Nicotinic acetylcholine receptors(nAChRs) construct a family of ligand-gated ion channels. nAChRs distribute extensively in central nerve system, neuromuscular junctions and surface of other cells. The differences on subunits and tissue location determinate the diversity of receptor functions. Early research has found that nerve signal transmission is its main function and recent research found it also the key receptor of cholinergic anti-inflammatory pathway. To illuminate the physiological mechanism of these functions has great clinical significance for the treatment of correlated diseases such as myasthenia gravis, epilepsy and multiple organ failure.

Objective:To observe the emergency treatment effect of levosimendan combined noninvasive mechanical ventilation on acute heart failure during emergency treatment period .Methods :According to random number table , 120 cases with acute heart failure were randomly and equally divided into routine treatment group and levosimendan group (levosimendan + noninvasive mechanical ventilation ) .Improvements of arterial blood gas [partial pressure of carbon dioxide and oxygen (PaCO2 ,PaO2 ) ,pH etc .] after 72h ,change of N terminal pro brain natriuretic pep-tide (NTpro-BNP ) level 4d after hospitalization and mortality rate were observed and compared between two groups .Results:After treatment ,PaO2 ,mean arterial pressure and NTpro-BNP level of the two groups significant-ly improved compared with before treatment ;compared with routine treatment group ,there was significant rise in PaO2 [ (78.2 ± 9.4) mmHg vs .(86.2 ± 10.5) mmHg] and significant reductions in mean arterial pressure [ (86.3 ± 8.2) mmHg vs .(82.2 ± 9.0) mmHg] and NTpro-BNP level [ (4340.5 ± 540.7) pg/ml vs .(4012.1 ± 426.3) pg/ml] in levosimendan group , P<0.01 all;total effective rate of levosimendan group was significantly higher than that of routine treatment group (86.7% vs .76.6% , P=0.047);after three-month follow-up ,mortality rate of le-vosimendan group was significantly lower than that of routine treatment group (11.7% vs .20.0% , P= 0.026 ) . Conclusion:Emergency treatment effect of levosimendan combined noninvasive mechanical ventilation on acute heart failure is significant ,which is worthy of further research and extension .

Objective: To observe the therapeutic effect of nicorandil on microvascular angina pectoris (MAP). Methods: A total of 60 MAP patients were randomly divided into nicorandil group (n=30) and routine treatment group (n=30), and they were treated for 12 weeks. Onset times and duration of angina pectoris, changes of related parameters of ECG treadmill exercise test before and after treatment, and total effective rate were compared between two groups. Results: Compared with before treatment, there were significant reductions in onset times and duration of angina pectoris and maximum depression extent of ST segment (P<0.05 or <0.01) and significant increase in total exercise time (P<0.01) after treatment in both groups; compared with routine treatment group, there were significant reductions in onset times of angina pectoris [(10.3±1.6) times/week vs. (9.6±1.7) times/week] and maximum depression of ST segment [(0.8±0.3)mm vs. (0.6±0.2)mm], and significant increase in total exercise time [(7.8±1.4) min vs. (9.4±1.6) min] and total effective rate (73.3% vs. 93.3%) in nicorandil group, P<0.05 or <0.01. Conclusion: Nicorandil possesses significant therapeutic effect on microvascular angina pectoris, and it is worth further study.

Objective To investigate the potential role of MCP-1/CCL2 in experimental acute necrotizing pancreatitis (ANP) and complications. Methods 60 SD male rats were randomly divided into 3 groups: sham operation group ( n = 20 ), ANP group ( n = 20 ) and MCP-1 group ( n = 20 ). ANP model was induced by retrograde infusion of 3.5% sodium taurocholate, MCP-1 group received subcutaneous injection of MCP-1 antibody 0 h and 6 h after ANP induction. The serum levels of amylase, MCP-1, D-lactic acid,histological changes and the expression of MCP-1 mRNA of lung, small intestine and pancreas, the expression of MCP-1 protein in pancreas, MPO levels of small intestine MPO were determined. Results The serum levels of amylase, MCP-1, D-lactic acid in MCP-1 group at 12 h were (4666 ±412)U/L, (39.53 ±8.25)pg/ml and (6.3 ±2.2)mg/L, which were significantly lower than those in ANP group [ (9611 ±363)U/L, (63.42 ±9.32) pg/ml, (9.3 ± 2. 1 ) mg/L, P< 0.05 ) ]; the expression of MCP-1 mRNA in pancreas, small intestine and lung were 0.431 ± 0.009, 0. 211 ± 0.018 and 0.442 ± 0.017, which were significantly lower than those in ANP group [ (0.624 ±0. 010, 0. 523 ±0. 019 and 0. 569 ±0. 024, P <0.05) ]; the expression of MCP-1 protein in pancreas was 2.0 ± 0. 1, which was significantly lower than that in ANP group (4. 0 ± 0. 2, P <0.05). Lung and small intestine MPO were (11.1 ±3.0)U/g and ( 19.2 ±2.0)U/g, which were significantly lower than those in ANP group[(39.2±3.1)U/g and(13.1±2.1)U/g, P<0.05]. Conclusions Early blockade of MCP-1 not only attenuates the severity of ANP, but also decreases the degree of acute lung injury and intestine barrier dysfunction.

