Study of the intensive care unit activity scale in the early rehabilitation of patients after direct cardiac surgery

BACKGROUND Direct cardiac surgery often necessitates intensive post-operative care,and the intensive care unit(ICU)activity scale represents a crucial metric in assessing and guiding early rehabilitation efforts to enhance patient recovery.AIM To clarify the clinical application value of the ICU activity scale in the early recovery of patients after cardiac surgery.METHODS One hundred and twenty patients who underwent cardiac surgery between September 2020 and October 2021 were selected and divided into two groups using the random number table method.The observation group was rated using the ICU activity scale and the corresponding graded rehabilitation interventions were conducted based on the ICU activity scale.The control group was assessed in accordance with the routine rehabilitation activities,and the postoperative rehabilitation indexes of the patients in both groups were compared(time of tracheal intubation,time of ICU admission,occurrence of complications,and activity scores before ICU transfer).The two groups were compared according to postoperative rehabilitation indicators(time of tracheal intubation,length of ICU stay,and occurrence of complications)and activity scores before ICU transfer.RESULTS In the observation group,tracheal intubation time lasted for 18.30±3.28 h and ICU admission time was 4.04±0.83 d,which were significantly shorter than the control group(t-values:2.97 and 2.038,respectively,P<0.05).The observation group also had a significantly lower number of complications and adverse events compared to the control group(P<0.05).Before ICU transfer,the observation group(6.7%)had few complications and adverse events than the control group(30.0%),and this difference was statistically significant(P<0.05).Additionally,the activity score was significantly higher in the observation(26.89±0.97)compared to the control groups(22.63±1.12 points)(t-value;-17.83,P<0.05).CONCLUSION Implementation of early goal-directed activities in patients who underwent cardiac surgery using the ICU activity scale can promote the recovery of cardiac function.

Development of Nursing Protocol for Preventing Interruptions during Clinical Examinations and Treatments in the Early Days of Hospitalization for Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 11 nurses in dementia care to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.

Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms

BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.

The Early Triassic Helongshan Formation in Anhui,China:Record of the Triassic Biotic Recovery in the Lower Yangtze Region

The Lower Triassic is well outcropped in central and southern Anhui Province,East China,and it consists of the Yinkong,Helongshan and Nanlinghu Formations in an ascending order.The Helongshan Formation belonging to the Smithian has been well studied in this project because of the typical sedimentary features and different fossil types which are not similar to the lower Yinkeng Formation or

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery

BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.

Countermeasures and Prevention of Railway Traffic Accidents in the Early Days of the Founding of the People’s Republic of China

In the early days of the founding of the People’s Republic of China,in order to restore the national economy as soon as possible,the Communist Party of China carried out maintenance and repairs on the railways that caused serious damage to transportation tasks through war-torn smoke,and carried out large-scale railway construction.However,in the course of operation,railway safety accidents occur frequently due to outdated equipment,low quality of staff,lack of rules and regulations,vandalism,and various natural disasters.In the face of severe conditions,the railway authorities summed up the accidents and learned the safety of the railways,so that the railway transportation industry,which started after the founding of the country,was gradually on the right track,and laid a solid foundation for the safe development of the railway industry.

Explore the clinical nursing path of daytime laparoscopic cholecystectomy under the guidance of enhanced recovery after surgery

Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h discharged daytime laparoscopic cholecystectomy patients which assessmended and guided by ERAS,with the 180 case of routine cholecystectomy patients as control group at the same time.To quantitatively analyze the related indexes of perioperative period and ERAS concept,and evaluate the clinical safety,and effectiveness.Results:It displayed no significant differences in average age,gender distribution,duration of gallbladder related disease and distribution of clinical symptoms between the two groups(P>0.05).There were also no significant differences in preoperative smoking history,hypertension history,cardio-cerebrovascular history,abdominal operation history and disease composition ratio between the two groups(P>0.05).None of the patients had conversion to laparotomy.Compared with the conventional surgery group,there were no significant differences in the average amount of intraoperative blood loss,operation time and muscle strength before returning to the ward in patients with ERAS guided day surgery(P>0.05).When compared with the conventional surgery group,ERAS guided day surgery group had no significant difference in muscle strength between the two groups when going under the ground(t=1.64,P=0.082).Also,the level of peripheral white blood cells in patients with ERAS guided day surgery group was not significantly increased at 6 h after surgery.Meanwhile,liver function related indexes,transaminase,total bilirubin,indirect bilirubin were not significantly abnormal(P>0.05).Conclusion:12 h daytime laparoscopic cholecystectomy guided by ERAS concept can improve the clinical efficacy of patients with cholecystolithiasis,which is safe and feasible.

