Admission Glucose and In-hospital Mortality after Acute Myocardial Infarction in Patients with or without Diabetes: A Cross-sectional Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hyperglycemia on admission has been found to elevate risk for mortality and adverse clinical events after acute myocardial infarction (AMI), but there are evidences that the relationship of blood glucose and mortality may differ between diabetic and nondiabetic patients. Prior studies in China have provided mixed results and are limited by statistical power. Here, we used data from a large, nationally representative sample of patients hospitalized with AMI in China in 2001, 2006, and 2011 to assess if admission glucose is of prognostic value in China and if this relationship differs depending on the presence or absence of diabetes.</p><p><b>METHODS</b>Using a nationally representative sample of patients with AMI in China in 2001, 2006, and 2011, we categorized patients according to their glucose levels at admission (Results: Compared to patients with euglycemia (5.8%), patients with moderate hyperglycemia (13.1%, odds ratio [OR] = 2.44, 95% confidence interval [CI, 2.08-2.86]), severe hyperglycemia (21.5%, OR = 4.42, 95% CI [3.78-5.18]), and hypoglycemia (13.8%, OR = 2.59, 95% CI [1.68-4.00]), all had higher crude in-hospital mortality after AMI regardless of the presence of recognized diabetes mellitus. After adjustment for patients' characteristics and clinical status, however, the relationship between admission glucose and in-hospital mortality was different for diabetic and nondiabetic patients (P for interaction = 0.045). Among diabetic patients, hypoglycemia (OR = 3.02, 95% CI [1.20-7.63]), moderate hyperglycemia (OR = 1.75, 95% CI [1.04-2.92]), and severe hyperglycemia (OR = 2.97, 95% CI [1.87-4.71]) remained associated with elevated risk for mortality, but among nondiabetic patients, only patients with moderate hyperglycemia (OR = 2.34, 95% CI [1.93-2.84]) and severe hyperglycemia (OR = 3.92, 95% CI [3.04-5.04]) were at elevated mortality risk and not hypoglycemia (OR = 1.12, 95% CI [0.60-2.08]). This relationship was consistent across different study years (P for interaction = 0.900).</p><p><b>CONCLUSIONS</b>The relationship between admission glucose and in-hospital mortality differs for diabetic and nondiabetic patients. Hypoglycemia was a bad prognostic marker among diabetic patients alone. The study results could be used to guide risk assessment among AMI patients using admission glucose.</p><p><b>TRIAL REGISTRATION</b>www.clinicaltrials.gov, NCT01624883; https://clinicaltrials.gov/ct2/show/NCT01624883.</p>

Assessment of Early Clopidogrel Therapy Use among Acute Myocardial Infarction Patients in Central-rural China in 2006 and 2011 / 中国医学科学院学报

Objective To explore the application and influencing factors of early clopidogrel use in patients with acute myocardial infarction (AMI) in the central-rural region of China in 2006 and 2011. Methods A representative sample of patients in central-rural region of China admitted to hospital for AMI was created from a two-stage random sampling. In the first phase,a simple random-sampling procedure was used to identify participating hospitals. In the second stage,we selected patients admitted to each participating hospitals for AMI with a systematic sampling approach. Then we obtained clinical information via central medical record abstraction for each patient. For analysis of early clopidogrel therapy (within 24 hours of admission) status,we used multilevel Logistical regression models with the use of generalized estimating equations. Results We identified 1464 patients eligible for early clopidogrel therapy. From 2006 to 2011,the early application rate of clopidogrel increased significantly,from 3.98% to 48.72% (P<0.0001). Logistic regression analysis showed that patients with hypertension were more likely to receive early clopidogrel(OR=1.65,95% CI=1.21-2.26,P=0.001),smokers were associated with greater likelihood to receive early clopidogrel(OR=1.87,95% CI=1.19-2.95,P=0.007),and patients with chest discomfort during hospitalization indicated association with higher likelihood of early clopidogrel use within 24 hours of admission (OR=2.17,95% CI=1.35-3.49,P=0.001). Conclusions Early clopidogrel use in AMI patients has been improved from 2006 to 2011. However,tremendous gap still exists between guidelines and clinical practice. Quality improvement initiatives are in urgent need to support further improvements in early clopidogrel use for AMI patients.

