Surgery is an important treatment for the anterior mediastinal disease. With the rapid development of minimally invasive techniques, complete resection of the lesion in most patients with thymic disease can be achieved through thoracoscopic surgery. Practice has proved that the three-port resection of anterior mediastinal thymus disease via the subxiphoid approach is an ideal surgical method for the treatment of anterior mediastinal thymic tumors at present, which has strong popularization and popularity and can benefit the patients. The procedure focuses primarily on the anterior and upper mediastinum and can thoroughly expose the anatomy of the mediastinum and both sides, with minimal intraoperative bleeding, high safety, minimal trauma and postoperative pain, and a short hospital stay. It has clear advantages over conventional thoracic open-heart surgery and transversal resection. However, the surgical approach and field of view, and intraoperative precautions of this procedure are completely different from those of previous thoracoscopic procedures, and from the subxiphoid single-port approach adopted by other centers. Based on 10 years of surgical experience at our center, a modular mode of surgical operation has been developed and its procedure has been standardized. This paper will share and discuss relevant operational points and experiences.

Objective:To summarize the clinical and genetic characteristics of mental retardation disorder (MRD) with TRIO gene variant in children.Methods:Case series study. The data of 9 children with TRIO gene variants were collected retrospectively from August 2019 to March 2024 in Department of Neurology, Beijing Children′s Hospital, Capital Medical University and Department of Pediatrics, the Third Affiliated Hospital of Zhengzhou University. The data included gender, age, intellectual and motor development, appearance, seizures, neuroimaging and genetic results. The clinical features and genotype-phenotype correlations were summarized.Results:Of the 9 children, 6 boys and 3 girls, 4 MRD63 children presented with moderate to severe developmental delays accompanied by macrocephaly; 5 MRD44 children had mild to moderate developmental delays with microcephaly. A total of 5 children had dysmorphic facial features (flat occiput, thick eyebrows, unibrow, large ears, short fingers, pale skin, yellow hair, and strabismus), 2 children experienced seizures (1 child with myoclonic seizure and 1 with absence seizure), 4 children had feeding difficulties, 1 child had congenital cataracts, 1 child had congenital heart disease, 1 child had recurrent infections, and 1 child had tiger-striped changes in the fundus examination. TRIO gene variants carried by the 9 children were all de novo, involving 8 variant sites, including 7 missense variants and 1 frameshift variant, c.3232C>T/p.R1078W (2 cases), c.3920A>G/p.Y1307C, c.4112A>T/p.H1371L, c.4283G>T/p.R1428L, c.4394A>G/p.N1465S, c.6041T>C/p.I2014T, c.6821G>A/p.R2274H, c.7027delC/p.Q2343Sfs*70. Among them, 2 sites are located in the Spectrin domain, 4 sites are in the GEFD1 domain, 2 sites are in the GEFD2 domain, and 1 site (frameshift variant) is in the PH2-SH3 domain. The individual with frameshift variant exhibit absence seizures, mild developmental delay, and the mildest phenotype. The child with myoclonic seizures was treated with valproic acid and levetiracetam for seizure control, while the child with absence epilepsy was treated with valproic acid and lamotrigine for seizure control. All 9 children underwent regular rehabilitation exercises, making slow progress.Conclusions:TRIO gene related MRD is characterized by varying degrees of developmental delay, and often accompanied by macrocephaly or microcephaly, dysmorphic facial features, and with or without seizures. The main variant types are missense variants, which are mostly concentrated in the Spectran domain and GEFD domain. p. R1078W may be a relative hotspot variant. The phenotype caused by the frameshift variant is relatively milder.

National Comprehensive Cancer Network (NCCN) has updated and released the latest content of NCCN guidelines version 1. 2023 thymomas and thymic carcinomas (known as "guidelines"). The guideline sets standards for the diagnosis and treatment of thymoma and thymic carcinoma based on high quality clinical evidence and the latest advances in research. There have been some updates and revisions in the latest two versions of the guidelines, mainly focusing on the principles of radiotherapy, the principles of systematic therapy, multidisciplinary participation and the improvement of some footnotes, compared with the first version of the guidelines in 2022. In this paper, the contents of the new guideline will be interpreted in order to provide reference for the work of thymoma and thymic carcinoma in our country at the present stage.

