Objective To investigate the effects of Linggui Zhugan Decoction(LGZGD)on left ventricular myocardial fibrosis and the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)signaling pathway in rats with chronic heart failure(CHF).Methods A rat model of CHF with myocardial fibrosis was established via coronary artery ligation.Rats were randomly divided into sham-operated,model,LGZGD low/medium/high-dose,and Captopril groups,with 10 rats in each group.After treatment,cardiac function was assessed by echocardiography.Myocardial histopathology was examined using hematoxylin-eosin(HE)staining(with cardiomyocyte cross-sectional area calculated),while collagen deposition was evaluated via Masson's trichrome staining(collagen volume fraction quantified).ELISA was used to measure myocardial TNF-α and IL-6 levels.Western Blot was used to analyze expression of fibrosis markers(TGF-β1,α-SMA,collagen Ⅰ/Ⅲ)and PI3K/AKT pathway components(p-PI3K,p-AKT,p-mTOR).Results Compared with the sham-operated group,the model group showed significantly reduced LVEF and LVFS levels,as well as significantly increased myocardial cell cross-sectional area,collagen deposition area ratio,myocardial tissue TNF-α and IL-6 levels,and TGF-β1,α-SMA,collagen Ⅰ,collagen Ⅲ,p-PI3K,p-AKT,and p-mTOR levels,with statistically significant differences(P＜0.01);compared with the model group,the Captopril group and the medium-and high-dose groups of LGZGD showed significantly increased LVEF and LVFS,as well as significantly increased myocardial cell cross-sectional area,collagen deposition area ratio,TNF-α and IL-6 levels,and TGF-β1,α-SMA,collagen Ⅰ,collagen Ⅲ,p-PI3K,p-AKT,and p-mTOR levels were significantly reduced,with statistically significant differences(P＜0.01);compared with the Captopril group,the high-dose group of LGZGD showed a significant increase in LVEF and LVFS,as well as a significant decrease in myocardial cell cross-sectional area,collagen deposition area ratio,TNF-α,IL-61evels,andTGF-β1,α-SMA,collagen Ⅰ,collagen Ⅲ,p-PI3K,p-AKT,and p-mTOR levels were significantly reduced,with statistically significant differences(P＜0.01).Conclusion LGZGD ameliorates left ventricular myocardial fibrosis and pathological damage in CHF rats,potentially through inhibition of the PI3K/AKT signaling pathway.

Objective:To explore the prognostic effect and safety of neurally adjusted ventilatory assist (NAVA) mode on the patients with severe neurological cerebrovascular disease undergoing mechanical ventilation.Methods:A prospective study was conducted. Fifty-four patients with cerebrovascular disease undergoing mechanical ventilation admitted to the neurosurgery intensive care unit (NSICU) of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from December 2020 to May 2022 were enrolled. They were divided into NAVA group and pressure support ventilation (PSV) group by computer random number generator with 27 patients in each group. The ventilation time of the two groups was ≥72 hours. The general basic data of the two groups were recorded. The time without mechanical ventilation 28 days after enrollment, total length of mechanical ventilation, survival rate of 90 days after enrollment, length of NSICU stay, total length of hospital stay, NSICU mortality, in-hospital mortality, Glasgow outcome score (GOS), complications related to mechanical ventilation, and changes of respiratory mechanics indexes, arterial blood gases, vital signs, and diaphragm function indexes were observed.Results:The time without mechanical ventilation 28 days after enrollment in the NAVA group was significantly longer than that in the PSV group [days: 22 (15, 26) vs. 6 (0, 23), P < 0.05]. However, there were no significant differences in the total length of mechanical ventilation, 90-day survival rate, length of NSICU stay, total length of hospital stay, NSICU mortality, in-hospital mortality, GOS score, and incidence of mechanical ventilator-related complications between the two groups. In terms of respiratory mechanics parameters, the expiratory tidal volume (VTe) on 3 days after mechanical ventilation of patients in the NAVA group was significantly lower than that on 1 day and 2 days, and significantly lower than that in the PSV group [mL: 411.0 (385.2, 492.6) vs. 489.0 (451.8, 529.4), P < 0.01]. Minute ventilation (MV) at 2 days and 3 days in the NAVA group was significantly higher than that at 1 day, and significantly higher than that in the PSV group at 2 days [L/min: 9.8 (8.4, 10.9) vs. 7.8 (6.5, 9.8), P < 0.01], while there was no significant change of MV in the PSV group. At 1 day, peak airway pressure (Ppeak) and mean airway pressure (Pmean) in the NAVA group were significantly lower than those in the PSV group [Ppeak (cmH 2O, 1 cmH 2O≈0.098 kPa): 14.0 (12.2, 17.0) vs. 16.6 (15.0, 17.4), Pmean (cmH 2O): 7.0 (6.2, 7.9) vs. 8.0 (7.0, 8.2), both P < 0.05]. However, there was no significant difference in the Ppeak or Pmean at 2 days and 3 days between the two groups. In terms of arterial blood gas, there was no significant difference in pH value between the two groups, but with the extension of mechanical ventilation time, the pH value at 3 days of the two groups was significantly higher than that at 1 day. Arterial partial pressure of oxygen (PaO 2) at 1 day in the NAVA group was significantly lower than that in the PSV group [mmHg (1 mmHg≈0.133 kPa): 122.01±37.77 vs. 144.10±40.39, P < 0.05], but there was no significant difference in PaO 2 at 2 days and 3 days between the two groups. There was no significant difference in arterial partial pressure of carbon dioxide (PaCO 2) or oxygenation index (PaO 2/FiO 2) between the two groups. In terms of vital signs, the respiratory rate (RR) at 1, 2, and 3 days of the NAVA group was significantly higher than that of the PSV group [times/min: 19.2 (16.0, 25.2) vs. 15.0 (14.4, 17.0) at 1 day, 21.4 (16.4, 26.0) vs. 15.8 (14.0, 18.6) at 2 days, 20.6 (17.0, 23.0) vs. 16.7 (15.0, 19.0) at 3 days, all P < 0.01]. In terms of diaphragm function, end-inspiratory diaphragm thickness (DTei) at 3 days in the NAVA group was significantly higher than that in the PSV group [cm: 0.26 (0.22, 0.29) vs. 0.22 (0.19, 0.26), P < 0.05]. There was no significant difference in end-expiratory diaphragm thickness (DTee) between the two groups. The diaphragm thickening fraction (DTF) at 2 days and 3 days in the NAVA group was significantly higher than that in the PSV group [(35.18±12.09)% vs. (26.88±8.33)% at 2 days, (35.54±13.40)% vs. (24.39±9.16)% at 3 days, both P < 0.05]. Conclusions:NAVA mode can be applied in patients with neuro-severe cerebrovascular disease, which can prolong the time without mechanical ventilation support and make patients obtain better lung protective ventilation. At the same time, it has certain advantages in avoiding ventilator-associated diaphragm dysfunction and improving diaphragm function.

Influenza vaccination is considered the most effective measure to prevent the occurrence and pandemic of influenza.Beijing has implemented free influenza vaccination policy to the elderly above 60 years old and students in middle and primary schools since 2007.To provide a more effective intervention and let influenza vaccination achieve its role of immune protection among the population,the influenza vaccination rate and its influencing factors,barriers and driving factors of free influenza vaccination for recipients in Beijing have been studied successively.This article aims to summarize previous findings,review social factors influencing the vaccination and introduce the experience and lesson learnt from Beijing.