Objective To study the reference values and related factors of tympanometry for children between 2 and 15 year-old .Methods From December 2014 to March 2015 ,a total of 120 children (240 ears total) among 2 to 15 year-old (6 .95-3 .12) with Type A tympanograms received the singe -frequency component tympanometry test ,including acoustic equivalent volume (Vea ) ,peak-compensated static admittance (Ytm ) ,tympanometric peak pressure (TPP) and tympanometric gradient (TG) .With the results of each test ,the relationships were conducted according to the differences of age and gender .The outcomes also were compared with the recent studies abroad .Re-sults The difference of TPP was statistically significant among the gender group ,and the differences of Vea and TPP were statistically significant between different age groups ,2-6 year pre-school children and 7~15 yr school children .Conclusion The normative values of each tests were significantly different between Chinese and western children of 2-15 years .We would speculate that the differences of TPP in the age and gender group have changed with the physiological characteristics of Eustachian tubes and eardrums and the differences among male and female .

Objective To investigate the role of Staphylococcus aureus enterotoxin B (SEB) in non-IgE mediated activation of mast cells (MCs) by in vitro co-culture of laboratory of allergic disease 2 (LAD2) cells and SEB.Methods The LAD2 cells were incubated with SEB at different concentrations of 0.01,0.1,1,10 and 100 μg/ml,A23187 positive control and negative control separately for 30 minutes.Then,effects of SEB on the morphology of MCs were observed by using a light microscope,and culture supernatants of the above incubation systems were collected.The concentration of tryptase released from MCs was analyzed by enzymatic activity assay,and the level of histamine was detected by enzyme-linked immunosorbent assay (ELISA).Results After 30-minute co-culture of LAD2 cells and SEB,MCs showed larger size,obscure boundaries,increased number of protuberances on the cell surface and decreased refractivity,with a radial burr fin-like appearance.After 30-minute co-culture of LAD2 cells and SEB at different concentrations of 0.01,0.1,1,10 and 100 μg/ml,the concentrations of tryptase in the culture supematants were 4.116 ± 0.651,5.344 ± 0.874,3.806 ± 0.459,1.309 ± 0.247,0.310 ± 0.199 ng/ml respectively.Additionally,the tryptase levels were significantly higher in the 0.01-,0.1-,1-μg/ml SEB groups than in the negative control group(1.538 ± 0.490,all P ＜ 0.05),and gradually decreased along with the increase of SEB concentrations.The histamine levels in the 0.01-,0.1-,1-,10-and 100-μg/ml SEB groups were 242.409 ± 63.915,522.491 ± 73.466,550.926 ± 84.466,334.397 ± 33.640,226.527 ± 5.678 ng/ml respectively.In the 0.01-,0.1-,1-μg/ml SEB groups,the levels of histamine released from MCs were gradually increased along with the increase of SEB concentrations,and were significantly higher than those in the negative control group (146.436 ± 3.100,all P ＜ 0.05).However,with the continued increase of SEB concentrations,the histamine levels gradually decreased.Conclusion SEB can directly activate MCs by a non-IgE mediated mechanism,followed by morphologic changes of MCs and release of tryptase and histamine.

Objective To evaluate the features of carotid atherosclerotic plaques on ultrasonographic elastography. Methods A total of 45 atherosclerotie plaques of the carotid artery in 33 patients were found with routine ultrasonography, all the 45 atherosclerotic plaques were divided into soft plaque, fibrous plaque, mixed plaque and calcified plaque. The elastograms of the plaques were oberseved and the strain contrast(stiffness ratio) of blood tissue in common carotid artery to plaques were calculated. Results Seventeen soft plaques, 15 mixed plaques and 13 calcified plaques were founded using routine ultrasonography, but 0 fibrous plaques were founded. The soft plaques were shown in green, the mixed plaques were showen as mosaic of green and blue and the calcified plaques were showen in blue by ultrasonographic elastography. The strain contrast in patients with calcified plaques and mixed plaques were significantly higher when compared with the soft plaques group(P 0. 001, P <0.05). The strain contrast in patients with calcified plaques was significantly higher than the mixed plaques group (P < 0.001). Conclusions Ultrasonographie elastography could be used in carotid arteries atherosclerotic plaques. Various of acoustic characteristics plaques has different elastography and strain contrast.