Discharging patients home from the intensive care unit:A new trend

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

Key theoretical and technical issues and countermeasures for effective development of Gulong shale oil, Daqing Oilfield, NE China

Aiming at the four issues of underground storage state,exploitation mechanism,crude oil flow and efficient recovery,the key theoretical and technical issues and countermeasures for effective development of Gulong shale oil are put forward.Through key exploration and research on fluid occurrence,fluid phase change,exploitation mechanism,oil start-up mechanism,flow regime/pattern,exploitation mode and enhanced oil recovery(EOR)of shale reservoirs with different storage spaces,multi-scale occurrence states of shale oil and phase behavior of fluid in nano confined space were provided,the multi-phase,multi-scale flow mode and production mechanism with hydraulic fracture-shale bedding fracture-matrix infiltration as the core was clarified,and a multi-scale flow mathematical model and recoverable reserves evaluation method were preliminarily established.The feasibility of development mode with early energy replenishment and recovery factor of 3o%was discussed.Based on these,the researches of key theories and technologies for effective development of Gulong shale oil are proposed to focus on:(1)in-situ sampling and non-destructive testing of core and fluid;(2)high-temperature,high-pressure,nano-scale laboratory simulation experiment;(3)fusion of multi-scale multi-flow regime numerical simulation technology and large-scale application software;(4)waterless(CO_(2))fracturing technique and the fracturing technique for increasing the vertical fracture height;(5)early energy replenishment to enhance oil recovery;(6)lifecycle technical and economic evaluation.Moreover,a series of exploitation tests should be performed on site as soon as possible to verify the theoretical understanding,optimize the exploitation mode,form supporting technologies,and provide a generalizable development model,thereby supporting and guiding the effective development and production of Gulong shale oil.

Influence of Early Pregnancy Termination by Focused Ultrasound Beams on Menstrual Recovery of Macaques

Objective To explore the effects on macaques’ menstrual recovery after terminating early pregnancy by focused ultrasound beams (FUB) Methods FUB was used to terminate early pregnancy in 5 macaques with gestation duration ranging from 37-66 d. Two circles after the recovery of menstruation, color Doppler flow imaging (CDFI) and magnetic resonance imaging (MRI) were used to estimate the shape, size and blood flow of uterus, and pathological examinations were performed to check against any lesions to uterine endometrium and ovary. Results Forty days after FUB abortion, menstruation recovered and the volume and duration of each macaque’s menstruation were not changed compared with those be- fore gestation. CDFI and MRI suggested that the size and shape of uterus were normal. The endometrial line was clear and no lesions were found in adjacent organs. Conclusion FUB termination of early pregnancy in macaques did not damage their ovarian tissue and had no influence on subsequent menstrual recovery.Key words: focused ultrasound beams (FUB); macaque; early pregnancy; menstrual recovery

Effect of early recovery training on motor function's recovery in stroke patients

Objective To observe theeffectof early recovery trainingonmotorfunctioninstrokepatients.Method118casessufferingfromcerebralapoplexywererandomlydividedintotwogroupsrehabilitationgroup59casescontrastgroup59cases.Theformertooktheearlyrecoverytrainingandthelattertooktheroutinetreatment.ResultAfterthetreatmenttheformer’scurativeeffectwasbetterthanthelatterandtheirdyskinesiaturnedforthebetterobviously.ConclusionTheearlyrecoverytrainingcandecreasethecripplingrateinstrokepatients.

Research on Early Fault Self-Recovery Monitoring of Aero-Engine Rotor System

In order to increase robustness of the AERS (Aero-engine Rotor System) and to solve the problem of lacking fault samples in fault diagnosis and the difficulty in identifying early weak fault, we proposed a new method that it not only can identify the early fault of AERS but also it can do self-recovery monitoring of fault. Our method is based on the analysis of the early fault features on AERS, and it combined the SVM (Support Vector Machine) with the stochastic resonance theory and the wavelet packet decomposition and fault self-recovery. First, we zoom the early fault feature signals by using the stochastic resonance theory. Second, we extract the feature vectors of early fault using the multi-resolution analysis of the wavelet packet. Third, we input the feature vectors to a fault classifier, which can be used to identify the early fault of AERS and carry out self-recovery monitoring of fault. In this paper, features of early fault on AERS, the zoom of early fault characteristics, the extraction method of early fault characteristics, the construction of multi-fault classifier and way of fault self-recovery monitoring are studied. Results show that our method can effectively identify the early fault of AERS, especially for identifying of fault with small samples, and it can carry on self-recovery monitoring of fault.