China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction: Study Design / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite the rapid growth in the incidence of acute myocardial infarction (AMI) in China, there is limited information about patients' experiences after AMI hospitalization, especially on long-term adverse events and patient-reported outcomes (PROs).</p><p><b>METHODS</b>The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study will enroll 4000 consecutive AMI patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to document their treatment, recovery, and outcomes. Details of patients' medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1- and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics.</p><p><b>CONCLUSION</b>The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient's experiences and outcomes after AMI in China and serve as a foundation for quality improvement activities.</p>

Clinical Control Study of Endoscopic Full-thickness Resection and Laparoscopic Surgery in the Treatment of Gastric Tumors Arising from the Muscularis Propria / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastric stromal tumors arising from the muscularis propria are located in deeper layers. Endoscopic resection may be contraindicated due to the possibility of perforation. These tumors are therefore usually removed by surgical or laparoscopic procedures. This study evaluated the curative effects, safety and feasibility of endoscopic full-thickness resection (EFR) of gastric stromal tumors originating from the muscularis propria.</p><p><b>METHODS</b>This study enrolled 92 patients with gastric stromal tumors >2.5 cm originating from the muscularis propria. Fifty patients underwent EFR, and 42 underwent laparoscopic intragastric surgery. Operation time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared in these two groups.</p><p><b>RESULTS</b>EFR resulted in complete resection of all 50 gastric stromal tumors, with a mean procedure time of 85 ± 20 min, a mean hospitalization time of 7.0 ± 1.5 days and no complications. Laparoscopic intragastric surgery also resulted in a 100% complete resection rate, with a mean operation time of 88 ± 12 min and a mean hospitalization period of 7.5 ± 1.6 days. The two groups did not differ significantly in operation time, complete resection rates, hospital stay or incidence of complications (P > 0.05). No patient in either group experienced tumor recurrence.</p><p><b>CONCLUSIONS</b>EFR technique is effective and safe for the resection of gastric stromal tumors arising from the muscularis propria.</p>

Endoscopic full-thickness resection of gastric stromal tumor arising from the muscularis propria / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastric stromal tumors are the most common type of tumor originating from mesenchymal tissue. The traditional method for the treatment of gastric stromal tumor is surgical operation or therapeutic laparoscopy. More recently, endoscopic micro-traumatic surgery has become possible for gastric stromal tumors, with any perforation caused by endoscopic therapy mended endoscopically. We assessed the effectiveness of endoscopic full-thickness resection (EFR) in the treatment of gastric stromal tumors arising from the muscularis propria.</p><p><b>METHODS</b>Of the 42 gastric stromal tumors, each > 2.0 cm in diameter, arising from the muscularis propria, 22 were removed by EFR and 20 by laparoscopic surgery. Tumor expression of CD34, CD117, Dog-1, S-100, and smooth muscle actin (SMA) was assessed immunohistochemically. Operating time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared between the two groups. Continuous data were compared by using independent samples t-tests and categorical data by using χ(2) tests.</p><p><b>RESULTS</b>Comparisons of the 22 gastric stromal tumors treated with EFR and the 20 treated with laparoscopic surgery showed similar operation times (60 - 155 minutes (mean, (90 ± 17) minutes) vs. 50 - 210 minutes (mean, (95 ± 21) minutes), P > 0.05), complete resection rates (100% vs. 95%, P > 0.05), and length of hospital stay (4 - 10 days (mean, (6.0 - 1.8) days) vs. 4 - 12 days (mean, (7.3 - 1.7) days), P > 0.05). None of the patients treated with EFR experienced complications, whereas one patient treated with laparoscopy required a conversion to laparotomy and one experienced postoperative gastroparesis. No recurrences were observed in either group. Immunohistochemical staining showed that of the 42 gastric stromal tumors diagnosed by gastroscopy and endoscopic ultrasound, six were leiomyomas (SMA-positive) and the remaining 36 were stromal tumors.</p><p><b>CONCLUSIONS</b>Gastric stromal tumors arising from the muscularis propria can be completely removed by EFR. EFR may replace surgical or laparoscopic procedures for the removal of gastric stromal tumors.</p>