Objective To investigate the effects of oral glucose-electrolyte solution (GES) on resuscitation of hemorrhagic shock induced by 40% blood volume loss in rats. Methods SD rats were randomly divided into three groups; oral GES without hemorrhagic shock (GES group, n = 16) , hemorrhage shock without fluid resuscitation (HS group, n = 20) and hemorrhagic shock resuscitated with oral GES (HS + GES group, n = 20). About 40% of total blood volume was bled from carotid artery of rats to produce a model of hemorrhagic shock. GES with a volume of three times of blood loss was given three times intragastrically at 0.5, 1 and 6 hours after hemorrhage. Mean arterial pressure (MAP) was measured constantly. Blood flow in liver, kidney, stomach and small intestines, and parameters like hemato-crit, plasma osmotic pressure, alanine aminotransferase (ALT) , creatinine (Cr) and diamine oxidase (DAO) were determined 24 hours after hemorrhage. Survival rates of the rats in three groups were calculated 24 hours after hemorrhage. Results MAPs of HS + GES group were 9. 7% and 10. 9% higher than those of HS group 4 and 24 hours after hemorrhage (P < 0. 05). The blood flow of liver, stomach and small intestines in HS + GES group were 18.6% , 88.4% and 22.0% respectively, higher than those in HS group(P <0.05 or P <0.01) 24 hours after hemorrhage. The hematocrit level of HS + GES group was significantly lower than that of HS group, while the levels of ALT, Cr and DAO in HS + GES group were significantly lower than those in HS group (P <0.01). The survival rate of rats in HS + GES group was 80% , which was significantly higher than 30% in HS group (P <0.01). Conclusions Oral rehydration can significantly improve MAP and tissue perfusion, maintain blood volume and plasma osmotic pressure, alleviate organ damage and hence promote the survival rates of rats with hemorrhagic shock.

Objective To evaluate the short?term functional outcome of Multiloc Proximal Humeral Nails (PHN) in the treatment of proximal humeral fractures, by retrospectively reviewing the function and complications of our institutional experi?ence. Methods 15 patients were treated operatively for displaced proximal humeral fractures using the Multiloc PHN. Fractures were classified according to Neer's classification. Male 4 cases, female 11 cases, with a mean age 63.7 years (58-73 years), and the mean follow?up was 5.2 months (3-10 months). A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the rating scale of the American Shoulder and Elbow Surgeons (ASES) and Constant Score, Visual Analogue Scale (VAS) scores. Results 15 patients completed the follow?up more than 3 months, the operation time was 145.3minutes (70-200 min), the blood loss was 189.3ml (50-310 ml). The union rate was 100%(mean time to union: 2.5 months). The ASES score was 83.1 and Constant Score was 81.7 , while the VAS was 1.7. The Constant score 87 (85, 92) and ASES 90 (83.5, 100) were higher for 5 cases without calcar screw than those of the other 10 cases using the calcar screw whose Constant 83 (77, 90), ASES 85 (73, 95). The average Constant score 88 (78, 92) and ASES score 91.5 (75, 100) were higher in 7 cases with 1 screw?in?screw than those with more than 2 screw?in?screw in 8 cases whose Constant 80.5 (74, 88.5), ASES 81.8 (73, 92.5). There were no complications such as hardware failure, protruded screws, infection, nonunion, avascular necrosis of humeral head or impingement syndrome, but 1 patient suffered from elbow stiff?ness (complication rate:6.7%). Conclusion The Multiloc proximal humeral nail is an effective implant for stabilisation of dis?placed proximal humeral fracture with a good short?term functional outcome. Its advantages are short operation time, small inci?sion, less trauma, less blood supply and less complications. The shoulder pain history and or with intraoperative findings of rotator cuff injuries, may have a negative impact on the prognosis.

Objective To analyze and discuss the effect of heat preservation on the recovery time of BIS and the concentration of propofol in the recovery period of the elderly patients with general anesthesia in order to provide guidance for clinical treatment.Methods78 elderly patients with general anesthesia were selected as the subjects, and the patients were divided into the control group and the study group with 39 cases in each group.The patients were divided into the control group and the study group.Control group, only to be liquid input and covered by drapes, research group take liquid input and peritoneal flushing fluid heating and heating blanket coverage of insulation measures, were recorded and compared between the two groups from anesthesia began to operation to complete the different time points of esophageal temperature and MAP, and to observe the recovery time of patients and effect compartment concentration differences.ResultsTwo groups at T0, T1 esophageal temperature no significant difference, study group t2-t6 esophageal temperatures were significantly higher than those of the control group (P<0.05), maps of the other two groups at different time points had no significant difference;when two groups of patients with propofol withdrawal BIS values had no significant difference (P<0.05), and in the time of discontinuation BIS is more than or equal to 80 recovery time and effect compartment concentration have significant difference (P<0.05).ConclusionThe surgical treatment of elderly patients with general anesthesia can help maintain the body temperature, shorten the recovery time of BIS and reduce the concentration of propofol in the recovery period.

