This paper makes persuasive demonstrations on some problems about the human ear sound transmission principle in existing physiological textbooks and reference books, and puts forward the authors' view to make up for its literature. Exerting the knowledge of lever in physics and the acoustics theory, we come up with an equivalent simplified model of manubrium mallei which is to meet the requirements as the long arm of the lever. We also set up an equivalent simplified model of ossicular chain--a combination of levers of ossicular chain. We disassemble the model into two simple levers, and make full analysis and demonstration on them. Through the calculation and comparison of displacement amplitudes in both external auditory canal air and internal ear lymph, we may draw a conclusion that the key reason, which the sound displacement amplitude is to be decreased to adapt to the endurance limit of the basement membrane, is that the density and sound speed in lymph is much higher than those in the air.
Acoustics ; Ear Canal ; Ear Ossicles ; physiology ; Ear, Inner ; physiology ; Humans ; Lymph ; Models, Anatomic ; Sound

Objective To investigate the preoperative biliary drainage on the effect of surgical treatment for hilar cholangiocarcinoma patients.Methods A total of 52 hilar cholangiocarcinoma patients who underwent resection operation in Renmin Hospital of Wuhan University from January 2005 to December 2015 were divided into preoperative biliary drainage group (24 cases) and non-preoperative biliary drainage group (28 cases).To compare the operation time,intraoperative blood loss,hospital stay,perioperative changes in liver function,and incidence of postoperative complications,tumor recurrence rate,1-,3-,and 5-year survival rate and some other indicators.The data was analyzed using SPSS 19.0 software.The patients of two groups were followed up by telephone,out-patient review and hospital examination.Patients were followed up for 8-60 monthes.Results The hospital stay for biliary drainage group was longer than that in non-preoperative biliary drainage group and the difference was statistically significant (P ＜ 0.05).The differences of operation time,intraoperative blood loss,postoperative tumor recurrence rate,postoperative complications (including bile leakage,blooding,fever,pleural effusion,abdominal infection,wound infection,pulmonary infection,liver failure and some others) and 1-,3-,and 5-year survival rate were not statistically significant (P ＞ 0.05).Alanine aminotransferase,aspartate aminotransferase,total bilirubin and direct bilirubin in preoperative biliary drainage group before biliary drainage were(98.0 ± 51.7) U/L,(94.2 ± 44.2) U/L,(177.5 ± 64.1) μmol/L and (160.2 ± 61.9) μmol/L,respectively,and after biliary drainage were (71.2 ± 13.8) μmol/L,(60.0 ± 12.1) μmol/L,(93.5 ± 20.7) μmol/L and (76.3 ± 18.1) μmol/L,respectively.The differences of the above parameters before and after biliary drainage were statistically significant (P ＜ 0.05).However,the changes of albumin before and after biliary drainage were not significant (P ＞ 0.05).The follow-up patients of biliary drainage group were 21 cases and the follow-up patients of non-preoperative biliary drainage group were 25 cases.The differences of 1-,3-,and 5-year survival rate between the two groups were not statistically significant (P ＞ 0.05).Conclusions Preoperative biliary drainage for hilar cholangiocarcinoma patients may improve the liver function to a certain extent.However,preoperative biliary drainage cannot improve the prognosis of the hilar cholangiocarcinoma patients.Therefore preoperative biliary drainage is not suggested for patients with good general conditions.

ABSTRACT:Objective To study the effects of arotinolol,propranolol and carvedilol on rat portal hypertension and make a comprehensive evaluation of the three drugs.Methods Portal hypertension was induced with CCl4 in rats.Arotinolol,propranolol,and carvedilol were administered for 2 weeks after the model was stable.Mean arterial pressure (MAP),heart rate (HR)and portal venous pressure (PVP)were measured at intubation;α-SMA expression was measured by immunohistochemistry;Masson staining was used to test collagen fibers area.Results Compared with model group,both arotinolol and carvedilol could significantly reduce PVP level (P <0.001),which was lower than that in propranolol group (P <0.001,P =0.032).Compared with those in model group,both MAP and HR in arotinolol group and carvedilol group were significantly reduced (P <0.05),MAP in carvedilol group was lower than in arotinolol group (P = 0.01 1 ).MAP was obviously decreased in propranolol group compared with model group (P =0.003),but HR had no sighificant difference between the two groups (P =0.143).Only TBIL in arotinolol and propranolol groups reduced significantly compared with model group (P <0.001 ).However,ALT, ALB and TBIL were obviously ameliorated in carvedilol group compared with model group (P <0.001,P <0.001, P =0.045).The expression ofα-SMA and the area of collagen fibers in arotinolol,carvedilol and propranolol groups
significantly declined compared with those in model group (P <0.05 ).Conclusion Arotinolol can significantly reduce cirrhotic rats’ portal pressure,with effects similar to those of carvedilol.The effect of arotinolol in improving liver function is weaker than that of carvedilol,but the side effects on MAP are milder than those of carvedilol.

