Table of Content

20 August 2026, Volume 25 Issue 04

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Original Articles and Clinical Research

Clinicopathological features and prognostic factors of breast invasive micropapillary carcinoma

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

2026, 25(04):  207-214.  DOI: 10.3969/j.issn.1009-976X.2026.04.001

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Objective To investigate the clinicopathological features and survival of invasive micropapillary carcinoma （IMPC） of the breast. We compared pure-type IMPC with mixed-type IMPC in clinicopathological characteristics, disease-free survival （DFS）, and overall survival （OS）, and further assessed the prognostic impact of a 75% IMPC proportion threshold. Methods We retrospectively reviewed the clinicopathological and follow-up data of 230 patients with breast IMPC treated at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from January 2005 to October 2025. Pure-type IMPC was defined as a micropapillary component accounting for 100% of the invasive carcinoma （n=104）; mixed-type IMPC was defined as IMPC admixed with other invasive carcinoma components （n=126）. Patients were also stratified by a 75% threshold into an IMPC ≤75% group （n=96） and an IMPC >75% group （n=134）. Clinicopathological features and factors influencing DFS and OS were compared between the groups. Results The ER positivity rate differed significantly between pure-type and mixed-type IMPC. The overall 5-year DFS rate was 76.2%, and the 10-year OS rate was 67.8%. The 5-year DFS rates were 67.1% and 82.5% for pure-type and mixed-type IMPC, respectively （P=0.066）; the 10-year OS rates were 61.4% and 73.8% （P=0.352）. The 5-year DFS rates （82.4% vs. 70.7%） and 10-year OS rates （79.1% vs. 63.0%） did not differ significantly between the IMPC ≤75% and IMPC >75% groups. Multivariable analysis showed that TNM stage（HR=7.320,95%CI：3.473~15.428,P<0.001） and endocrine therapy （HR=0.391,95%CI：0.166~0.919,P=0.031） were independent factors for DFS, and TNM stage（HR=6.628,95%CI：2.407~18.251,P<0.001） was an independent factor for OS. Conclusion Although the 5-year DFS and 10-year OS rates were numerically lower in pure-type than in mixed-type IMPC, neither difference was statistically significant. In clinical practice, TNM stage assessment should be emphasized, and endocrine therapy should be actively considered for hormone receptor-positive patients to improve DFS.

Evaluation of the efficacy of transaxillary single-port endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction

WEN Junhong, CAI Jiamin, HUANG Xiaomei, GUAN Jianhua

2026, 25(04):  215-221.  DOI: 10.3969/j.issn.1009-976X.2026.04.002

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Objective To evaluate the efficacy of transaxillary single-port endoscopic nipple-sparing mastectomy （NSM） with immediate implant-based breast reconstruction for early-stage breast cancer. Methods We retrospectively analyzed 126 patients with early-stage breast cancer who underwent NSM with immediate prepectoral implant-based reconstruction at Jiangmen Central Hospital from February 2022 to February 2025. Based on the surgical procedure, they were divided into an endoscopic surgery group （74 patients） and an open surgery group （52 patients）. The endoscopic group received transaxillary single-port endoscopic nipple-sparing mastectomy with immediate prepectoral implant-based reconstruction, while the open group received conventional open nipple-sparing mastectomy with the same type of breast reconstruction. We compared the two groups on perioperative indicators （operative time, 72-hour postoperative drainage volume, and length of stay）, complications, prognosis, and patient satisfaction with breast reconstruction. Results The endoscopic group reported higher BREAST-Q breast satisfaction scores at 1 year postoperatively [71 （64, 82） vs. 64 （61, 82）, P=0.031]. The endoscopic group also had lower 72-hour postoperative drainage volume （265±116 mL vs. 340±194 mL, P=0.014） and a shorter hospital stay （12.43±3.46 days vs. 14.17±3.82 days, P=0.009） than the open group. No significant differences were observed between the two groups in postoperative bleeding or infection, nipple-areolar or flap ischemia/necrosis, or implant removal rate （all P>0.05）. Over a median follow-up of 2 years, local axillary lymph node recurrence occurred in 2 patients （2.7%） in the endoscopic group, while in the open group, 1 patient developed ipsilateral supraclavicular lymph node recurrence and 1 developed chest wall recurrence （3.8% overall）, with no significant intergroup difference （P=1.000）. No distant recurrence was observed in either group. Conclusion Transaxillary single-port endoscopic NSM with immediate prepectoral implant reconstruction appears to reduce postoperative drainage volume, shorten hospital stay, and improve patient satisfaction with breast appearance.