Objective To evaluate the dyssynchrony of left ventricle in patients with coronary artery disease(CAD) by two-dimensional strain echocardiography (2-DS). Methods The myocardium of left ventricle of 33 patients with CAD and 30 nomal controls were detected by 2-DS. The time from onset QRS complexes to peak systolic longitudinal strain(Ts) and the standard deviation of Ts of 18 left ventricular segments (Ts-SD)were measured. Results There were 168 segments whose flow was provided by coronary artery with stenosis≤75% ,210 segments whose flow was provided by coronary artery with stenosis 75 %. ①Ts was delayed significantly and Ts-SD was obviously higher in patients with stenosis≥75% when compared with the control group. ②Ts was delayed and Ts-SD was higher in patients with stenosis≥75% compared with those whose stenosis was ≤75%. ③There were no statistical differences in Ts and Ts-SD between the patients with stenosis ≤75% and the control group. ④When left ventricular systolic dyssynchrony was defined as Ts-SD≥33.0 ms, there were 22 patients with systolic dyssynchrony of all 26 patients whose coronary artery stenosis≥75%, there were no patient with systolic dyssynchrony of all 7 patients whose stenosis ≤75%. Conclusions Although there are no evident regional wall motion abnormalities by routine echocardiography,in patients with severe coronary artery stenosis,2-DS can detect exactly the dyssynchrony of left ventricle.

Objective To assess the myocardial strain in patients with coronary artery disease by two dimensional strain echocardiography.Methods Forty-three patients with coronary artery disease and thirty five healthy subjects were included.High frame rate two-dimensional images were recorded from the left ventricular short-axis views at the levels of mitral annulus,papillary muscle and apex,and the apical four chamber view,two-chamber view and long-axis view of the left ventricle respectively.The longitudinal strain was measured in the apical views,radial strain and circumferential strain were measured in the left ventricular short-axis views using two-dimensional strain software.Results There were 96 segments whose flow was provided by coronary artery with stenosis＜75%,147 segments whose flow was provided by coronary artery with stenosis≥75%.The peak systolic longitudinal strain of different segments in patients with stenosis≥75% significantly reduced when compared with the control group(P＜0.05).The peak systolic radial strain and circumferential strain of different segments in patients with stenosis≥75% had no statistical difference compared with the control group(P＞0.05).When taking peak systolic longitudinal strain≥-16.1% as cut-off value for coronary artery stenosis of≥75%,the sensitivity and specificity were 78.7% and 76.4% respectively.There was no significant difference in systolic longitudinal strain,radial strain and circumferential strain between normal myocardium and stenosis＜75%(P＞0.05).Conclusions Although there are no evident regional wall motion abnormalities by two dimensional echocardiography,in patients with severe coronary artery stenosis,the longitudinal strain which can reflect the subendocardial myocardial function significantly reduced.

Objective To investigate the prevalence, accessory gene regulator (agr) and staphylococcal cassette chromosome mec (SCCmec, only for methicillin resistantS. aureus, MRSA) types of theS. aureus strains carrying toxic shock syndrome toxin-1 (tst) and/or panton-valentine leukocidin (pvl) genes.Methods Nine hundred and sixteen isolates ofS. aureus were collected from seven hospitals in Shanghai and Zhejiang Province and subjected to detection oftst,pvl,mecA andmecC genes by polymerase chain reaction (PCR). Theagr and SCCmec (only for MRSA) types were determined in thetst orpvl gene positive isolates.Results Of the 916 isolates, 208 carriedtst gene (22.7%), 35 harboredpvl gene (3.8%), and 665 weremecA positive (MRSA). No isolate was mecC positive. Out of the 665 MRSA isolates, 198 hosted thetst gene (29.8%). The most commonagr and SCCmec types were agr 2 (97.0%) and SCCmec II (94.4%), respectively. For thepvl gene, only 14 isolates were positive (2.1%). Theagr 1 (85.7%), SCCmecIII (42.9%) and SCCmec IVa (28.6%) were the most commonagr type and SCCmec type. In the 251 methicillin-sensitiveS. aureus (MSSA) isolates, 10 carriedtst gene (4.0%) and 21 carriedpvl gene (8.4%). The prevalence oftst gene in MRSA was higher than that in MSSA, while the prevalence ofpvlgene was just the opposite. However, the prevalence ofpvlgene in MRSA isolates from Zhejiang Province was higher than that in the MRSA isolates from Shanghai (P<0.05).Conclusions The prevalence oftst gene in MRSA is signiifcantly higher than that in MSSA. The prevalence ofpvlgene is low in theS. aureus isolates studied. However, clinicians should pay close attention to these strains due to the implication of PVL toxin in some
severeS. aureus infections.

