Objective:To explore the application effect of case-based learning (CBL) combined with three-dimensional (3D) imaging technology in thoracic surgery probationary teaching.Methods:Ninety thoracic surgery interns in the Affiliated Hospital of Yangzhou University, China in 2019 were selected and divided into the conventional theoretical teaching group (group A), CBL group (group B), and CBL combined with 3D imaging technology group (group C) according to the random number table method. Group A was taught with conventional theory; group B was taught by CBL; in group C, 3D imaging software was used to reconstruct computed tomography data based on CBL. The theoretical scores of the three groups were evaluated respectively, and a questionnaire survey was conducted on the students (including whether the teaching is conducive to stimulating the interest and enthusiasm of learning, whether it is conducive to the establishment of clinical thinking, evaluation of advantages and disadvantages of the teaching method, and whether the teaching method is conducive to the mastery of theoretical knowledge). SPSS 20.0 was used for analysis of variance, t test, and Chi-square test. Results:The theoretical score of group A (85.83±4.62) was the lowest, and the theoretical score of group B was significantly lower than that of group C (89.71±5.84 vs. 94.60±6.28); the answer time of group C (286.68±77.56 seconds) was the shortest, and the answer time of group B was significantly shorter than that of group A (359.78±80.55 vs. 423.31±83.53 seconds, P<0.001). Group C was significantly better than group B and group A in the aspects of stimulating interest and enthusiasm in teaching, conducive to the establishment of clinical thinking, advantages of the teaching method, and conducive to the mastery of theoretical knowledge, and group B was significantly better than group A ( P<0.001). Conclusion:The combination of CBL and 3D reconstruction technology improves the recognition of thoracic surgery interns to the teaching method, increases their theoretical scores, stimulates their learning interest and enthusiasm, cultivates their clinical thinking, and enhances their mastery of theoretical knowledge.

BACKGROUND: Lung cancer is currently the leading malignant tumor in both domestic and foreign morbidity and mortality. Surgical treatment is the main treatment option for lung cancer. The aim of this study is to explore the effects of enhanced recovery after surgery (ERAS) combined with respiratory function exercise combined with single-hole thoracoscopic surgery on lung cancer patients with postoperative pulmonary complications, postoperative pain, time to get out of bed, time to extubation and length of hospital stay. METHODS: A total of 240 patients who underwent endoscopic lung cancer surgery at the Affiliated Hospital of Yangzhou University and the Yancheng First People's Hospital from October 2017 to October 2019 were randomly divided into 4 groups, with 60 patients in each group. Patients in group A underwent single-hole thoracoscopic surgery, and preoperatively performed ERAS concept education and respiratory function training; group B used conventional 3-hole thoracoscopic surgery, and performed ERAS concept education and respiratory function training before operation; group C used conventional 3-hole thoracoscopic operation surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept education; group D used single-hole thoracoscopic surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept mission. The number of postoperative pulmonary complications, postoperative pain, time to get out of bed, extubation time, and hospital stay were recorded in the four groups. RESULTS: Compared with the groups B, C, and D, the incidence of pulmonary complications was significantly reduced, and the time to get out of bed, extubation time, and hospital stay were significantly shortened in group A. Compared with groups B, C, the postoperative pain was significantly reduced in group A. Compared with group C, the pulmonary complications were significantly reduced, and the time to get out of bed, extubation time and hospital stay were significantly shortened in group B. The differences were statistically significant (P<0.05). There was no significant difference in postoperative pain between group A and group D, group B and group C (P>0.05). CONCLUSIONS For patients with single-hole thoracoscopic lung cancer surgery, the ERAS concept guidance can effectively reduce the incidence of pulmonary complications and postoperative pain, shorten the time to get out of bed, the time to extubate, and the length of hospital stay.

Objective To investigate the effect of exosomal miR-146a-5p expression on gray matter volume in patients with major depressive disorder(MDD).Methods A total of 113 MDD patients(MDD group)and 107 healthy controls(HC)(HC group)were selected.Peripheral blood was collected and exosomes were isolated to quantify miR-146a-5p expression.Brain high-resolution T1 WI images of MDD and HC were obtained via MR,and gray matter volume was computed via SPM12 software.The interaction effect of"Depression×miR-146a-5p expression"on gray matter volume was analyzed using SPM's Flexible factorial design,and the between-group difference was assessed by extracting the mean value,thus to analyze whether MDD-related gray matter volume abnormalities were dependent on miR-146a-5p expression.Results Exosomal miR-146a-5p expression was significantly elevated in MDD group compared to HC group.Voxel-based factorial analysis revealed a relationship between high miR-146a-5p expression in MDD group and reduced gray matter volume in the anterior and posterior cingulate cortices(independent voxel threshold P＜0.001,AlphaSim corrected),and a significantly reduced gray matter volume as compared with HC group was detected in the two regions.Conclusion The exosomal miR-146a-5p is overexpressed in patients with MDD and may be associated with specific cortical atrophy in patients with MDD.

Esophageal cancer threatens the lives and health of humans for a long time owing to its high morbidity and mortality. Surgical treatment is still the first choice for early-stage esophageal cancer now, but its high mortality and complication rate during perioperative period cause a huge physiological and psychological burden on patients. The concept of enhanced recovery after surgery (ERAS) was first proposed for colorectal surgery, and later promoted to other surgical fields. Its application in esophagectomy successfully reduces the high mortality and complication rate in the perioperative stage and promotes the rapid recovery of patients. However, the application of ERAS in the field of esophageal cancer is relatively late, and its promotion and application are relatively limited compared to other surgical procedures. In this paper, we review the relevant literature at home and abroad in combination with the current progress of ERAS application of esophageal cancer in China. We also summarize the relevant problems related to the implementation of ERAS, in order to help the promotion and application of ERAS in the surgical treatment of esophageal cancer.