Analysis of the incidence and influencing factors of preoperative anxiety and depression in patients with breast and thyroid diseases

HAN Yingying, ZHENG Yuenan, WANG Morigen, WANG Mofei

2026, 25(04):  222-229.  DOI: 10.3969/j.issn.1009-976X.2026.04.003

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Objective To investigate the detection rates and influencing factors of preoperative anxiety and depression in patients with breast and thyroid diseases, and to provide evidence for clinical psychological intervention. Methods Patients who underwent breast or thyroid surgery in the Department of Thyroid, Breast, and Hernia Surgery of the Affiliated Hospital of Inner Mongolia Minzu University from October to December 2025 were enrolled. Demographic and clinical data were collected. The Generalized Anxiety Disorder7 （GAD7） and Patient Health Questionnaire9 （PHQ9） scales were used to assess anxiety and depression status. Univariate and multivariate logistic regression analyses were performed to explore influencing factors of preoperative anxiety and depression. Results The preoperative detection rates of anxiety and depression were 23.9% and 25.0% among patients with thyroid diseases, versus 36.2% and 38.3% among patients with breast diseases, with mild-to-moderate symptoms being predominant. Surgical approach （P=0.048） and lack of preoperative puncture biopsy （P=0.044） were independent correlative factors for preoperative anxiety. Surgical approach （P=0.020） and low income level （P=0.044） were independent correlative factors for preoperative depression. No independent statistical association was found between disease type and preoperative anxiety or depression in this study. Conclusion Mild-to-moderate anxiety and depression are prevalent among patients undergoing breast and thyroid surgery preoperatively. Surgical approach, preoperative puncture status and income level are key influencing factors. Clinicians should attach importance to preoperative psychological assessment, implement individualized interventions targeting relevant risk factors, and comprehensively improve patients’ quality of life.

Proximal versus total gastrectomy for proximal gastric cancer after neoadjuvant therapy： a systematic review and meta-analysis

HE Junfei, KAIWUSAI·Tuerhongjiang, CAI Xiuqin, DAI Weigang, ZHAO Risheng

2026, 25(04):  230-238.  DOI: 10.3969/j.issn.1009-976X.2026.04.004

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Objective To compare the safety and efficacy of radical proximal gastrectomy （PG） versus total gastrectomy （TG） in patients with proximal gastric cancer after neoadjuvant therapy. Methods A systematic search was conducted in PubMed, Ovid, Web of Science, the Cochrane Library, CNKI, and Wanfang Data. Quantitative pooling was restricted to observational cohorts from which data could be extracted after propensity score matching （PSM）. Conference abstracts of randomized trials, database studies, preprints, and studies with potential cohort overlap were descriptively synthesized. Meta-analysis was performed using R software and the metafor package for overall survival, R0 resection rate, anastomotic leakage rate, and perioperative outcomes. The number of studies eligible for pooling did not exceed three. Results from the common-effect model were primarily reported, with the random-effects model and the modified Hartung-Knapp method used as sensitivity analyses. Results Seven reports were included, of which three PSM cohorts were included in the quantitative pooling （a maximum of 514 patients, 241 in the PG group and 273 in the TG group）. The remaining four reports were descriptively synthesized only; their reported sample sizes contained potential overlaps and were not summed to derive a total number of cases. The common-effect model showed no statistically significant differences between PG and TG in overall survival （HR=0.91, 95%CI： 0.70~1.17）, R0 resection rate （RR=1.00, 95%CI： 0.97~1.02）, anastomotic leakage （RR=1.46, 95%CI： 0.54~3.97）, or overall complications （RR=0.97, 95%CI： 0.50~1.90）. Operative time was shorter in the PG group under the common-effect model （MD=-13.79 min, 95% CI： -28.1 to 0.70）, but with high inter-study heterogeneity. Conclusion Current evidence is insufficient to determine whether there are differences in survival, R0 resection rates, and perioperative safety between PG and TG after neoadjuvant therapy. These findings still require validation by prospective randomized trials.

