Objective To identify the risk factors for postoperative reintubation in patients undergoing general anesthesia.Methods Forty-six thousand five hundred and seven patients,aged 18-83 yr,requiring reintubation after planned extubation in the postanesthesia care unit (PACU) of our hospital from January 2010 to December 2012,served as reintubation group.Patients in a 1∶5 ratio,aged 18-83 yr,admitted to the PACU of our hospital from January 2010 to December 2012,with successful extubation,served as control group.The general data of patients and operation-related factors including type of operation (emergency operation/elective operation),operative sites (head and neck,airway,within the chest,upper abdomen,lower abdomen,other sites) and operation time and anesthesia-related factors including requirement for opioids and muscle relaxants within 30 min before operation,and for neostigmine at the end of operation were recorded.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify reintubation-related risk factors.Results Thirty-two patients were reintubated after operation and the incidence was 0.069％.There was significant difference in age,gender,body mass index,ASA physical status,preoperative SpO2,complication with upper respiratory infections within 2 weeks before operation,chronic obstructive pulmonary disease (COPD),or systemic inflammatory response syndrome (SIRS) and hypoproteinemia,operative sites and operation time between the two groups (P ＜ 0.05 or 0.01).The logistic regression analysis showed that ASA physical status ≥ Ⅲ,complication with COPD or SIRS,and thoracic surgery were closely correlated with postoperative reintubation in patients undergoing general anesthesia.Conclusion ASA physical status ≥ Ⅲ,complication with COPD or SIRS,and thoracic surgery are risk factors for postoperative reintubation in patients undergoing general anesthesia.

Objective To investigate the anatomy of the skull base for minimally invasive keyhole approach to sellar lesions.MethodsSixty-seven samples of adult skull bone(134 sides) were collected and sawed at the levels of the supraorbital arch and anterior skull base.After inspecting the opening of the frontal sinus,we observed the appearance of the orbit roof(cerebral juga),and measured the maximum height of the two cerebral jugas.Afterwards,the operation distances and angles with regard to the anterior and posterior clinoid processes through the trans-upper orbit,trans-lateral front,trans-pterion,and trans-sub-temple keyhole approaches in 15 skull bone samples were measured.And then,we statistically analyzed the variance in these measurements among the four operative approaches.ResultsOf the 67(134 sides) adult skull bone samples,52 sides showed frontal sinus openness(38.8%,52/134).Most of the skull bases were clawed(multicuspidity or oblique ridge multicuspidity).The maximum height of the cerebral juga that was less than 2.50 mm was found in 36 sides(26.9%),and over 2.51 mm in 98 sides(73.1%).Among the four methods,the shortest distances between the keyhole and the anterior and posterior clinoid processes were found in the trans-sub-temple keyhole approach [(4.87?0.47) cm and(4.93?0.45) cm],and the longest were observed in the trans-lateral front keyhole approach[(6.45?0.30) cm and(7.83?0.54) cm],and trans-upper orbit keyhole approach[(6.47?0.28) cm and(8.31?0.34) cm].The angle between the sagittal section and the keyhole in the trans-lateral front keyhole approach [(40.83?1.11) ? and(37.86?1.37)?] was larger than that in the trans-upper orbit one [(10.23?0.90) ? and(12.29?0.86)?],while the angle between the cross section and the keyhole in the trans-sub-temple keyhole approach [(21.21?0.45) ? and(20.10?0.63)?] was larger than that in the trans-pterion one [(5.49?0.30)? and(9.84?0.58)?].ConclusionsThe size of the frontal sinus,shape and height of the cerebral juga,depth of the skull base operation,and angle between the operational and the skull base planes play important roles in the selection of minimally invasive keyhole approach for sellar lesions.

Objective To investigate the prevalence of H.Pylori infection and antibiotic resistance in patients with peptic ulcer.Methods A retrospective analysis of 429 endoscopy and H.Pylori culture results in the First People's Hospital of Hangzhou from 2012 to 2013 was conducted.The rate of H.Pylori infection in patients with peptic ulcer, and the resistance rates of H.Pylori to metronidazole, levofloxacin, clarithromycin,amoxicillin, gentamicin, furazolidone were analysed.Results The positive rate of H.Pylori in people with peptic ulcer was 53.1％ (228/429).The resistance rates to metronidazole, levofloxacin, clarithromycin,amoxicillin, gentamicin and furazolidone were 94.7％ (216/228), 18.9％ (43/228), 18.9％ (43/228), 0, 0 and 0.Double antibacterial resistant rates of metronidazole and clarithromycin, metronidazole and levofloxacin were 18.0％ (41/228) and 17.1％ (39/228).Triple antibacterial resistant percentage of levofloxacin + metronidazole + clarithromycin was 8.3％ (19/228).The resistance rate of clarithromycin in 43 patients who were also resistant to levofloxacin was 46.5％ (20/43), while the resistance rate of clarithromycin in 185 patients who were also sensitive to levofloxacin was 12.4％ (23/185)with significant difference(x2 =26.480,P =0.000).A positive association between the resistance to levofloxacin and to clarithromycin was found.Conclusion The H.Pylori infection is closely related to the occurrence of peptic ulcer.Without the basis of culture results in patients with H.Pylori positive, amoxicillin, gentamicin and furazolidone could be the first choices in clinical,because of their low resistance rates.Clarithromycin can be used as an alternative.

