Objective:To investigate the learning curve of laparoscopic transanal total mesorectal excision (taTME) for rectal cancer operated by one or two surgery teams.Methods:The retrospective cross-sectional study was conducted. Based on the concept of real-world research, the clinical data of 1 458 patients undergoing laparoscopic rectal cancer taTME from 44 medical centers who were registered in the Chinese taTME registry collaborative (CTRC) database from May 2010 to May 2020 were collected. The 1 458 patients were divided into cohorts with one surgery team or two surgery teams according to the operation method. Patients with one surgery team underwent taTME by transabdominal operation and then by transanal operation. Patients with two surgery teams underwent taTME by transabdominal and transanal operation simultaneously with duration of the simutaneous operation time ≥30 minutes. The entire surgical process of patients with two surgery teams is not required to be performed by two surgery teams simutaneously. The clinical data were collected from the medical centers with similar operation amount according to the operation time sequence to analyze the difference between different operation stages and explore the learning curve. The operation time was taken as the parameter to carry out cumulative sum analysis and draw the learning curve of laparoscopic rectal cancer taTME in each medical center. The clinicopathological characteristics of patients from two medical centers with the largest difference in learning curves were analyzed. Observation indicators: (1) screening results of clinical data; (2) clinical data collection of patients with one surgery team; (3) surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages; (4) learning curve of the one surgery team; (5) clinical data collection of patients with two surgery teams; (6) surgical situations of laparoscopic rectal cancer taTME from the two surgery teams; (7) learning curve of the two surgery teams. The cumulative sum was calculated by the CUSUM=∑i=1nXi-U, where Xi represented the operation time of each taTME, U represented the average operation time of all cases, and n represented the operation number. Fitting process was conducted on scatter plot of learning curves. Taking the apex of learning curve as the boundary, the learning curve was divided into two stages. The abscissa corresponding to the apex of learning curve was the number of operations that needed to be performed to cross the learning curve. Measurement data with normal distribution were represented as Mean±SD. Comparison between two groups was conducted using the t test and comparison between multiple groups was conducted using the ANOVA. Measurement data with skewed distribution were represented as M( P25,P75), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was analyzed using the rank sum test. Count data were analyzed using the chi-square test or Fisher exact probability. Results:(1) Screening results of clinical data:the clinical data of 661 patients from 7 medical centers with one surgery team and two surgery teams were collected. (2) Clinical data collection of patients with one surgery team: the clinical data of 312 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected including 42 cases in the number 2 medical center, 97 cases in the number 20 medical center, 82 cases in the number 33 medical center, 35 cases in the number 37 medical center and 56 cases in the number 39 medical center, respectively. (3) Surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages: three medical centers including the number 2, number 37 and number 39 medical center with close operation volume provided the clinical data of cases distributed in five operation stages. Among the five operation stages, the proportion of high-quality operation of total mesorectal excision (TME) was ≥17/18, the incidence of postoperative complications was ≤13.3%(4/30) and the incidence of anastomotic leakage was ≤10.0%(3/30). There was no significant difference in the TME quality, postoperative complications or anastomotic leakage among the five operation stages ( P>0.05). There was no significant difference in the operation time among the five operation stages ( χ2=6.950, P>0.05). (4) Learning curve of the one surgery team: the number of operations corresponding to the turning point of learning curve in number 2 and number 20 medical center was 22 and 39, respectively. The number of operations corresponding to the turning points of learning curve in number 33 and number 37 medical center was 15, 66 and 10, 28, respectively. The number of operations corresponding to the turning point of learning curve in number 39 medical center was 20. The overall curve of number 20 medical center was in line with the trend of learning curve and 39 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 20 and number 33 medical center. Cases with the gender of male or female, age, body mass index, cases classified as stage 1, stage 2, stage 3 or stage 4 of the American Society of Anesthesiologists (ASA) Classification, cases with neoadjuvant therapy, duration of postoperative hospital stay of the number 20 medical center were 77, 20, (60±10)years, 24 kg/m 2(22 kg/m 2, 26 kg/m 2), 1, 88, 8, 0, 8, 8, 11 days (9 days, 13 days), respectively, versus 51, 31, (64±11)years, 23 kg/m 2(21 kg/m 2, 26 kg/m 2), 0, 35, 43, 1, 31, 16 days (13 day, 21 day) of number 33 medical center, showing significant differences in the above indicators between the two medical centers ( χ2 =6.442, t=-2.265, Z=-2.032, -6.870, χ2 =22.120, Z=-8.408, P<0.05). (5) Clinical data collection of the two surgery teams: the clinical data of 259 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected, including 46 cases in the number 2 medical center, 47 cases in the number 8 medical center, 78 cases in the number 18 medical center, 43 cases in the number 33 medical center and 45 cases in the number 44 medical center, respectively. (6) Surgical situations of laparoscopic rectal cancer taTME from the two surgery teams: four medical centers including the number 2, number 8, number 33 and number 44 medical center with close operation volume provided the clinical data of cases distributed in four operation stages. Among the four operation stages, the proportion of high-quality operation of TME was ≥50.0%(13/26), the incidence of postoperative complications was ≤35.0%(14/40) and the incidence of anastomotic leakage was ≤22.5%(9/40). There was no significant difference in the TME quality, postoperative complications or operation time among the four operation stages ( χ2 =3.252, 4.733, 8.848, P>0.05). There was a significant difference in the incidence of anastomotic leakage among the four operation stages ( P<0.05). (7) Learning curve of the two surgery teams: the number of operations corresponding to the turning point of learning curve in number 2 and number 8 medical center was 28 and 16, respectively. The number of operations corresponding to the turning points of learning curve in number 18, number 33 and number 44 medical center was 12 and 58, 10 and 36, 14 and 36, respectively. The overall curve of number 2 medical center was in line with the trend of learning curve and 28 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 2 and number 33 medical center. The age and cases with tumor in stage T0 and (or) Tis, stage T1, stage T2, stage T3 or stage T4 of the T staging of the number 2 and number 33 medical center were (60±12)years, 3, 1, 9, 11, 20 and (65±10)years, 2, 3, 22, 15, 0, respectively, showing significant differences in the above indicators between the two medical centers ( t=-2.280, Z=-4.033, P<0.05). Conclusion:Thirty-nine cases of operations was the minimum number for the one surgery team to cross the learning curve of laparoscopic rectal cancer taTME and 28 cases of operations was the minimum number for the two surgery teams to cross the learning curve of laparoscopic rectal cancer taTME.