Endoscopic nanocarbon localization combined with a modified management protocol for gastrointestinal tumors： associations with lymph node dissection and postoperative recovery

RUAN Jianmin, ZENG Baoling, LIU Jie, LIN Lijun, ZHANG Min, OUYANG Xia

2026, 25(04):  239-246.  DOI: 10.3969/j.issn.1009-976X.2026.04.005

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Objective To establish a modified management protocol for endoscopic localization using submucosal nanocarbon injection, assess the interval from endoscopic localization with a nanocarbon tracer to surgery, and evaluate the association between the “three-stage, six-step” modified protocol and clinical indicators, to provide a reference for perioperative management of precise localization of gastrointestinal tumors. Methods A retrospective study was conducted among patients who underwent preoperative endoscopic localization by submucosal tracer injection at our digestive endoscopy center from October 2023 to April 2026. Patients were divided into three groups according to tracer type and management protocol： Group G1 （methylene blue with the conventional protocol, n=26）, Group G2 （nanocarbon with the conventional protocol, n=20）, and Group G3 （nanocarbon with the modified protocol, n=21）. The interval from endoscopic localization to surgery, operative duration, postoperative hospital stay, time to first flatus, time to enteral nutrition resumption, number of lymph nodes dissected, number of positive lymph nodes, and lymph node dissection adequacy rate （≥12 nodes for colorectal cancer, ≥16 nodes for gastric cancer） were compared among the three groups. Results Significant differences were observed among the three groups in the interval from endoscopic localization to surgery （P<0.001）, postoperative hospital stay （P=0.013）, number of lymph nodes dissected （P=0.008）, and lymph node dissection adequacy rate （P=0.045）, while no significant differences were found in operative duration, time to first flatus, or time to enteral nutrition resumption （all P>0.05）. Pairwise comparisons with Bonferroni correction showed that： under the same conventional management protocol （G1 vs. G2）, the nanocarbon group （G2） had a longer interval from endoscopic localization to surgery than the methylene blue group （G1） [median 22.29 （18.04, 27.27） h vs. 3.74 （3.15, 5.47） h, Z=-5.874,P<0.001]; with the same nanocarbon tracer （G2 vs. G3）, the modified management group （G3） had a shorter postoperative hospital stay than G2 [6.00 （6.00, 7.50） d vs. 8.00 （7.00, 9.00） d, Z=-2.869, P=0.012]; the lymph node dissection adequacy rate in G3 was 20.5 percentage points higher than that in G2 [90.5% （19/21） vs. 70.0% （14/20）, Yates′ corrected χ²=1.586, P=0.208]. Although the difference was not statistically significant after Yates′ correction, the magnitude of the increase suggested potential clinical relevance. Conclusion Nanocarbon tracer was associated with a longer observed interval from endoscopic localization to surgery compared with methylene blue, a finding consistent with the established evidence of its prolonged tissue retention. The “three-stage, six-step” modified management protocol was associated with a shorter postoperative hospital stay and showed a trend toward improved lymph node dissection quality. The protocol is well-structured and reproducible; however, its safety and long-term outcomes require further validation in prospective studies.

Correlation and diagnostic value of median nerve cross-sectional area measured by musculoskeletal ultrasound and nerve conduction velocity in grading the severity of carpal tunnel syndrome