Objective: To investigate the status and influencing factors of influenza vaccination among the elderly, so as to provide insights into improving the strategies for influenza vaccination among the elderly. Methods: Elderly people aged 60 years and above were recruited from one community each in five sub-districts of Shihezi City, Xinjiang Uygur Autonomous Region using a random sampling method. Demographic information, knowledge about influenza and influenza vaccines, vaccine literacy and influenza vaccination status in the past year were collected through questionnaire surveys. Factors affecting influenza vaccination among the elderly were analyzed using a multivariable logistic regression model. Results: Totally 1 121 valid questionnaires were recovered, with an effective recovery rate of 95.08%. There were 417 males (37.20%) and 704 females (62.80%). The majority were aged 60-<81 years, accounting for 80.37% (901 individuals). The awareness of knowledge about influenza and influenza vaccines was 78.86%. Low vaccine literacy was observed in 786 individuals, representing 70.12%. The influenza vaccination rate was 20.96%. Multivariable logistic regression analysis showed that age (71-<81 years, OR=1.607, 95%CI: 1.041-2.479; ≥81 years, OR=1.719, 95%CI: 1.040-2.842), educational level (middle school/technical secondary school, OR=0.616, 95%CI: 0.416-0.911), medical expense payment (employee medical insurance, OR=6.531, 95%CI: 2.030-21.010; resident medical insurance, OR=3.385, 95%CI: 1.095-10.466; public expense, OR=4.828, 95%CI: 1.700-13.712), vaccination willingness (yes, OR=6.237, 95%CI: 3.277-11.871), influenza vaccination history (yes, OR=14.600, 95%CI: 8.733-24.408) and vaccine literacy (medium and above, OR=2.412, 95%CI: 1.636-3.555) were associated with influenza vaccination among the elderly. Conclusion The influenza vaccination rate among the elderly was relatively low, and was mainly affected by age, educational level, medical expense payment, vaccination willingness, influenza vaccination history and vaccine literacy.

