Objective To study the role of aminophylline in COPD patients undergoing abdominal surgery under general anesthesia.Methods A total of 60 COPD patients who received the upper abdominal surgery under general anesthesia were randomly assigned as regular treatment group (control,n=30) and aminophylline group (aminophylline,n=30).The aminophylline group was intravenously injected aminophylline (2mg/kg) after intubation,and the same volume of saline was injected for the control group.The respiratory mechanics,serum cytokines including tumor necrosis factor-α(TNF-α),interleukin-8 (IL-8) and interleukin-10(IL-10),recovery time and adverse cardiovascular events were measured.Results The general conditions,including gender,age,weight,smoking status,lung function,GOLD standard,surgical site,operation time and anesthetic time had no statistically significant differences between the two groups.During general anesthesia,aminophylline decreased the peak airway pressure(15 minutes,t=9.220,P=0.047),the plate airway pressure(15 minutes,t=5.906,P=0.025) and the airway resistance(15 minutes,t=10.438,P=0.04).Aminophylline increased the respiratory compliance(15 minutes,t=-7.431,P=0.001).Aminophylline attenuated the increase of inflammatory cytokines,such as TNF-α(8 hours,t=6.374,P=0.000),IL-8(8 hours,t=7.716,P=0.000) and hsCRP(8 hours,t=6.665,P=0.000).Aminophylline shortened the time to spontaneous ventilation(t=3.439,P=0.001),opening eyes(t=3.516,P=0.001),limb movement(t=6.249,P=0.000) and extubation (t=3.159,P=0.003).Administration of aminophylline had no obvious adverse effects on blood pressure and heart rate.Conclusion Administration of aminophylline for COPD patients undergoing abdominal surgery under general anesthesia can improve respiratory mechanics,downregulate inflammatory cytokines,accelerate recovery after general anesthesia and possess no obvious adverse cardiovascular effects,which is worthy of popularization.

Objective:To establish a nomograph prediction model of early critical changes in children with febrile convulsion, and to provide guidance for the prevention and nursing of children with febrile convulsion.Methods:Convenient sampling method was adopted to select 384 children with febrile convulsion in Anhui Children ′s Hospital from January 2018 to April 2021 as the research objects. Based on pews, the children with febrile convulsion were divided into 334 cases of non risk group and 50 cases of risk group. Binary Logistic regression analysis were used to determine the independent risk factors affecting the early critical changes of children with febrile convulsion. A nomogram was drawn based on the independent risk factors. The discrimination and consistency of the model were verified by model ROC curve and Hosmer Lemeshow goodness of fit.The external validation of model prediction efficiency were verified by validation data. Results:Binary Logistic regression analysis showed that age, respiratory rhythm disorder, unconsciousness, breath rate, heart rate, neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), duration of first convulsion and mean body temperature after first convulsion were influence factors for early critical changes in children with febrile convulsion ( P<0.05). The C-index of the model was 0.974 (95% CI 0.954-0.993), and the C-index of the external validation of the model was 0.922 (95% CI 0.880-0.966). The results of H-L fitting test showed that the difference was not statistically significant( χ2=0.29, P>0.05). Conclusions:The early critical changes of children with febrile convulsion may be affected by respiratory rhythm disorder, confusion of consciousness, breath rate, heart rate, NLR, RDW, duration of the first convulsion, mean temperature after the first convulsion and other factors. Pediatric emergency department should collect corresponding intervention measures for children with febrile convulsion according to the establishment of prediction model to prevent their early deterioration.

Objective To evaluate the surgical complications and root vascular lymph node dissection by high versus low ligation the inferior mesenteric artery (IMA) retaining left colonic artery (LCA) in laparoscopic radical resection of rectal cancer.Methods Clinical data of 357 cases of rectal cancer in our center from Jan 2015 to Dec 2016,were retrospectively analyzed,including 247 cases in high ligation group,110 cases of low ligation group.Results There was no statistically significant difference in operative time and intraoperative blood loss between the two groups [(105 ± 10)min vs.(113 ±9)min,t =0.138,P =0.092;(96 ± 21) ml vs.(99 ± 23) ml,t =0.171,P =0.118].Nor that in the incidence of anastomotic leakage between the two groups (7.3％ vs.4.5％,x2 =0.949,P =0.330).The incidence of low anterior resection syndrome in the two groups was statistically significant (21％ vs.12％,x2 =4.358,P =0.037).There was no significant difference in the total number of lymph nodes dissected between the two groups ([(14.5±4.3) vs.(13.6±3.5),t=1.851,P=0.065].Conclusion Low ligation of IMA with preservation of LCA in laparoscopic radical operation for rectal cancer provides better blood supply for proximal colon,while achieving same radical clearance of lymph nodes as with high ligation of IMA.

Objective: To investigate the effect of dexmedetomidine on cognition (MMSE score), immune inflammatory reaction and oxidative stress in lung cancer patients with VATS. Methods: From January 2016 to December 2017, 89 lung cancer patients underwent VATS in the Second Hospital of Qinhuangdao were randomly divided into the control group (n=46) and the dexmedetomidine group (n=43) according to the digital table.The MMES, CD4 and CD8 lymphocytes, inflammatory factors and oxidative stress factors were compared between the two groups before operation (T0) and at 3 hours (T1), 12 hours (T2), 24 hours (T3) after operation. Results: There were no statistically significant differences in MMSE, CD4 and CD8 lymphocytes, inflammatory factors and oxidative stress factors between the two groups (P>0.05). At the time points of T1, T2 and T3, MMSE scores decreased in both two groups, but the MMSE score in the dexmedetomidine group was higher than those in the control group [(27.67±1.97)points vs.(25.61±1.81)points, (26.47±1.92)points vs.(24.70±2.26)points, (26.16±1.90)pouints vs.(23.41±2.33)points, t=-2.122, -2.553, -2.528, P=0.037, 0.012, 0.013]. The CD8 lymphocyte, inflammatory factors and oxidative stress factors increased after operation in both two groups, and dexmedetomidine could inhibit the increase of immune inflammatory factors and oxidative response factors(IL-6: t=3.038, 2.489, 3.291, P=0.003, 0.015, 0.001; hsCRP: t=2.147, 2.164, 2.752, P=0.035, 0.033, 0.007; TNF-α: t=2.119, 2.323, 2.485, P=0.037, 0.023, 0.015; MDA: t=2.499, 2.116, 2.094, P=0.014, 0.037, 0.039; MPO: t=2.190, 2.166, 2.849, P=0.031, 0.033, 0.005; SOD: t=-2.551, -2.598, -3.141, P=0.012, 0.011, 0.002). The incidence rate of adverse reactions in dexmedetomidine group was lower than that in control group(6/43 vs.18/46, P=0.011). Conclusion Dexmedetomidine can improve cognition, reduce immune inflammatory reaction and oxidative stress, and alleviate adverse effects in lung cancer patients with VATS.