Objective:To study the risk factors of very early recurrence (VER, within 3 months) after R 0 resection of hepatocellular carcinoma (HCC), and to establish a predictive model. Methods:Of 427 HCC patients [with 368 males, 59 females, aged (52.7±12.1) years] who developed early recurrence (within 2 years) after R 0 resection from January to December 2008 at Zhongshan Hospital, Fudan University were enrolled in the test cohort. Another 590 patients [with 525 males, 65 females, aged (54.7±11.0) years] who underwent R 0 resection from January to June 2009 were enrolled in the validation cohort. Risk factors were investigated and a predictive model was established. Results:In the test cohort, 126 patients (29.5%) developed VER and their survival outcomes were extremely poor. Serum α-fetoprotein (AFP) level >827 μg/L, multiple tumors, microvascular invasion (MVI) and tumor number were independent risk factors for VER. A new predictive model (0.809·AFP+ 1.262·tumor number+ 0.983·MVI) was established by logistic regression in predicting VER after surgery. The receiver operating characteristic curve showed that the area under the curve (AUC) in predicting VER was 0.722 (95% CI: 0.669-0.774, P<0.001). In the validation cohort, the AUC of this model was 0.785 (95% CI: 0.715-0.855, P<0.001). Conclusions:A high AFP level, multiple tumors, and MVI were independent risk factors for VER of HCC after R 0 resection. The prediction model consisting of these three factors demonstrated robustness and it has the potential in clinical application.

Objective? To optimize the emergency process with the healthcare failure mode and effect analysis (HFMEA) tool among lumbar surgery patients with muscle weakness so as to shorten the first-aid time, standardize doctor-nurse behavior and improve the timely cure rate. Methods? The emergency process from muscle weakness to hematoma evacuation in operating room was optimized based on the HFMEA. From June 2016 to May 2017, a total of 6 lumbar surgery patients with muscle weakness were in control group before optimization. From June 2017 to May 2018, a total of 7 lumbar surgery patients with muscle weakness were in experimental group after optimization. We compared the time from muscle weakness to effective cure of patients between two groups, and the detection rate for lumbar surgery patients with muscle weakness within 6 hours by nurses as well as the misjudgment probability for muscular strength assessment after lumbar surgery by nurses. Results? After implementing optimal process, the time from muscle weakness to effective cure of patients decreased from (23.78±1.95) h to (5.37±0.78) h. The detection rate for lumbar surgery patients with muscle weakness within 6 hours by nurses increased from 33.3% to 100.0%. The misjudgment probability for muscular strength assessment after lumbar surgery by nurses decreased from 12.2% to 4.6%. Conclusions? The application of HFMEA tool can optimize the muscular strength assessment management process for patients after lumbar surgery, standardize doctor-nurse behavior, shorten the first-aid time of muscle weakness and improve the detection rate for muscle weakness within 6 hours so as to guarantee the safety of patients.

Objective To explore the application effects of the clinical nursing muscle strength assessment record for patients with spinal cord injury based on the color separation Symbol Marking Method. Methods According to the neural classification standard of spinal cord injury formulated by the American Spinal Cord Injury Association, the main 10 groups of key muscles innervated by the motor function of spinal cord were sequentially set from top to bottom and from left to right. Different colors were used to distinguish the base plates of left and right limbs, and a special muscle strength evaluation record sheet was designed and made for patients with spinal cord injury. A total of 40 nurses for the Spinal Surgery Department of He'nan People's Hospital were recruited as the research subjects, and divided into study group and control group with 20 cases in each. 60 patients with spinal cord injury who were admitted to the spinal ward from June 2016 to December 2016 in this department were selected as the objects of assessment. The self-made muscle strength assessment record was applied in the study group, while the conventional writing method were applied in the control group. The rate of error evaluation, the rate of missing evaluation, the time of evaluation record were compared between the two groups,evaluate the satisfaction of study group nurses. Results In the study group, the rate of missing evaluation was lower than that in the control group (P＜ 0.05), and the time of recording in the observation group was shorter than that in the control group (P＜0.05), but there was no significant difference between the two groups on error evaluation (P ＞ 0.05). 95% of nursing staff in the study group were willing to use muscular strength assessment record, with a high satisfaction. Conclusions Muscle strength assessment records based on the color separation area symbol method can reduce the error rate, save the recording time, and improve the satisfaction of nurses. It also standardizes the working process and recording standards of nurses.

