This research provides an overview of the perioperative nursing care for a patient with a massive renal cell carcinoma and Mayo Stage Ⅲ tumor thrombus who underwent a robot-assisted nephrectomy complicated by significant intraoperative bleeding and CO₂ embolism. Key nursing considerations included multidisciplinary preoperative discussions，developing stepwise intraoperative emergency plans，establishing an integrated nursing workstation，and the optimization of patient monitoring. During the surgery，nursing efforts were focused on supporting the robot-assisted procedure，closely monitoring the patient’s condition，preventing intraoperative complications，initiating emergency plans as needed，actively managing major bleeding and CO₂ embolism，and implementing structured positioning to minimize the risk of falls during the procedure. Postoperatively，the focus was on preventing secondary thrombus formation，managing active bleeding，and monitoring for liver and kidney ischemia-reperfusion injury. Through multidisciplinary interventions and meticulous nursing care，the patient was discharged after a 13-day postoperative recovery.

Objective To explore the longitudinal trajectories of symptom clusters in patients with rectal cancer within 6 months after laparoscopic anal preservation surgery，and analyze the predictive factors of each trajectory subgroup. Methods A longitudinal survey was conducted to select 128 patients who underwent laparoscopic anal preservation surgery for rectal cancer at the Department of Gastrointestinal Surgery，a tertiary hospital in Nanchong from November 2021 to April 2022. The general information questionnaire，Chinese version of Anderson Symptom Inventory for Gastrointestinal Cancer and Charlson Comorbidity Index were used to conduct follow-up surveys of the selected patients at 2 weeks，1 month，3 months and 6 months after surgery. The symptom cluster were extracted by exploratory factor analysis，and the latent category growth model was constructed to identify the trajectory subgroups of each symptom cluster. The predictive factors of each trajectory subgroup were analyzed by Mplus statistical software. Results There were 4 symptom clusters within 6 months after laparoscopic anus preserving surgery for rectal cancer，which were named as sickness symptom cluster，psychological-sleep symptom cluster，gastrointestinal symptom cluster，and psychological-treatment-related symptom cluster. The variance contribution rates were 65.173%，66.225%，62.421%，and 60.492%，respectively. The latent class growth model identified that there are 4 to 5 trajectory subgroups in the symptom cluster. Gender，education level，Charles Comorbidity Index，clinical T stage，medical cost burden，and treatment method were the predictors of high-risk trajectory subgroups in the symptom cluster（P<0.05）. Conclusion There are 4 symptom clusters within 6 months after laparoscopic anus preserving surgery for rectal cancer. The gastrointestinal symptom cluster is a specific symptom cluster for this type of patients with the heaviest symptom burden. The overall trajectory of each symptom cluster shows a dynamic decline trend，but individual trajectory subgroups still have an exacerbation trend. There are differences in predictive factors for different symptom clusters. Clinical medical staff should pay attention to the management of symptom clusters in patients with female patients，low education level，high Charles Comorbidity Index，high clinical T stage，heavy medical cost burden，and patients whose treatment method is chemotherapy plus surgery. High-risk groups should be timely identified；corresponding intervention methods were dynamically adjusted；the quality of precision nursing was improved.

Objective To translate the English version of Perioperative Thirst Discomfort Scale （PTDS） into Chinese,and to test the reliability and validity of the Chinese version of PTDS. Methods The English version of PTDS was translated into Chinese and back translated and modified for cultural adaptation according to the guidelines. A convenience sample of 316 perioperative patients at 4 tertiary hospitals in Fujian was investigated by the Chinese version of PTDS,in order to test its reliability and validity. Results The Cronbach’s α of the Chinese PTDS was 0.813; both the scale-level content validity index and the item-level content validity index were 1.Factor analysis showed 2 factors explaining 64.312% of the total variance. The score of PTDS was significantly associated with the thirst intensity score（r=0.681,P<0.001）. Conclusion The Chinese version of PTDS has been proved to be reliable and valid.It can be used for measuring thirst discomfort in perioperative patients.