Objective To investigate the expression of gastric and intestinal phenotypic markers in Siewert typeⅡand Ⅲ early gastroesophageal junction(GEJ) cancer, and to explore its correlation with clinic-pathological features.Methods From April 2010 to July 2015, 53 cases diagnosed as early GEJ cancer were enrolled.The gastric and intestinal phenotypic markers such as mucin5AC(MUC5AC),mucin6(MUC6),mucin2(MUC2),caudal related homeodomain transcription 2(CDX2) and cluster of differentiation 10(CD10) were detected, and then the patients were divided into gastric type, gastrointestinal type, intestinal type and non-classified type according to the results of immunohistochemical staining.Combined with Siewert classification the clinicopathological features were analyzed.Chi square test or Fisher′s exact test was performed for statistical analysis.Results In the cancer tissues of 47 patients with Siewert type Ⅱand Ⅲ early GEJ cancer, the case numbers of positive expression of MUC5AC,MUC6,MUC2, CDX2 and CD10 were 21(44.7%),19(40.4%),31(66.0%),27(57.4%) and 17(36.2%),respectively;the case numbers of gastric type, gastrointestinal type, intestinal type and non-classified type were 11(23.4%),14(29.8%),21(44.7%) and one(2.1%), respectively.The positive expression rates of MUC5AC and MUC6 in Siewert typeⅡwere 55.9%(19/34) and 50.0%(17/34),which were higher than those of Siewert typeⅢ(2/13), and the positive expression rate of MUC2 was 55.9%(19/34), which was lower than that of Siewert typeⅢ(12/13), and the differences were statistically significant (x2=6.240,4.679 and 4.053;all P<0.05).In Siewert typeⅡ, the proportion of intestinal type was 32.4%(11/34), which was lower than that of Siewert typeⅢ(10/13), and the differences were statistically significant (x2=7.142,P=0.010).In patients with Siewert typeⅡand Ⅲ early cancer, males predominated in intestinal type which were mostly well differentiated type with less submucosal carcinoma.The maximum diameter of tumor was less than those of gastric type and gastrointestinal type.In paracancerous mucosal tissues, the incidences of intestinal metaplasia in gastrointestinal type and intestinal type were 11/14 and 81.0%(17/21), which were higher than that of gastric type (3/11);the incidences of atrophy in gastrointestinal type and intestinal type were 12/14 and 85.7%(18/21),which were higher than that of gastric type (4/11),and the differences were statistically significant (Fisher′s exact test,all P<0.05).Conclusions Siewert typeⅡand Ⅲ early GEJ cancer can directly originated not only from gastric mucosa, but also from gastrointestinal and intestinal mucosa.Atrophy and intestinal metaplasia could exist before cancer genesis.

Objective:To analyze the impacts of the clinics-pharmacy separation reform on outpatient CT utilization and provide policy recommendations for the rational use, refined management and subsequent price adjustment for large-scale imaging equipments.Methods:The number of outpatient CT examinations of a tertiary public hospital in Beijing from January 1st, 2015 to April 30th, 2019 was collected. Data were analyzed using single-and multi-group interrupted time series analysis model(ITS), along with qualitative interviews.Results:The number of CT examinations increased by 0.216 per 100 visits after the reform( P<0.001). The trend of changes(slope)in the number of CT examinations increased by 0.012 person-times/month( P<0.001). There were no statistically significant differences in the slope change of CT examinations between patients under Urban Employee Basic Medical Insurance and those under Urban Resident Basic Medical Insurance( P=0.504). Conclusions:The reform has significantly increased the utilization of outpatient CT examinations. However, the impacts of the reform may be similar among patients covered by different insurance systems. The qualitative interviews imply it as necessary to pay attention to the overworking status of relevant practitioners and be alert to the excessive use of large-scale imaging equipments.

Objective:To explore the current status and related factors of eHealth literacy in cardiovascular and cerebrovascular patients by selecting an appropriate digital eHealth literacy scale.Methods:From February to May 2023, convenience sampling was used to select 310 cardiovascular and cerebrovascular patients from the Department of Cardiology and Neurology of two ClassⅢ Grade A hospitals in Beijing as study subjects. E-Health Literacy Scale (EHLS), the eHealth Literacy Scale (eHEALS), and the Mobile eHealth Literacy Scale (m-eHEALS) were used to survey patients. Correlation analysis, internal consistency analysis, and structural validity analysis were used to select the main scale for the study. Binomial Logistic regression was used to explore the related factors of eHealth literacy in cardiovascular and cerebrovascular patients.Results:A total of 310 questionnaires were distributed, and 302 were effectively collected, with an effective rate of 97.42%. Among the three scales, the EHLS had good reliability and validity. The EHLS score of 302 patients was (37.73±9.66), with a qualified rate of 13.91% (42/302). Binomial Logistic regression analysis showed that the course of cardiovascular and cerebrovascular disease ( OR=0.615, 95% CI: 0.465-0.813) and the level of concern for one's own health status ( OR=0.669, 95% CI: 0.478-0.937) were related factors for eHealth literacy in cardiovascular and cerebrovascular patient ( P<0.05) . Conclusions:The qualification rate of eHealth literacy for cardiovascular and cerebrovascular patients is relatively low. A short course of disease and a high level of concern for one's own health status are protective factors for eHealth literacy in cardiovascular and cerebrovascular patients.