National survey of doctor-reported secondary preventive treatment for patients with acute coronary syndrome in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Long-term use of antiplatelet agents, statins, beta-blockers and angiotensin-converting enzyme inhibitors are proven therapies for secondary prevention in acute coronary syndrome. However, little is known of physicians' opinion about their use in China.</p><p><b>METHODS</b>In 2010, standard questionnaires were posted to chief cardiologists in 1397 geographically diverse and representative sample of tertiary and secondary hospitals in China, collecting information about their opinions on the recommended treatments for acute coronary syndrome.</p><p><b>RESULTS</b>A total of 1009 (72%) cardiologists responded with a valid questionnaire. Of them, 77% reported routine use of all the four main secondary preventive treatments, with little difference between secondary and tertiary hospitals (75% vs. 79%, P = 0.16). Of the cardiologists reporting routine or selective use of aspirin, beta-blockers, statins and angiotensin-converting enzyme inhibitors, 94%, 85%, 73% and 86% would recommend indefinite use respectively. For all the 4 treatments combined, only 63.5% reported indefinite use at the same time, with no significant difference between secondary and tertiary hospitals (62% vs. 65%, P = 0.17), nor between hospitals with or without fast track for primary percutaneous coronary intervention (66% vs. 61%, P = 0.50).</p><p><b>CONCLUSIONS</b>Although Chinese cardiologists seem well informed about the value of main secondary preventive treatments for acute coronary syndrome, there is still gap in their understanding of the need for combined and prolonged use of these treatments.</p>

ACEI/ARB use among high risk patients with coronary heart disease in China: a cross-sectional study / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study investigated current use of ACEI/ARB among high risk patients with coronary heart disease (CHD) in China and factors affecting ACEI/ARB use in these patients.</p><p><b>METHODS</b>This cross-sectional survey was performed between June to December 2007 and May to November 2009 in 51 hospitals from 14 cities. The characteristics of patients with established CHD were collected by electronic questionnaire.</p><p><b>RESULTS</b>Only 45.8% high risk CHD patients were taking ACEI/ARB and the ACEI/ARB medication decreased significantly with time after initial CHD diagnosis. ACEI/ARB was taken in 46.1% CHD patients complicated with diabetes mellitus and in 56.3% CHD patients complicated with hypertension. Logistic regression analysis showed that comorbid hypertension was the strongest factor associated with ACEI/ARB use. In addition, male gender, history of myocardial infarction (MI), PCI and the time after initial CHD diagnosis were independent factors affecting the use of ACEI/ARB. Captopril was the most commonly prescribed ACEI in this cohort.</p><p><b>CONCLUSION</b>ACEI/ARB is underused in secondary prevention among high risk CHD patients in China. It remains a major challenge for healthcare professionals and policy makers to make efforts on narrowing the gap between evidence and practice.</p>