AIM: To study the role of peroxisome proliferator-activated receptor-α (PPAR-α) signal transduction pathway in cardiac hypertrophy induced by high glucose and insulin (HGI). METHODS: The cultured neonatal rat cardiomyocytes were used to observe the effect of fenofibrate (FF), a selective PPAR-α agonist, on cardiomyocyte hypertrophy induced by HGI (glucose at concentration of 25.5 mmol/L and insulin at 0.1 μmol/L). The cardiomyocyte hypertrophic responses were assayed by measuring the cell surface area, protein content, and mRNA expression of atrial natriuretic factor (ANF). The expressions of mRNA and protein were assayed by real -time PCR and Western blotting. RESULTS: In cultured cardiomyocytes, HGI induced profound change of hypertrophic morphology, the significant increase in cell surface area, protein content and ANF mRNA expression compared to those in vehicle control (P<0.01), but the expressions of PPAR-α mRNA and protein decreased significantly (P<0.05). At the same time, the expression of cyclooxygenase 2 (COX-2), one of the PPAR-α downstream effectors was obviously elevated (P<0.05). However, FF (0.1, 0.3 and 1 μmol/L) inhibited the cardiomyocyte hypertrophy induced by HGI in a concentration-dependent manner (P<0.01). FF at concentration of 0.3 μmol/L increased the expressions of PPAR-α in both mRNA and protein levels (P<0.05) and inhibited the expressions of COX-2 (P<0.05), which were abolished by MK 886 (0.3 μmol/L), a selective PPAR-α antagonist (P<0.05). CONCLUSION: PPAR-α signal transduction pathway and its downstream effector COX-2 might involve in the cardiomyocyte hypertrophy induced by HGI.

This study was aimed to optimize extraction techniques of Compound Rhubarb Enema. Based on the for-mula principle of Compound Rhubarb Enema, effects of the amount of water, soaking time, extraction time and fre-quency on each index were studied. The content of Aloe-emodin, Rhein, Emodin, Chrysophanol, Physcion, Citric acid, and water soluble substance were taken into consideration. The best extraction condition was optimized by using the orthogonal test coupled with the multi-index comprehensive evaluation. The results showed that the best condi-tion was soaking for 10 min, extraction time for 60 min, extraction for 3 times; and 6 times of water was added. It was concluded that this preparation techniques were feasible and reliable for the manufacturing process of Compound Rhubarb Enema.

Objective To evaluate the value of nuchal translucency (NT) thickness in the fetal chromosome abnormality screening. Methods 11 086 pregnant women received NT measurement in 11 ~ 13+6 weeks at Hainan general hospital from January 2010 to December 2014 were selected in the study. The NT thickness was measured according to guidelines from Fetal Medicine Foundation. 122 fetuses (NT≥2.5 mm) were recruited to accept karyotype analysis. Results 11 086 pregnant women received NT measurement in 11 ~13+6 weeks, in which 122 cases′ NT are more than or equal to 2.5 mm, with a positive rate of 1.10%. 122 cases of fetal NT thickening are between 2.5 to 12.0 mm, with the average degree at (4.5 ± 2.1)mm. 122 invasive prenatal diagnostic specimens chromosome karyotype analysis results showed chromosomal abnormalities in 21 cases (abnormal rate of 17.2%), the abnormal chromosome number in 17 cases and abnormal structure in 4 cases. The top 3 are trisomy 21 (12 cases, 57.1%), chromosome pericentric inversion (3 cases, 14.3%), and trisomy 18 (2 cases, 9.5%). Fetal chromosomal abnormalities resulting from different childbirth age, the sex of the fetus, NT thickness showed significant statistical difference (P < 0.05). The concrete manifestation is that fetal chromosomal anomaly detection rate in childbirth by women more than 35 years old age are higher than other age. Female fetal chromosomal anomaly detection rate is higher than the male , and NT thickness of 5mm of fetal chromosomal abnormality rate is significantly higher than the thickness of NT group at 2.5mm~ and 3.5mm~. Fetal NT thickening of NT measurements was in significant positive correlation with fetal chromosome abnormal rate (χ2=15.533, P < 0.001). Logistic regression analysis found that with a higher NT thickness , risk of fetal chromosomal abnormalities would be significantly higher , and thickening of NT could be an independent predictor of fetal chromosome abnormalities. Conclusion In early pregnancy, ultrasound examination of fetal ultrasound screening of NT thickness can be used as an important index of fetal chromosomal abnormality , and interventional diagnosis of prenatal NT thickness increase could pose increased risk of fetal chromosomal abnormalities.