Enhanced recovery after surgery protocol enhances early postoperative recovery after pancreaticoduodenectomy

Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy(PD). Methods: A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube(NGT) was removed on postoperative day(POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula(POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications(defined as per the ISGPS definitions). Results: NGT was removed on POD1 in 45(90%) patients, abdominal drain removed by POD4 in 41(82%) and 43(86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three(6%) patients had delayed gastric emptying(DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay(LOS) with age( P < 0.05) and a marginal relation between LOS and postoperative albumin( P = 0.05). Conclusions: ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.

QTL analysis of early flowering of female flowers in zucchini(Cucurbita pepo L.)

Early flowering promotes early maturity, production, and the capacity to counteract biotic and abiotic stresses, making it an important agronomic trait in zucchini. The present study demonstrated that the zucchini inbred line ‘19’ consistently flowered early, taking significantly fewer days to bloom the first female flower(DFF) than the inbred line ‘113’. Genetic analysis revealed that DFF, an inheritable quantitative trait, is controlled by multiple genes. Based on the strategy of quantitative trait locus(QTL) sequencing(QTL-seq) combined with linkage analysis, three QTLs for DFF were identified on chromosomes 4, 11, and 20. This study used additional F2 populations grown under different environmental conditions for QTL mapping analysis of DFF with insertion/deletion(InDel) markers to validate these results. Using the composite interval mapping(CIM) method of R/qtl software, we only identified one major locus under all environmental conditions, located in a 117-kb candidate region on chromosome 20. Based on gene annotation, gene sequence alignment, and qRT-PCR analysis, we found that the Cp4.1LG20g08050 gene encoding a RING finger protein may be a candidate gene for the opposite regulation of early flowering in zucchini. In summary, these results lay a foundation for a better understanding of early flowering and improving early flowering-based breeding strategies in zucchini.

Prophylactic drains in totally laparoscopic distal gastrectomy:are they always necessary?

Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been debated,due to mounting evidence that they could be harmful rather than beneficial.Based on recent published articles,Liu et al reported that the routine use of prophylactic drains in total laparoscopic distal gastrectomy might not be necessary for all patients.Herein,we express our opinion regarding this interesting publication.

Analysis of stable components for extended-range (10-30 days) weather forecast:A case study of continuous overcast-rainy process in early 2009 over the mid-lower reaches of the Yangtze River

A continuous overcast-rainy weather(CORW) process occurred over the mid-lower reaches of the Yangtze River(MLRYR) in China from February 14 to March 9 in 2009,with a large stretch and long duration that was rarely seen in historical records.Using the empirical orthogonal function(EOF),we analyzed the geopotential height anomaly field of the NCEP-DOE Reanalysis II in the same period,and defined the stable components of extended-range(10-30 days) weather forecast(ERWF).Furthermore,we defined anomalous and climatic stable components based on the variation characteristics of the variance contribution ratio of EOF components.The climatic stable components were able to explain the impact of climatically averaged information on the ERWF,and the anomalous stable components revealed the abnormal characteristics of the continuous overcast-rainy days.Our results show that the stable components,especially the anomalous stable components,can maintain the stability for a longer time(more than 10 days) and manifest as monthly scale low-frequency variation and ultra-long-wave activities.They also behave as ultra-long waves of planetary scale with a stable and vertically coherent structure,reflect the variation of general circulation in mid-high latitudes,display the cycle of the zonal circulation and the movement and adjustment of the ultra-long waves,and are closely linked to the surface CORW process.

Anachronistic facies in the Lower Triassic of South China and their implications to the ecosystems during the recovery time

The end-Permian mass extinction not only severely distressed the Paleozoic ecosystems but also dramatically changed the sedimentary systems, resulting in a peculiar Early Triassic ecosystem and submarine environment during the recovery time following the mass extinction. The Lower Triassic is characteristic of the wide occurrence of various distinctive sediments and related sedimentary structures, such as flatpebble conglomerates, vermicular limestone, subtidal wrinkle structures, microbialite, carbonate seafloor fans, thin-bedded limestone and zebra limestone-mudstone. These sediments were common in the Precambrian to Early Ordovician marine settings, and then they occurred only in some extreme and unusual environments with the expansion of metazoan faunas. However, the Early Triassic witnessed an "anachronistic" reappearance of some distinctive sedimentary records in normal shallow marine settings. The study of these anachronistic facies should be of great importance for the understanding of the unique ecosystem and marine environment through the great Paleozoic-Mesozoic transition. The anachronistic facies characterized by vermicular limestone have been documented in many localities in South China and occur at various horizons of the Lower Triassic. Most types of re- ported distinctive sediments over the world have been observed in the Lower Triassic of South China. This provides an excellent opportunity for understanding the Early Triassic environment and its co- evolution with the biotic recovery. Among the anachronistic facies the vermicular limestone is the most characteristic and common distinctive sediments in the Lower Triassic of South China but has received relatively few investigations. Taking it as a case study, we will detail the variation of vermicular limestone and its stratigraphic distribution in the Three Gorges area, Hubei Province. The investigation on the vermicular limestone and other distinctive sediments from the Lower Triassic of South China further indicates that the appearance of anachronistic facies immediately following the mass extinction and the elimination from normal shallow marine facies with the radiation of Mesozoic marine faunas imply the natural response of the sedimentary systems and ecosystems to the great Paleozoic-Mesozoic transitional events and their induced harsh environments. Therefore, the ups and downs of the anachronistic facies may act as a proxy for the evolution of ecosystems independent of fossil analyses.