Correlation of red cell distribution width with the severity of coronary artery disease: a large Chinese cohort study from a single center / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has been reported that increased red blood cell width (RDW) is a marker associated with the presence and adverse outcomes of various cardiovascular diseases. The aim of the present study was prospectively evaluate the severity of coronary artery disease (CAD) and RDW in a large Chinese cohort.</p><p><b>METHODS</b>A total of 677 consecutive individuals who underwent coronary angiography due to the presence of angina-like chest pain and/or positive treadmill exercise test were enrolled in this study. All patients received coronary angiography and were then divided into two groups based on the results of coronary angiography (CAD group (n = 499) and control group (n = 178)). The clinical information including classical CAD risk factors and RDW were analyzed to identify their relationship to CAD. The severity of CAD was evaluated by Gensini score and its relationship with RDW was also analyzed.</p><p><b>RESULTS</b>Patients with angiographic CAD had significantly elevated RDW levels compared with controls ((12.95 ± 0.77)% vs. (12.73 ± 0.83)%, P = 0.001). There was a significant positive correlation between RDW and the Gensini score (r = 0.37, P < 0.001). In multivariate Logistic regression analysis, RDW was demonstrated to be an independent predictor for both angiographic CAD (OR = 1.34, 95%CI: 1.02 - 1.77, P < 0.05) and for a higher Gensini score (> 13, OR = 2.23, 95%CI: 1.62 - 3.08, P < 0.001). In a receiver operating characteristic (ROC) curve analysis, an RDW value of 12.85% was identified as an effective cut-point in predicting the presence or absence of CAD with a sensitivity of 50.0% and a specificity of 65.2%.</p><p><b>CONCLUSION</b>RDW is associated with both presence of CAD and the severity of coronary stenosis, suggesting that it might be a readily available marker for the prediction of CAD and its severity.</p>

Focused ultrasound induces apoptosis in pancreatic cancer cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The incidence and mortality rate of pancreatic cancer have increased dramatically in China over recent decades. Focused ultrasound (FU) has been somewhat successful in treating pancreatic cancer. The purpose of this study was to investigate apoptosis in pancreatic cancer cells induced by FU.</p><p><b>METHODS</b>Suspension of human pancreatic carcinoma cell line PaTu 8988t was radiated by FU, using five doses with different radiation parameters and patterns, including one blank control. Temperature increase of the cell suspension was monitored. Cell apoptosis and death after FU radiation was observed using fluorescence microscopy and was tested by flow cytometer at 3, 6, 12, 24, and 48 hours after ultrasound radiation.</p><p><b>RESULTS</b>The maximum cell suspension temperatures following five radiation doses were 28°C, (42.20 ± 2.17)°C, (50.80 ± 0.84)°C, (55.80 ± 2.17)°C, and (65.20 ± 3.11)°C; differences between the doses were statistically significant (P < 0.05). The apoptosis rate peaked at 24 hours after radiation, at (0.56 ± 0.15)%, (1.28 ± 0.16)%, (1.84 ± 0.29)%, (5.74 ± 1.15)%, and (2.00 ± 0.84)% for the five doses; differences between the doses were statistically significant (P < 0.05). Between doses 1 - 4, cell apoptosis rates increased as the T(max) increased. In dose 5, as the T(max) was above 60°C, the apoptosis rate decreased.</p><p><b>CONCLUSION</b>Sub-threshold thermal exposures of FU radiation with a continuous radiation pattern could result in higher percentage of apoptosed cells.</p>

Underuse of statins in patients with atherosclerotic ischemic stroke in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Well designed randomized trials and meta-analyses have clearly shown that statins reduce the risk of major vascular events, including ischemic stroke, in a wide range of patients and their routine use is recommended for patients at an increased cardiovascular risk. Survivors of a first ischemic stroke are at a risk of recurrence and of other vascular events and statins are generally recommended to reduce this risk. This study investigated how widely statins were being used for such patients in China.</p><p><b>METHODS</b>Totally 6422 patients with a history of ischemic stroke were identified by reviewing medical records at 51 highest-ranking hospitals in 14 cities in China, and invited to attend a screening clinic to assess eligibility for a randomized trial. Their current statin and other drug uses were recorded alongside clinical and demographic characteristics. Univariate chi-square test and multivariate Logistic regression were used to determine the factors associated with treatment.</p><p><b>RESULTS</b>Only 24% of these patients reported currently taking a statin. The most important predictor of statin use among these patients was prior history of coronary heart disease. History of diabetes or hypertension, as well as treated in university affiliated hospitals is related to increased use. The status had improved significantly during a 2-year period. Atorvastatin (40%) and simvastatin (39%) were the most commonly used.</p><p><b>CONCLUSIONS</b>In China, statins are still underused for secondary prevention among survivors of ischemic stroke. Reasons for this poor use need to be understood in order to increase use of these evidence based therapies.</p>