Objective To investigate the prognostic significance of serum cystatin C in multiple myeloma (MM).Methods 160 cases of newly diagnosed MM patients with average age of 61.38 years old.Determine the levels of serum cystatin C,serum creatinine,β 2-microglobulin,lactate dehydrogenase and hemoglobin before the treatment; median follow-up of 38 months,observe the relationship between serum cystatin C with overall survival (OS) and event-free survival (EFS).Results Median serum cystatin C level in 160 MM patients was higher than that in the 80 healthy controls [(0.96 ± 0.32) mg/L vs (0.71 ± 0.16) mg/L,P ＜ 0.000].All the patients in ISS stage were divided into 3 stages.Median serum cystatin C levels significantly increased in higher ISS stages [stage Ⅰ (0.70±0.13) mg/L,stage Ⅱ (0.87±0.16) mg/L,stage Ⅲ(1.23±0.33) mg/L (P ＜ 0.05)],serum cystatin C level was positively correlated with levels of serum creatinine (r =0.669,P ＜ 0.000),β2-microglobulin (r =0.672,P ＜ 0.000).lactate dehydrogenase (r =0.521,P ＜ 0.000),and negatively correlated with hemoglobin levels (r =-0.436,P ＜ 0.000).Using ROC analysis,patients with serum cystatin C levels ＞ 0.95 mg/L had significantly shorter EFS and OS patients with serum cystatin C levels ≤0.95 mg/L (median EFS:30 vs 57 months,P ＜ 0.05; median OS:43 vs 68 months,P ＜ 0.05).Conclusion Serum cystain C is not only a sensitive marker of kidney damage,but also reflects tumor burden and delivers prognostic information in MM.

BACKGROUND:In recent years, pathological calcification such as vascular calcification has been an active deposition of the mineralizer in the abnormal parts, can promote the occurrence and development of many diseases. Moreover, extensive studies believe that micro-inflammatory state is strongly associated with pathological calcification. OBJECTIVE:To further summarize the relationship between micro-inflammatory state and calcification based on the relationship between inflammatory factor and calcification-related factors. METHODS: A computer-based search of CNKI, Wanfang database and PubMed database from January 2000 to January 2015 was performed for articles addressing the relationship between micro-inflammatory state and calcification. The key words were “calcification, micro-inflammatory state, inflammatory factor” in Chinese and English. RESULTS AND CONCLUTION:Micro-inflammatory state is a non-dominant inflammatory state, caused by an infection of non-pathogenic microorganisms, mainly for the elevated inflammatory protein, inflammatory cytokines in the systemic circulation. At present, pro-inflammatory cytokines interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-alpha and acute phase protein C reactive protein were considered as the objective and sensitive detection index of micro-inflammation state. A large number of studies have found that a slight elevation of interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-alpha and C reactive protein was positively correlated with calcification promoting factors, which ilustrated that the micro-inflammatory state has the role of promoting the calcification.

BACKGROUND:With good biocompatibility, bioactivity, control able biodegradation rate, amorphous calcium phosphate is considered as a natural reservoir of calcium and phosphorus, which has been widely used in the biomedical field. OBJECTIVE:To review the latest progress of amorphous calcium phosphate in biomedicine based on its clinical application and characteristics. METHODS:A computer-based search of CNKI, Wanfang database and PubMed database from January 1980 to June 2014 was performed for articles relevant to amorphous calcium phosphate materials with the key words of“amorphous calcium phosphate, biomaterials”in Chinese and English. RESULTS AND CONCLUSION:Amorphous calcium phosphate has been widely used in orthodontic care, bone substitutes, drug delivery material and stents, but it is stil in the developmental stage for the special low differentiated cells, cytokines, targeted drug delivery materials and new biodegradable coronary stent. Based on amorphous calcium phosphate, there are various possible treatments for human diseases. But we cannot blindly exaggerate its advantages but outweigh its disadvantages. For example, whether it wil increase the formation of dental calculus during prevention of dental caries? Whether it wil promote its adjacent tissue calcification or hardening? And whether there are risks leading to vascular calcification or hardening? The advantages and disadvantages of amorphous calcium phosphate when used in human are stil needed to carry out a large scale and long-time research.

Objective To investigate the role of PET-CT in evaluating the response to the treatment in patients with multiple myeloma.Methods 55 newly diagnosed multiple myeloma patients were collected.Patients were provided with 3 CTD chemotherapy,complete blood examination before and after treatment,parallel PET-CT,and measuring the spine,pelvis,rib SUVmax,each with an average of the SUVmax.The curative effect observated in SUV changes and disease were evaluated.Results In 24 patients after treatment,CR,SUV values were significantly decreased [(3.82±0.83) vs (2.05±0.49),t=9.045,P ＜ 0.001].11 cases of VGPR,SUV values were decreased [(4.77±1.13) vs (3.29±0.49),t =3.998,P =0.001].9 cases of PR,SUV values were slightly decreased [(5.36±0.47) vs (4.97±0.40),t =1.886,P ＞ 0.05],in 8 cases of SD,the SUV values had no obvious change [(6.40±0.96) vs (5.63±0.69),t =1.819,P ＞ 0.05],in 3 cases of disease progression we had higher SUV values from the previous [(6.57±0.72) vs (7.53±4.69),t =-0.353,P ＞ 0.05].CR of 24 cases were followed up for 12 months,SUV values were still high in patients after treatment of the short progression-free survival (PFS) (Some patients only lasted 4 months).Conclusion PET-CT has important value in the evaluation of therapeutic effect of multiple myeloma,it helps to determine the early clinical efficacy,and to plan individualized treatment.