LAI Shaoyan, DENG Qingquan, ZENG Ying, ZOU Longhua

2026, 25(04):  247-252.  DOI: 10.3969/j.issn.1009-976X.2026.04.006

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Objective To investigate the correlation and diagnostic value of median nerve cross-sectional area （CSA） measured by musculoskeletal ultrasound and nerve conduction velocity （NCV） for grading the severity of carpal tunnel syndrome （CTS）. Methods A single-center, cross-sectional study of diagnostic accuracy and correlation was conducted. A total of 120 patients （184 wrists） with clinically suspected CTS admitted between January 2023 and December 2025 were enrolled. All patients underwent high-frequency musculoskeletal ultrasound （measuring median nerve CSA at the carpal tunnel inlet） and nerve conduction studies [distal motor latency （DML）, sensory nerve conduction velocity （SCV）, and compound muscle action potential amplitude （CMAP）]. Using neuroelectrophysiological findings as the independent reference standard, the wrists with confirmed CTS were classified according to grading criteria into mild （56 wrists）, moderate （68 wrists）, and severe （60 wrists） groups. One-way analysis of variance and Spearman rank correlation analysis were used to analyze the correlations of CSA and NCV with CTS severity, and receiver operating characteristic curve analysis was used to evaluate the discriminative performance of CSA for severe CTS. Results The median nerve CSA values in the mild, moderate, and severe CTS groups were （12.35±2.11） mm², （15.68±2.43） mm², and （20.57±3.02） mm², respectively, with statistically significant differences among the three groups （P<0.001）. The SCV values were （44.21±3.56） m/s, （36.84±4.12） m/s, and （28.93±5.07） m/s, respectively, with statistically significant differences among groups （P<0.001）. The DML values were （3.68±0.54） ms, （5.21±0.78） ms, and （7.36±1.25） ms, and the CMAP values were （9.12±1.85） mV, （6.85±1.63） mV, and （3.47±1.12） mV, respectively, with statistically significant differences in both DML and CMAP among the three groups （all P<0.001）. Spearman correlation analysis showed that CSA was significantly positively correlated with CTS severity （r=0.862, 95%CI： 0.812 - 0.900, P<0.001）, while SCV was significantly negatively correlated with CTS severity （r=-0.841, 95%CI： -0.884 - -0.787, P<0.001）. CSA was significantly positively correlated with DML （r=0.794, 95%CI： 0.725 - 0.850, P<0.001） and significantly negatively correlated with CMAP （r=-0.756, 95%CI： -0.820 - -0.678, P<0.001）. Using severe CTS as the reference standard, the area under the ROC curve for CSA was 0.932 （95%CI： 0.895 - 0.970, P<0.001）. The optimal diagnostic cutoff was 17.82 mm², with a sensitivity of 90.00% and a specificity of 85.48%. Conclusion The median nerve CSA measured by musculoskeletal ultrasound is significantly negatively correlated with nerve conduction velocity, and CSA increases significantly with higher CTS severity grading. When CSA exceeds 17.82 mm², it demonstrates high discriminative efficacy for severe CTS. Ultrasound measurement can serve as an effective complement to neuroelectrophysiological testing for grading CTS severity.

Impact of urinary catheter removal timing on recatheterization after intracranial surgery

WU Huiwen, LI Jiarong, MO Yaping

2026, 25(04):  253-259.  DOI: 10.3969/j.issn.1009-976X.2026.04.007

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Objective To investigate the effect of urinary catheter removal timing on the rate of recatheterization in patients undergoing intracranial surgeries, identify the optimal timing of postoperative catheter removal, and reduce complications associated with prolonged bed rest. Method A retrospective analysis was conducted on the clinical data of 444 patients who underwent neurosurgery and received indwelling urinary catheterization between November 2022 and December 2025. Patient data were retrieved and recorded via the medical record system, nursing information system, radiological imaging system, B-mode ultrasound system, and laboratory system. Based on the duration of catheterization, patients were divided into three groups： Group 1, catheter removal on postoperative day 1, Group 2, removal on postoperative days 2~5, and Group 3, removal on postoperative day ≥6. We used group 1 as the reference, and performed logistic regression models to evaluate the associations of catheter removal timing with urinary recatheterization, and lower-extremity deep vein thrombosis. Results A total of 444 patients were included: 196 in Group 1, 155 in Group 2, and 93 in Group 3. The recatheterization rates in Groups 1, 2, and 3 were 3.57%, 5.81%, and 22.58%, and the incidences of lower-extremity deep vein thrombosis （DVT） were 4.08%, 8.39%, and 33.33%, respectively. Bonferroni-corrected pairwise comparisons showed that both outcomes were more frequent in Group 3 than in Groups 1 and 2 （all P<0.001）, whereas neither outcome differed significantly between Groups 1 and 2 （both P>0.017）. In fully adjusted logistic regression models with Group 1 as the reference, catheter removal on or after postoperative day 6 （Group 3） was independently associated with higher odds of recatheterization （OR=6.758, 95%CI： 2.696~18.765） and DVT （OR=11.222, 95%CI： 4.601~30.306） （both P<0.001）, whereas removal on postoperative days 2~5 （Group 2） was not significantly associated with either outcome （P=0.441 and 0.102, respectively）. When removal timing was analyzed as a continuous variable, each 1-day delay in catheter removal was associated with adjusted ORs of 1.096 （95%CI： 1.055~1.145） for recatheterization and 1.055 （95%CI： 1.020~1.094） for DVT. Conclusion Later catheter removal was associated with higher risks of recatheterization and lower-extremity DVT, particularly when the catheter was removed on or after postoperative day 6.

