Objective:To investigate the effect of extemal diaphragm pacemaker(EDP)on the duration of mechanical ventilation,diaphragm function,and other prognosis in coma patients with difficult weaning after brain injury surgery. Method:A total of 66 postoperative coma patients with brain injury were enrolled and divided into control group(n=33)and experimental group(n=33)according to the random number table method.The control group was treated with conventional drugs and mechanical ventilation in ICU,and the experimental group was treated with EDP on the basis of the control group,20 minutes each time,twice a day for 14 consecutive days.The mechanical ventilation time and respiratory parameters of the two groups were observed at the start-ing point(within 72-96 hours of mechanical ventilation after operation)and the end point(the day of suc-cessful weaning,and the day after the end of treatment cycle if the patients were not successfully weaned).The changes of diaphragm thickness(DT),diaphragm thickening fraction(DTF),and diaphragm excursion(DE)were observed by ultrasound,and other prognostic parameters were recorded. Result:There was no significant difference between the two groups at the time of enrollment(P＞0.05).After treatment,in terms of respiratory function,except for the control group with no statistical difference in shal-low rapid respiratory index before and after treatment(P＞0.05),the mechanical ventilation time of the experi-mental group was significantly shorter than that of the control group,and the success rate of offline was im-proved.Tidal volume and shallow rapid respiratory index of the two groups were improved compared with that before treatment,and the tidal volume of the control group was increased after treatment with statistical difference(P＜0.05).The tidal volume of experimental group after treatment was increased compared with be-fore treatment,and the shallow rapid respiratory index of experimental group was decreased compared with be-fore treatment,with significant differences(P＜0.001).In terms of diaphragm function,there was no statistical significance in DT,DTF and DE between the two groups before treatment(P＞0.05),and there was a signifi-cant difference in the composition ratio of DT changes between the two groups after treatment(P＜0.001).DTF and DE showed significant differences between the two groups and within the two groups after treatment,(P＜0.001).In terms of prognosis,the rate of recovery,mortality and length of hospital stay in the experimen-tal group were lower than those in the control group,but there was no significant difference(P＞0.05). Conclusion:EDP treatment can shorten the mechanical ventilation time of coma patients with difficult wean-ing after brain injury surgery,improve the success rate of weaning,improve respiratory parameters,and im-prove diaphragm function.However,it did not reduce the probability of recovery,mortality and length of hos-pital stay.

At present, the passive simulated lung including the splint lung is an important device for hospitals and manufacturers in testing the functions of a respirator. However, the human respiration simulated by this passive simulated lung is quite different from the actual respiration. And it is not able to simulate the spontaneous breathing. Therefore, including" the device simulating respiratory muscle work "," the simulated thorax" and" the simulated airway", an active mechanical lung to simulate human pulmonary ventilation was designed:3D printed human respiratory tract was developed and connected the left and right air bags at the end of the respiratory tract to simulate the left and right lungs of the human body. By controlling a motor running to drive the crank and rod to move a piston back and forth, and to deliver an alternating pressure in the simulated pleural, and so as to generate an active respiratory airflow in airway. The experimental respiratory airflow and pressure from the active mechanical lung developed in this study are consistent with the target airflow and pressure which collected from the normal adult. The developed active mechanical lung function will be conducive to improve the quality of the respirator.
Adult ; Humans ; Lung/physiology* ; Respiration ; Pulmonary Ventilation ; Respiration, Artificial ; Ventilators, Mechanical

OBJECTIVE: To investigate the effect of Akt2 inhibitor on macrophage polarization in the periapical tissue in a rat model of periapical inflammation. METHODS: Rat models of periapical inflammation were established in 28 normal SD rats by opening the pulp cavity of the mandibular first molars, followed by injection of normal saline and Akt2 inhibitor into the left and right medullary cavities, respectively. Four rats without any treatment served as the healthy control group. At 7, 14, 21 and 28 days after modeling, 7 rat models and 1 control rat were randomly selected for observation of inflammatory infiltration in the periapical tissues by X-ray and HE staining. Immunohistochemistry was used to detect the expression and localization of Akt2, macrophages and the inflammatory mediators. RT-PCR was performed to detect the mRNA expressions of Akt2, CD86, CD163, inflammatory mediators, miR-155-5p and C/EBPβ to analyze the changes in macrophage polarization. RESULTS: X-ray and HE staining showed that periapical inflammation was the most obvious at 21 days after modeling in the rats. Immunohistochemistry and RT-PCR showed that compared with those in the control rats, the expressions of Akt2, CD86, CD163, miR-155-5p, C/EBPβ, and IL-10 increased significantly in the rat models at 21 days (P < 0.05). Compared with saline treatment, treatment with the Akt2 inhibitor significantly decreased the expression levels of Akt2, CD86, miR-155-5p and IL-6 and the ratio of CD86⁺M1/CD163⁺M2 macrophages (P < 0.05) and increased the expression levels of CD163, C/EBPβ and IL-10 in the rat models (P < 0.05). CONCLUSION Inhibition of Akt2 can delay the progression of periapical inflammation in rats and promote M2 macrophage polarization in the periapical inflammatory microenvironment possibly by reducing miR-155-5p expression and activating the expression of C/EBPβ in the Akt signaling pathway.
Rats ; Animals ; Proto-Oncogene Proteins c-akt/metabolism* ; MicroRNAs/genetics* ; Interleukin-10 ; Rats, Sprague-Dawley ; Macrophages/metabolism* ; Inflammation/metabolism*