Early rehabilitation programs after laparoscopic colorectal surgery:Evidence and criticism

During the past several decades,early rehabilitation programs for the care of patients with colorectal surgery have gained popularity.Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection.Patients cared for based on these protocols had a rapid recovery of bowel movement,shortened length of hospital stay,and fewer complications compared with traditional care programs.However,most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection.Currently,limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection,although this procedure seems to be associated with a higher morbidity than that reported with traditional care.In this article,we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery.We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies.We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery,focusing on laparoscopic resection.

Early treadmill exercise increases macrophage migration inhibitory factor expression after cerebral ischemia/reperfusion

The neuroprotective function of macrophage migration inhibitory factor(MIF) in ischemic stroke was rarely evaluated.This study aimed to investigate the effects of early treadmill exercise on recovery from ischemic stroke and to determine whether these effects are associated with the expression levels of MIF and brain-derived neurotrophic factor(BDNF) in the ischemic area.A total of 40 male Sprague-Dawley rats were randomly assigned to the ischemia and exercise group [middle cerebral artery occlusion(MCAO)-Ex,n = 10),ischemia and sedentary group(MCAO-St,n = 10),sham-surgery and exercise group(Sham-Ex,n= 10),or sham-surgery and sedentary group(Sham-St,n = 10).The MCAO-Ex and MCAO-St groups were subjected to MCAO for 60 minutes,whereas the Sham-Ex and Sham-St groups were subjected to an identical operation without MCAO.Rats in the MCAO-Ex and Sham-Ex groups then ran on a treadmill for 30 minutes once a day for 5 consecutive days.After reperfusion,the hanging time tested by the wire hang test was longer and the relative fractional anisotropy determined by MRI was higher in the peri-infarct region of the MCAO-Ex group compared with the MCAO-St group.The expression levels of MIF and BDNF in the peri-infarct region were upregulated in the MCAO-Ex group.Increased MIF and BDNF levels were positively correlated with relative fractional anisotropy changes in the peri-infarct region.There was no significant difference in the levels of MIF and BDNF in the peri-infarct region between the Sham-Ex and Sham-St groups.Our study demonstrated that early exercise(initiated 48 hours after the MCAO) could improve motor and neuronal recovery after ischemic stroke.Furthermore,the increased levels of MIF and BDNF in the peri-infarct region(penumbra) may be one of the mechanisms of enhanced neurological function recovery.All experiments were approved by the Institutional Animal Care and Use Committee in Asan Medical Center in South Korea(2016-12-126).

Feasibility of totally laparoscopic gastrectomy without prophylactic drains in gastric cancer patients

BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed worldwide.However,reports on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy are few.AIM To evaluate the feasibility performing totally laparoscopic distal gastrectomy without prophylactic drains in selected patients.METHODS Data of patients with distal gastric cancer who underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed.The outcomes between patients with and without prophylactic drainage were compared.RESULTS A total of 457 patients who underwent surgery for gastric cancer were identified.Of these,125 patients who underwent totally laparoscopic distal gastrectomy were included.After propensity score matching,data of 42 pairs were extracted.The incidence of concurrent illness was higher in the drain group(42.9%vs 31.0%,P=0.258).The overall postoperative complication rates were 19.5%and 10.6%in the drain(n=76)and no-drain groups(n=49),respectively;there were no significant differences between the two groups(P>0.05).The difference between the two groups based on the need for percutaneous catheter drainage was also not significant(9.8%vs 6.4%,P=0.700).However,patients with a larger body mass index(≥29 kg/m2)were prone to postoperative complications(P=0.042).In addition,the number of days from surgery until the first flatus(4.33±1.24 d vs 3.57±1.85 d,P=0.029)was greater in the drain group.CONCLUSION Omitting prophylactic drainage may reduce surgery time and result in faster recovery.Routine prophylactic drains are not necessary in selected patients.A prophylactic drain may be useful in high-risk patients.