Use of secondary preventive medications in patients with atherosclerotic disease in urban China: a cross-sectional study of 16, 860 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite considerable improvements in the care of patients with cardiovascular disease in various populations over the last few decades, there are still limited data about long-term treatment patterns among patients with various atherosclerotic vascular conditions in China, especially the use of statin therapy.</p><p><b>METHODS</b>Between June 2007 and October 2009, 16 860 patients aged 50 - 80 years with established history of atherosclerotic vascular disease (coronary heart disease (CHD), atherosclerotic cerebrovascular disease (CVD), or peripheral arterial disease (PAD)) from 51 hospitals in 14 cities of China were screened for a large randomized trial. Detailed information about current use of statins and various other treatments was recorded and analyzed by prior disease history, adjusting for various baseline characteristics.</p><p><b>RESULTS</b>Among the 16 860 patients, the mean age was 63 years and 74% were male. Overall, 78% of the patients had documented CHD, 40% had CVD, 5% had PAD and 21% reported more than one condition. The median time from initial diagnosis of vascular disease to screening was 18 months. At screening, the proportions who took various treatments were 83% for antiplatelet agents, 49% for beta-blockers, 47% for statins and 28% for angiotensin-converting enzyme inhibitors. The proportion treated with statin was much higher in CHD than in CVD or PAD patients (61% vs. 10% vs. 22% respectively) and decreased significantly with time from initial diagnosis. Simvastatin (mainly 20 mg) and atorvastatin (mainly 10 mg) each accounted for about 40% of total statin use.</p><p><b>CONCLUSIONS</b>In urban China, there is still significant underuse of various proven secondary preventive therapies, with particularly low use of statins in patients with ischaemic stroke.</p>

Current statin use for patients with atherosclerotic cardiovascular disease in 39 large Chinese hospitals / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the current statin use among high-risk patients with atherosclerotic cardiovascular diseases in Chinese large hospitals.</p><p><b>METHODS</b>Clinical history and current medication were recorded in 11 783 patients with a history of atherosclerotic cardiovascular disease (CVD) from 39 highest-ranking hospitals in 10 Chinese cities.</p><p><b>RESULTS</b>Indication for statin use was given for all screened patients and statin was not prescribed in up to 59.6% (7022) patients. For patients with statin use, medication time was shorter than their atherosclerotic CVD history in 1120 (23.5%) patients. The proportion of statin use among patients with ischemic stroke was 19.6%, among patients with coronary heart disease without ischemic stroke was 59.2%.</p><p><b>CONCLUSION</b>Statin is underused in secondary prevention among patients with atherosclerotic CVD in China. There is a large gap between guideline recommended statin use and in practice. Thus, it remains a major challenge for healthcare professionals and policy makers to resolve this problem rapidly.</p>

A cross-sectional study on the use of statin among patients with atherosclerotic ischemic stroke in China / 中华流行病学杂志

Objective To investigate the degree and determinants of the use on statin among patients with atherosclerotic ischernic stroke in China. Methods In the context of an international multi-center clinical trial being undertaken in China, 5585 patients with atherosclerotic ischemic stroke were screened in 39 prestigious hospitals in 10 cities. The characteristics collected through electronic questionnaire were described and analyzed. Results All the screened patients had indications for statins. Among those, 60% of the patients had a history from 3 months to 2 years of suffering from stroke. However, up to 80% of the patients were not using statins when screened. Even in those with statins, about 1/4 of the patients took statins for much shorter period than the history of stroke. The proportion using statins among IS patients with CHD was 4 times more than in those without CHD. Simvastatin and Atorvastatin were most commonly used. Conclusion Statins were greatly nnderused for secondary prevention among patients with atherosclerotic ischemic stroke in China. There was a large gap between evidence and practice. It remains a major challenge for healthcare professionals and policy makers to tackle this problem more positively.