Application of perioperative multimodal preintervention in inguinal hernia repair under local anesthesia

WANG Liang, LIU Meibao, LAI Jiajun, WENG Weiming, TAN Yiyan

2026, 25(04):  260-264.  DOI: 10.3969/j.issn.1009-976X.2026.04.008

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Objective To explore the effectiveness and safety of tension-free inguinal hernia repair under local anesthesia with perioperative multimodal pre-intervention. Methods A prospective study was conducted. A total of 87 patients who met the inclusion criteria were divided into two groups： a treatment group and a control group. The patients in the treatment group, who underwent tension-free inguinal hernia repair under local anesthesia, were treated with perioperative multimodal pre-intervention guided by the concept of fast-track surgery. The patients in the control group underwent tension-free inguinal hernia repair under spinal anesthesia. The postoperative pain scores of the two groups were compared at 30 minutes, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours after surgery. The length of postoperative hospital stay, hospitalization costs, and the incidence of complications were also compared between the two groups. Results The visual analog scale （VAS） scores in the treatment group were lower than those in the control group at 2 h （3.47±1.06 vs. 5.55±1.25）, 4 h （3.29±1.01 vs. 5.57±1.11）, 6 h （3.87±1.12 vs. 5.79±1.26）, 12 h （4.11±1.09 vs. 5.50±1.11）, and 24 h （2.98±1.01 vs. 4.43±1.09） postoperatively （all P<0.05）; the length of hospital stay （4.33±1.09 vs. 5.21±1.12 d） and cost （4106.4±155.1 yuan vs. 5477.1±206.4 yuan） in the treatment group were also lower than those in the control group （all P<0.05）. There was no difference in the incidence of postoperative complications between the two groups （P>0.05）. No recurrence or other complications occurred during a follow-up of 6~18 months in either group. Conclusion Perioperative multimodal pre-intervention for patients undergoing tension-free inguinal hernia repair under local anesthesia can reduce early postoperative pain scores, shorten hospital stay, and lower hospitalization costs, without observed increases in complications or short-term recurrence risk.

Development and comparison of a random-primer high-throughput sequencing method for mid-sized non-coding RNA biomarker discovery in cancer

