematically summarizing optimization strategies with an emphasis on procedural details. Regarding puncture approaches, research indicates that, the application of percutaneous curved vertebroplasty （PCVP） or a bilateral puncture approach can optimize intravertebral stress distribution and reduce the risk of secondary fractures. The introduction of digital technologies, such as real-time ultrasound image fusion and computer navigation, significantly mitigates the risks of injury to surrounding tissues and bone cement leakage associated with unguided puncture. In terms of bone cement application, controlling the volume at 4~6 ml, utilizing high-viscosity cement, and ensuring sufficient contact with the superior and inferior endplates are essential for maintaining mechanical stability and preventing re-collapse. Furthermore, novel bioactive bone cements show potential for reducing thermal injury and promoting bone healing. Clinicians should minimize procedural risks associated with PVP and improve long-term outcomes through optimized combinations of techniques and precise control of procedural parameters.