Objective To explore the effects of application of standard evaluation process of spinal cord motor function in patients with thoracic or lumbar diseases. Methods Selected 60 patients with thoracic and lumbar disease treated in the orthopedic ward of Henan Provincial People's Hospital from April 2016 to June 2016 as the experimental group. We retrospectively analyzed 60 cases of patients with thoracic or lumbar diseases treated with routine nursing evaluation process admitted between January to March 2016. We compared before and after the standardization evaluation process of spinal cord motor function, the theory and operation achievements of nurses, satisfaction of doctors with nurse specialist ability, mean hospitalization days and average cost of two groups. Results The development and implementation of the standardized evaluation process of spinal motor neurotically function, after the training, the theoretical assessment score of the nurse was (94.70±1.18) points, and the operation assessment score was (93.50±2.34) points; the average length of stay was (6.10±1.98) days. The average cost of hospitalization was (29 088±341) yuan; the overall satisfaction of doctors to nurses increased to 14/15; compared with 42.30±12.95, 46.80±15.31, 7.80±2.37, 37 566±592 of the control group, the difference was statistically significant (t=4.76-8.31, P=0.00). Conclusion Application of the standard evaluation process for Spinal cord motor function in patients with thoracic or lumbar diseases can standardize nurses' working procedure, making nursing work more comprehensive, timely and professional, and can better guide clinical practice.

Objective To investigate the feasibility and safty of indocyanine green (ICG) fluorescence staining by laparoscopic ultrasound and three-dimensional (3D) visualization guided portal branch puncture approach in anatomical segmentectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 26 patients who underwent anatomical segmentectomy using ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approach in the Zhongshan Hospital of Fudan University between December 2016 and April 2018 were collected.The preoperative 3D visualization reconstruction and areas of portal branch perfusion were analyzed,laparoscopic ultrasound localization was intraoperatively applied to tumor and portal vein of targeted hepatic segment,and then portal branch puncture and staining were done under laparoscopic ultrasound and 3D visualization,finally laparoscopic anatomical segmentectomy was performed.Observation indicators:(1) intraoperative situations:success rate of portal vein puncture,targeted hepatic segment,effect of ICG fluorescence staining,intraoperative complications,operation time,volume of intraoperative blood loss,blood transfusion,conversion to open surgery,tumor diameter,the minimum resection margin to tumor;(2) postoperative situations:postoperative complications (Clavien-Dindo classification as a criteria) and duration of hospital stay;(3) follow-up situations:cases with follow-up,follow-up time and postoperative tumor recurrence.Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor recurrence up to April 2018.Measurement data with normal distribution and count data were respectively described as average (range) and percentage.Results (1) Intraoperative situations:a success rate of laparoscopic ultrasound and 3D visualization guided portal branch puncture in 26 patients was 100.0％ (26/26),and punctures in S8,S7,S2,S3,S6,S5 and S4 of the liver were respectively performed to 7,6,4,3,3,2 and 1 patients.Of 26 patients,22 achieved expected effect of ICG fluorescence staining,with a statisfaction of 84.6％ (22/26) and 4 failed to get expected effect,including 2 with uneven dying,1 with staining-uncovered partial areas of targeted liver segment and 1 with adjacent hepatic segmental staining induced to unclear boundary.All the 26 patients were not complicated with ICG injection induced to allergy.Average operation time and volume of intraoperative blood loss were 184 minutes (range,60-315 minutes) and 97 mL (range,10-400 mL),without intraoperative blood transfusion and conversion to open surgery.Average tumor diameter and average minimum resection margin to tumor in 26 patients were respectively 3.2 cm (range,1.2-10.0 cm) and 1.5 cm (range,0.4-3.0 cm).(2) Postoperative situations:of 26 patients,2 with grade Ⅰ-Ⅱ of Clavien-Dindo classification were improved by drug treatments (1 with deep venous thrombosis of the lower extremities and 1 with pleural effusion),no patient had grade Ⅲ and above complications,and there was no bile leakage,infection and hepatic dysfunction.Average duration of hospital stay in 26 patients was 6.9 days (range,5.0-14.0 days).(3) Follow-up situations:26 patients were followed up for 0.3-17.0 months,with a median time of 6.0 months.During the follow-up,1 patient with hepatocellular carcinoma had adrenal metastasis and 25 had tumor-free survival.Conclusion Laparoscopic anatomical segmentectomy with ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approaeh is safe and feasible,especially suitable in posterosuperior liver segments.