LI Hao, ZHANG Man, DENG Jinsi, ZHAN Ziling, LIAO Jianyou, ZHENG Cheng

2026, 25(04):  265-272.  DOI: 10.3969/j.issn.1009-976X.2026.04.009

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Objective Precision surgery and individualized cancer treatment increasingly rely on molecular biomarkers that inform tumor classification, recurrence risk, prognosis, and therapeutic response. Mid-sized non-coding RNAs （mncRNAs） participate in ribosome biogenesis, RNA processing, and selective translation and have been associated with malignant progression and treatment response in multiple cancers, suggesting their potential as a source of novel tumor biomarkers. However, the complex secondary structures, nucleotide modifications, and diverse terminal configurations of mncRNAs make their detection highly susceptible to library-preparation bias, limiting systematic biomarker discovery. To address these challenges, we developed a random-primer DNA-adapter ligation sequencing method and compared it with two commonly used library-preparation strategies to evaluate its technical performance for mncRNA biomarker discovery in cancer. Methods HeLa cells were used as a tumor cell model and profiled using RNA-adapter ligation, poly（A）-tailing/template-switching, and the random-primer DNA-adapter ligation methods developed in this study. In the random-primer methods, an RNA adapter was ligated to the RNA 3′ end, followed by reverse transcription using a random-sequence-containing RT primer and SuperScript IV, and subsequent ligation of a DNA adapter to the cDNA. The resulting datasets were compared in terms of full-length RNA recovery, RNA length distribution, and RNA biotype composition. Results The three strategies exhibited distinct technical biases. RNA-adapter ligation yielded the lowest proportion of full-length RNA reads. Poly（A）-tailing/template-switching improved full-length RNA recovery to some extent but predominantly generated shorter RNA fragments. In contrast, the random-primer methods achieved the highest proportion of full-length RNA reads （approximately 40%） and substantially enhanced the detection of tRNA-related sequences. All three approaches detected diverse classes of mncRNAs, including rRNAs, snoRNAs, tRNAs, snRNAs, and miRNAs, while showing clear preferences for specific RNA biotypes, indicating that library preparation can directly influence the spectrum of candidate tumor biomarkers identified. Conclusion The random-primer methods developed in this study showed advantages in recovering full-length RNAs and achieving broader coverage of tRNAs/tsRNAs, providing a new technical option for discovery-oriented studies of structurally complex and extensively modified mncRNAs. The method was validated using HeLa cells and should be further evaluated in surgical tumor specimens and blood-based samples from different solid tumors to establish its cross-cancer applicability and its ability to identify biomarkers associated with molecular stratification, recurrence, prognosis, and therapeutic response.

Case Report

Comprehensive treatment of advanced lung cancer with bidirectional transformation between small cell carcinoma and adenocarcinoma： a case report and literature review

YUE Lingdan, XIE Derong, JIANG Zhimin

2026, 25(04):  273-279.  DOI: 10.3969/j.issn.1009-976X.2026.04.010

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This report aimed to summarize the diagnosis and treatment process of a patient with advanced lung cancer with bidirectional transformation between small cell lung carcinoma and lung adenocarcinoma and to explore the disease transformation and multi-line treatment strategies. The clinical data, pathological features, genetic testing results, and treatment course of a patient with stage Ⅳ right-sided SCLC were analyzed. The patient was a 51-year-old woman who received first-line therapy with atezolizumab plus EP regimen, second-line therapy with bevacizumab plus osimertinib, and multiple subsequent lines of treatment. During the treatment course, bidirectional pathological transformation （SCLC → lung adenocarcinoma → SCLC） occurred, and an EGFR exon 19 mutation （p.L747_P753delinsS） was detected. The patient's overall survival reached 37 months. This case demonstrates the complexity of pathological transformation and genetic mutation evolution in SCLC under therapeutic pressure. Multi-line individualized therapy based on dynamic re-biopsy can provide survival benefits for patients with advanced SCLC. This report aims to provide a reference for clinical practice.

Review

Advances in Mendelian randomization and clinical application of exercise in osteoarthritis

ZENG Tao, CHEN Ziliang, LIU Weiqi

2026, 25(04):  280-286.  DOI: 10.3969/j.issn.1009-976X.2026.04.011

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Osteoarthritis （OA） is a common chronic degenerative joint disease characterized by joint pain and progressive functional impairment, which seriously affects the quality of life of patients. Multiple studies have shown that there is a close association between physical activity and the occurrence and development of OA, and moderate physical exercise can effectively delay the progression of the disease. Mendelian Randomization （MR）, as an advanced epidemiological analysis method, can effectively avoid the potential confounding bias in traditional observational studies and use genetic variations to explore the causal relationship between exposure factors and diseases. This review comprehensively analyzes the genetic evidence of the causal relationship between exercise and OA and the latest research progress in clinical exercise intervention. The results show that both genetic studies based on genetic prediction and intervention trials based on clinical practice consistently indicate that low-intensity exercises such as walking have a significant protective effect on OA, effectively alleviating pain, improving joint function, and regulating related inflammatory indicators. In conclusion, the existing evidence from mechanism to clinical practice fully confirms the effectiveness of exercise intervention in OA. In the future, more scientific and precise exercise rehabilitation plans should be developed in combination with individual genetic background and specific conditions to better serve the prevention and treatment of OA.