Evaluation of the virtual endoscopy on traumatic ossicular chain disruption pre- and post-operation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical use of virtual endoscopy in the traumatic ossicular chain disruption with intact tympanum pre- and post-operation.</p><p><b>METHODS</b>The series consisted of 17 cases with temporal bone fracture and 4 cases with tympanum contusion. All were examinated with a high resolution spiral CT by axial and oblique coronal planes of the temporal bone. Three-dimensional reconstruction was processed using the virtual endoscopy software. Ten cases of traumatic ossicular chain disruption were performed with intact canal wall epitympanum approach Ossicular reposition. Eleven patients with facial paralysis were performed ossiculoplasty and facial nerve decompression. Nine cases re-examinated virtual endoscopy after operation.</p><p><b>RESULTS</b>Seventeen cases with temporal bone fractures and traumatic ossicular chain disruption, including 3 cases with the long process of the incus fracture, 9 cases with incus bone dislocation, and 5 cases with incus shedding. In the 4 cases of tympanum contusion, 2 cases with incus bone dislocation, 2 cases with incus bone shedding. The axial plane of temporal bone CT could only showed the fracture line and the hammer and incus bone irregular shape. Perioperatively virtual endoscopy showed hammer incus joint separation, incus stirrup dislocation and joint deformation. Surgery confirmed that the incus body was torn off below the hammer following bone displacement, soft tissue wrapped articular surface, incus and stapes just connected with soft tissue. During the tympanum contusion operation could see incus bone-shedding was valgus. Three to six months after surgery, re-examinated virtual endoscopy showed incus bone dislocation ossicular chain was restored to normal, temporal bone shedding ossicular chain connecting almost intact Hearing increased significantly to the level of practical hearing. The coincidence of traumatic disruption of the ossicular chain by virtual endoscopy and surgery was 100%.</p><p><b>CONCLUSION</b>Virtual endoscopy was valuable for providing accurate assessment and individual program for treating and following-up the traumatic ossicular chain disruption.</p>

Construction and screening of plasmid expression vectors encoding the short hairpin RNA targeting hVEGF(165) gene / 南方医科大学学报

<p><b>OBJECTIVE</b>To construct a plasmid expression vector coding for the short hairpin RNA (shRNA) targeting hVEGF(165) mRNA.</p><p><b>METHODS</b>Three plasmid expression vectors coding for shRNA targeting exons 5 and 7 of hVEGF(165) gene sequence and a control vector containing random DNA fragment were constructed. The recombinant plasmids were identified by PCR, and then transfected separately into BHK cells expressing hVEGF(165) gene via Viofect(TM) reagent. The hVEGF(165) gene silencing effect was detected by quantitative RT-PCR and Western blotting.</p><p><b>RESULTS</b>he expected band was amplified from the plasmids coding for shRNA by PCR. Transfection of BHK cells expressing hVEGF(165) gene with the shRNA plasmids resulted in a inhibition of hVEGF(165) mRNA and protein expressions by 77% and 70%, respectively.</p><p><b>CONCLUSION</b>The plasmid expression vectors coding for shRNA targeting hVEGF(165) mRNA have been constructed successfully, of which pDC316- EGFP-U6-shRNA(2) most effectively silences hVEGF(165) gene in BHK cells.</p>

Distortion Product Otoacoustic Emissions in Normal Infants Hearing Screening / 实用儿科临床杂志

Objective To investigate the usage of distortion product otoacoustic emissions(DPOAE) in normal infants hearing screening.Methods One hundred infants(200 ears) without clinical condition of illness were checked in GSI 70 DPOAE screening.The pure tones were 2,3,4 kHz,the OAE screener scored the test result as a pass,when the responses were above the PASS/REFER line and the signal-to-noise was at least 10 dB.Results Ninty-four infants(188 ears) passed hearing screening. Four infants(8 ears) with ceruminous impaction didn′t pass screening;after extracting impacted cerumen from the external auditory meatus,the 4 infants(8 ears) passed screening.Two infants(2 ears) with secretory otitis media didn′t pass screening,but after medicine treatment for 1 week,they passed screening too.Conclusion DPOAE has advantages in infants hearing screening.J Appl Clin Pediatr,2006,21(3):168-169