Abstract Objective: Emergence delirium is a common complication in children. Recorded mother’s voice, as a non-pharmacological measure, is increasingly used to prevent the emergence of delirium in pediatric patients, but sufficient evidence is still needed to prove its efficacy. Methods: Embase, PubMed, Cochrane Library, Web of Science, CINAHL, and Sinomed databases were searched for randomized controlled trials exploring the efficacy of recorded mother’s voice in preventing the emergence of delirium in pediatric patients undergoing general anesthesia. The original data were pooled for the meta-analysis with Review Manager 5.4.1. This study was conducted based on the Cochrane Review Methods. Results: Eight studies with 724 children were included in the analysis. Recorded mother’s voice reduced the incidence of emergence delirium when compared with either no voice (RR: 0.45; [95 % CI, 0.34 - 0.61]; p < 0.01; I2 = 7 %) or stranger’s voice (RR: 0.51; [95 % CI, 0.28 - 0.91]; p = 0.02; I2 = 38 %) without increasing other untoward reactions. In addition, it shortened the post-anesthesia care unit stay time when compared with no voice (MD = -5.64; [95 % CI, -8.43 to -2.58]; p < 0.01, I2 = 0 %), but not stranger’s voice (MD = -1.23; [95 % CI, -3.08 to 0.63]; p = 0.19, I2 = 0 %). It also shortened the extubation time and reduced the incidence of postoperative rescue analgesia. Conclusion: The current analysis indicated that recorded mother’s voices could reduce the incidence of emergency delirium, shorten post-anesthesia care unit stay time and extubation time, and decrease the incidence of postoperative rescue analgesia in children. Objective mothers mother s nonpharmacological non pharmacological measure Methods Embase PubMed Library Science CINAHL anesthesia metaanalysis meta 541 5 4 1 5.4.1 Results 72 RR (RR 0.45 045 45 95 [9 CI 034 34 0.3 0.61 061 61 0.61] 0.01 001 01 I strangers stranger 0.51 051 51 028 28 0.2 0.91 091 91 0.91] 0.02 002 02 3 reactions addition postanesthesia post MD 5.64 564 64 -5.64 8.43 843 8 43 -8.4 2.58 258 2 58 -2.58] %, , 1.23 123 23 -1.23 3.08 308 08 -3.0 0.63 063 63 0.63] 019 19 0.19 %. . Conclusion 54 5.4. 0.4 04 9 [ 03 0. 0.6 06 6 0.0 00 0.5 05 0.9 09 5.6 56 -5.6 8.4 84 -8. 2.5 25 -2.58 1.2 12 -1.2 3.0 30 -3. 0.1 5.4 5. -5. 8. -8 2. -2.5 1. -1. 3. -3 -5 -2. -1 -2

Dexmedetomidine (DEX) is known to provide neuroprotection against cerebral ischemia and reperfusion injury (CIRI), but the exact mechanisms remain unclear. This study was conducted to investigate whether DEX pretreatment conferred neuroprotection against CIRI by inhibiting neuroinflammation through the JAK2/STAT3 signaling pathway. Middle cerebral artery occlusion (MCAO) was performed to establish a cerebral ischemia/reperfusion (I/R) model. Specific-pathogen-free male Sprague-Dawley rats were randomly divided into Sham, I/R, DEX, DEX+IL-6, and AG490 (a selective inhibitor of JAK2) groups. The Longa score, TTC staining, and HE staining were used to evaluate brain damage. ELISA was used to exam levels of TNF-α. Western blotting was used to assess the levels of JAK2, phosphorylated-JAK2 (p-JAK2), STAT3, and phosphorylated-STAT3 (p-STAT3). Our results suggested that both pretreatment with DEX and AG490 decreased the Longa score and cerebral infarct areas following cerebral I/R. After treatment with IL-6, the effects of DEX on abrogating these pathological changes were reduced. HE staining revealed that I/R-induced neuronal pathological changes were attenuated by DEX application, consistent with the AG490 group. However, these effects of DEX were abolished by IL-6. Furthermore, TNF-α levels were significantly increased in the I/R group, accompanied by an increase in the levels of the p-JAK2 and p-STAT3. DEX and AG490 pretreatment down-regulated the expressions of TNF-α, p-JAK2, and p-STAT3. In contrast, the down-regulation of TNF-α, p-JAK2, and p-STAT3 induced by DEX was reversed by IL-6. Collectively, our results indicated that DEX pretreatment conferred neuroprotection against CIRI by inhibiting neuroinflammation via negatively regulating the JAK2/STAT3 signaling pathway.

We develop the impulsive inequality and the classical lower and upper solutions, and establish the comparison principles. By using these results and the monotone iterative technique, we obtain the existence of solutions of periodic boundary value problems for a class of impulsive neutral differential equations with multi-deviation arguments. An example is given to demonstrate our main results. Mathematical subject classification: Primary: 34A37; Secondary: 34k10.