Objective To investigate the effects of carbachol on intestinal inflammation and mucosal blood flow after gut ischemia-repedusion(I/R) in rat. Method A jejunal sac was formed in Wistar rats. The superior mesenteric artery (SMA) was occluded for 45 mi-nutes followed by 240 minutes of reperfusion. Animals were random divided into three groups: sham operation, L/R + saline injection (I/R + NS) and I/R + carbachol injection (0.1mg/kg, I/R + Ca). Immediately after occluded of SAM blood flow, either 0.1mg/kg of carba-chol or same account of 0.9% saline was injected into the jejunal sac. The pathological injury was observed with HE staining. The activity of DAO and content of TNF-α in intestinal mucosa tissue were determined. Mucosal blood flow was measured by laser Doppler. All measure-ments were done at 0 min, 30 min, 60 min, 120 min, and 240 min after reperfusion. Result In I/R group the activity of DAO in intestinal mucosa and mucosal blood flow deceased, meanwhile the content of TNF-α gut tissue was dramatically increased than those in sham operation (P<0.01). Severe pathological changes were observed in intestinal mucosa. After injection of carbachol, the activity of DAO and mucosal blood flow increased (P<0.01), but the content of TNF-α in intestinal mucosa were dramatically decreased (P<0.01), compared with those in I/R group. Conclusion Administration of carbachol protects intestinal ischemia-reperfusion injury by attenuating intestinal mucosa inflammation and increasing gut mueosal blood flow.

ObjectiveTo analyze the therapeutic effect of open reduction with internal fixation (ORIF) and anatomic reconstruction locking plate in treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus.MethodsThe study involved 30 patients with Neer 3-part and 4-part fracture dislocations treated with anatomic reconstruction locking plate from September 2004 to December 2007.Twenty patients had complete follow-up data.The treatment methods included locking proximal humeral plate (LPHP) in seven patients and proximal humeral internal locking system (PHILOS) in 13.There were 15 males and five females,at age range of 29-84 years (average 52.5 years),including nine patients younger than 65 years and 11 older than 65 years.According to Neer classification,there were 15 patients with 3-part fracture dislocations including 12 anterior and three posterior dislocations and five patients with 4-part fracture dislocations including four anterior and one posterior dislocations. VAS and Constant scoring system were adopted to evaluate the shoulder joint function postoperatively. Results All 20 patients were followed up for 36-71 months ( average 51 months),which showed avascular necrosis of humeral head in six patients (30％),plating loosening in two,screw penetration in six,nonunion in two and infection in two.The mean visual analogue score (VAS) was 2.55 poiuts and the mean Constant score for the shoulder was 80.8.According to the Neer shoulder functional evaluation standard,eight patients were graded as excellent,six as good,three as fair and three as poor,with excellence rate of 70％.ConclusionsAlthough the anatomic reconstruction locking plate and ORIF can cause a high incidence of avascular necrosis of humeral head in the treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus,especially for the patients older than 65 years.However,there is no obvious correlation between necrosis of humeral head and shoulder function.Clinically,the method could be selected on the ba-sis of individual condition of the patients.

Objective To evaluate the clinical outcomes of primary repair of bony and ligamentous components in treatment of Mason-Johnston type Ⅳ radial head fractures.Methods From August 2007 to November 2011,16 cases of Mason-Johnston type Ⅳ radial head fractures were treated by open reduction and screw or plate fixation combined with simultaneous repair of ruptured capsular ligaments with suture anchors.There were 11 men and 5 women with a mean age of 31.6 years (range,18-52 years).Totally,left side was involved in seven cases and right side in nine； dominant side was involved in 13 cases and non-prominent side in three.Time from injury to operation averaged 6.2 days (range,2-11 days).Nine cases of partial articular fractures with 2 or 3 fragments were treated with 1.5 mm or 2.0 mm AO miniscrews and seven cases of complete articular fractures with 2-4 fragments were treated with 2.0 mm AO mini plastic plates and screws after reduction.Active and assisted functional exercise was instructed in the early period after surgery.Visual analogue scale (VAS) and Broberg-Morrey elbow performance were measured for function assessment at the latest follow-up.Results Follow-up averaged 22.6 months (range,12-38 months),which showed primary wound healing without infection.All fractures achieved bony union at an average of 4.8 months (range,3.3-6.2 months).Ten out of the 16 cases,four of partial articular fractures and six of complete articular fractures,had slight but asymptomatic ossification in the medial and lateral collateral ligament attachment.There were two excellent,six good and one fair results in partial articular fracture group,with excellent-good rate of 89％ as well as one excellent,four good and two fair results in complete articular fracture group,with excellent-good rate of 72％.Moreover,the total excellentgood rate reached 81％.Range of motion in extension,flexion and rotation,Broberg-Morrey score and VAS presented statistical differences between partial and complete articular fracture groups (P ＜ 0.05).Conclusion Primary management of bony and ligamentous components to treat Mason-Johnston type Ⅳ radial head fractures brings timely three-dimensional stability of the elbow joint,favors early functional exercise and further decreases incidence of postoperative complications,such as elbow stiffness,pain and heterotopic ossification.