Objective To study the clinical impact of microvascular invasion (MVI) on patients with intrahepatic cholangiocarcinoma (ICC) after R0 resections.Methods The clinicopathological data of 359 patients with ICC who underwent R0 resection in the Zhongshan Hospital,Fudan University between January 2000 and December 2008 were retrospectively studied.Univariate analysis and multivariate analysis were carried out to study factors related to postoperative survival outcomes and recurrence.The impact of MVI on patients with ICC after R0 resection was studied.Results The incidence of MVI was 13.6％ in the study cohort.MVI was correlated with HBV infection (P ＜ 0.05),liver cirrhosis (P ＜ 0.05) and tumor differentiation (P ＜ 0.05).The 1-,3-,5-year overall survival (OS) between the MVI positive and negative groups were 50.0％,20.9％,12.2％ and 63.9％,33.1％,22.0％ respectively (P ＜ 0.05),and the median survival time was 13 months and 18.5 months (P ＜0.05).The 1-,3-,5-year recurrence free survival (RFS) rates between the MVI positive and negative groups were 29.7％,12.7％,8.5％ and 50.6％,26.9％,18.4％,respectively (P ＜0.05),and the median recurrence free survival time was 8 months and 12.5 months (P ＜ 0.05).Multivariate analysis showed that MVI was an independent risk factor affecting recurrence after R0 resection (HR 1.852,95％ CI:1.075 ～ 3.195,P ＜ 0.05).Conclusions The occurrence of MVI in ICC patients was associated with hepatitis B infection.MVI was an independent risk factor affecting recurrence in ICC patients after R0 resection.However,it was not an independent risk factor of overall survival in patients after R0 resection.The clinical impact of MVI on patients with ICC was not as strong as for hepatocellular carcinoma.

Objective To explore the effects of application of self-made assessment card for spinal nerve motor function in clinical nursing.Methods An assessment card for spinal nerve motor function was designed and produced according to "spinal cord injury grading standards" by American Spinal Injury Association(ASIA).A total of 40 nurses working in orthopedic ward of our hospital were selected as study subjects,and divided into the experimental group and the control group with 20 nurses in each group.Theoretical and practical training regarding spinal nerve motor function was provided to nurses in both groups.Then totally 398 patieuts with spine or spinal cord diseases hospitalized in our orthopedic ward were recruited from June to September 2016 as subjects for assessment.The experimental group used self-made assessment card for spinal nerve motor function as guidance;the control group performed routine assessment for spinal nerve motor function.Results There were no significant differences between the experimental group and the control group in scores of theoretical and practical examinations (P＞0.05);compared with the control group,the error of assessment in the experimental group was reduced by 9.5％,missed assessment rate decreased by 16.2％;and the time for assessnent in the experimental group was significantly shorter than that in the control group(P＜0.05).Conclusion The assessment card for spinal nerve motor function can reduce the error of assessment,save the time for assessment,enhance the capacity of specialist nurses and improve work efficiency.