ObjectiveTo investigate the quality of life in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) and analyze the related influencing factors. MethodsA total of 139 patients who had undergone TAVR in Department of Cardiovascular Medicine, West China Hospital, Sichuan University, were selected through the hospital electronic medical record system from April of 2012 to April of 2017. By using the General Information Questionnaire for Patients, Charlson＇s co-morbidity Index (CCI), Morisky Medication Adherence Scale, and China Cardiovascular Quality of Life Questionnaire (CQQC), their life quality were investigated and the influencing factors were analyzed. ResultsThe average score of CQQC after TAVR was (78.76±16.52), lower than the national norm. There were statistical difference in the scores of CQQC in patients with different ages, marital status, educational background, cardiac function preoperation, CCI weight, smoking status, drinking status, and regular exercise status(P＜ 0.05). Stepwise regression analysis indicated that, age,marital status, cardiac function preoperation, time of length postoperation and regular exercise could be included into the regression modal, accounting for 34.9% of variances. ConclusionsThe quality of life of patients after TAVR is low. Age, marital status, preoperative cardiac function, postoperative time and regular exercise will affect the quality of life of patients. It is suggested that medical staff should pay attention to the quality of life of TAVR patients after operation and carry out targeted nursing intervention and health education actively, as well as scientific rehabilitation exercise so as to improve the quality of life of TAVR patients after operation.

Objective:To explore the research hotspots of flipped classroom in nursing education at home and abroad so as to provide a reference for nursing educators to further develop the flipped classroom in China.Methods:Visual analysis was carried out for literatures related to application of flipped classroom in nursing education retrieved in the Chinese National Knowledge Infrastructure (CNKI) and WanFang Data from 2015 to 2019, and in Web of Science core collection from 2013 to 2019 with the CiteSpace.Results:Totals of 135 Chinese literatures and 114 English literatures were screened. The number of published papers showed an increasing trend year by year. Chinese literatures key words had a low level of network density, and researchers were relative decentralization.Conclusions:Chinese literatures researches focused on practice. We should strengthen the theoretical model research and the localization exploration to promote the in-depth development of flipped classroom in nursing education.

Objective: To comb the development of transitional care, analyze and compare the research hotspots and frontiers at home and abroad. Methods: CNKI Database and Web of Science Core Collection were taken as data sources to retrieve the relevant literature published from 2000 to 2019; CiteSpace software was used to construct scientific knowledge maps for visualization analysis. Results: A total of 285 Chinese and 1 179 English documents were retrieved, and the annual publications showed an upward trend from 2012. The high-yield institutions and authors were relatively scattered. Chinese papers focused on subjective indicators such as quality of life, and most of which were literature review. While English papers tended to focus on objective indicators, such as readmission and mortality rate, and the research type was mainly intervention study. The Chinese keywords "WeChat" and English "palliative care" were with the strongest citation bursts in recent years. Conclusions The domestic development of transitional care is relatively lagging; cooperation between institutions and authors should be strengthened. Future researches on palliative care or combined with WeChat platform may become hotspots in this field.