To summarize perioperative nursing care in a case with acute left heart failure caused by giant ball thrombus blocking micro orifice in left atrium. The nursing points are as follows：quickly improving pre-operative preparations,activating the emergency team of the cardiac special bank,and preparing equipment and items;during the operation,rapidly establishing extracorporeal circulation,strengthening the blood management,carrying out the phased temperature management,conducting active blood sugar management and clustered surgical infection management;management and psychological care of post-complication. The patient was well rehabilitated and discharged from the hospital 27 days after surgery.

The nursing experience of a patient undergoing emergency coronary artery bypass grafting in the period of targeted drug therapy after lobectomy. The patient，who was complicated with multiple drug-resistant bacterial infections and other lesions，had acute myocardial infarction during the targeted drug therapy. The main points of nursing include the assessment and care of cardiac function，proper measures of excessive drainage fluid，protection and rehabilitation of lung function，prevention and control of infection，protection of liver and kidney function，targeted psychological care and health education to help him build confidence in overcoming disease. After the comprehensive management of a multidisciplinary team，tracheal intubation was removed 38 hours after surgery，and the patient was discharged 15 days after emergency operation.

This paper summarized the postoperative nursing of 3 children with long-gap esophageal atresia undergoing gastrostomy. Key points of care include：continuous low negative pressure suction of proximal esophagus to prevent aspiration pneumonia;good care of diet perfusion,the skin around gastrostomy and the tube;psychological nursing for parents. After careful treatment and care,3 children were successfully treated with delayed esophageal end-to-end anastomosis 4 to 7 months after birth.

Objective To evaluate and summarize the best evidence of exercise instructions for breast cancer-related lymphedema,and to provide references for clinical practice. Methods We searched BMJ Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute（JBI） Library,JBI Clinical Online Network of Evidence for Care and Therapeutics（JBI CONNECT+）,National Institute for Health and Clinical Excellence（NICE）,National Guideline Clearinghouse（NGC）,Guideline International Network（GIN）,Scottish Intercollegiate Guidelines Network（SIGN）,National Comprehensive Cancer Network（NCCN）,Registered Nurses’ Association of Ontario（RNAO）,National Lymphedema Network（NLN）,International Society of Lymphology（ISL）,PubMed,CINAHL,Embase,Web of Science,Physiotherapy Evidence Database,China Guideline Clearinghouse,CNKI,Wanfang Database,CBM and VIP Database to collect guidelines,expert consensuses,evidence summaries and systematic reviews on exercise for patients with breast cancer-related lymphedema. The retrieval period was from the inception of databases to July 2019. 2 researchers with evidence-based nursing background assessed the quality of the literature independently and identified the level of evidence. Results A total of 19 articles were incorporated,including 1 clinical decision,1 clinical practice recommendation,1 evidence summary,5 guidelines,3 expert consensuses,8 systematic reviews. A total of 23 pieces of best evidence including 8 dimensions were summarized,namely contraindication,pre-exercise assessment,pre-exercise test,exercise intensity,safety,exercise program,announcements and health education related exercise. Conclusion Exercise interventions can alleviate symptoms of lymphedema. Clinical staff should consider patients’ opinions and provide personalized exercise programs for patients with breast cancer-related lymphedema according to the clinical situation,in order to further improve effectiveness of the exercise and quality of life of patients.

Objective To investigate the knowledge and attitude of ICU physicians and nurses on physical environment in ICU setting and to explore the influencing factors.Methods A self-made questionnaire was used to survey 487 physicians and nurses from 8 tertiary hospitals and 14 secondary hospitals in Fujian Province.Results The ICU physicians and nurses’ knowledge and attitude scores were （33.25±7.14） and （42.17±3.26）. Multiple regre-ssion analysis showed that educational background and level of hospitals were influencing factors for knowledge scores for physical environment in ICU medical staffs（P<0.01）. Job title,position and level of hospitals were influencing factors for attitude score for physical environment in ICU medical staffs（P<0.01）.Conclusion ICU physicians and nurses took a positive attitude about physical environment,while the level of knowledge should be improved.