Objective To evaluate the clinical efficacy of entecavir (ETV) or adefovir dipivoxil (ADV) monotherapy in treatment of HBeAg-negative chronic hepatitis B (CHB) patients with mildly elevated ALT.Methods One hundred and seven HBeAg-negative CHB patients with ALT elevated by 1-2-fold of upper limit of normal (ULN) were enrolled in this prospective study.Sixty patients were assigned to receive ETV monotherapy and 47 patients to receive ADV monotherapy for at least 96 weeks.The ALT and HBV DNA levels were measured every 3 months.The liver biopsy was performed in 35 patients prior to therapy.Drug resistance and adverse reactions were documented.Results Four cases in ETV group and 2 cases in ADV group were lost in follow-up.Among 35 patients with liver biopsy,30 (86％) cases had significant fibrosis (stage 2-4) or inflammation (grade 2-4).At weeks 96,serum ALT was normalized in 67％ (30/45) cases of ADV group,and 95％ (53/56) cases of ETV group (x2 =13.33,P ＜ 0.01) ; the proportion of patients with undetectable HBV DNA in ADV and ETV groups was 78％ (35/45) and 100％ (56/56) respectively (x2 =13.81,P ＜ 0.01).No drug resistance occurred in ETV group,while 2 patients in ADV group were found with virological breakthrough and were confirmed to be of variants associated with ADV resistance.No adverse reactions were observed in either group during the trial.Conclusion Present study suggests that most HBeAg-negative CHB patients with mildly elevated ALT have significant fibrosis or inflammation and entecavir monotherapy was more effective than adefovir dipivoxil monotherapy in treatment of the patients.

Objective To identify and confirm a novel HLA allele.Methods A new human leukocyte antigen A allele was found during routine HLA genotyping by polymerase chain reaction-sequence specific oligonucleotide probes(PCR-SSOP) and sequencing-based typing (SBT).HLA-A locus was amplified from exon 1 through exon 8,and the nucleotide sequence of exon 2 to exon 4 for HLA-A were sequenced in both directions.Results The novel HLA-A * 31 allele is identical to A * 31 ∶ 01 ∶ 02 with an exception of one base substitution at position 245 of exon 2 where an ' A' change to ' C' resulting in codon 82 changed from GAG to GCG.Conclusion A novel HLA allele,A * 31 ∶ 22,was identified,and was named officially by the WHO Nomenclature Committee for factors of the HLA system.

Objective To explore intervention efficacy of clinical application of antimicrobial agents in internal medicine departments of a hospital.Methods 1 880 medical records from internal medicine and pediatrics departments this hospital in July-December 2010 were randomly selected as control group (before intervention),and 2 207 medical records in July-December 2011 were as trial group (after intervention),antimicrobial use of two groups was compared.Results The over-all usage rate of antimicrobial agents after intervention was lower than before intervention (48.12% vs 58.62%,χ2 =44. 45,P <0.001).Except endocrinology,pediatrics and hematology departments,the usage rates of antimicrobial agents in the other departments after intervention were all obviously lower than before intervention(all P <0.05).The usage rate of antimicrobial agents in endocrinology and hematology departments were both low(<40%),which met the requirements of Ministry of Health.Conclusion Comprehensive intervention in clinical use of antimicrobial agents reduced the usage rate of antimicrobial agents in internal medicine and pediatrics departments in this hospital.

Gastric duplication cyst is a very rare gastrointestinal tract malformation that accounts for 2％-4％ of alimentary tract duplications.It is a diagnostic dilemma for doctors because its clinical and radiological manifest is usually nonspecific.At the present stage,it can only rely on surgery.We should pay attention to ectopic pancreas resection and ligation of pancreatic duct during operation.There was one case of gastric duplication cyst with ectopic pancreas in adults from the Second Affdiated Hospital of Nanchang University.

Objective To explore the clinical characteristics of vestibular migraine in patients from the clinic and ward of the neurological department in comprehensive hospitals.Methods A total of 226 patients diagnosed as vestibular migraine were enrolled in the study.Clinical data were collected and analyzed,including the medical history,clinical symptoms and signs,as well as the result of diagnostic examinations.Results The mean age of the patients at the visit was 51.7 years old,with the male to female ratio of 1:1.48.The occurrence of vertigo and migraine varied in order,with 53.1％ (120/226) patients presented migraine several years before vertigo.The duration time of vertigo ranged from seconds to days,with 1.8％ (4/226) patients presented no headache during the whole course.Several punctate long T2 or high FLARE (fluid attented inversion recovery) signals scattered at the centrum ovale.Conclusions Vestibular migraine has complex mechanism and presents multiple clinical manifestations with certain regularities of the onset.Differential diagnosis should be made from the similar diseases.

Objective:To establish a method for the determination of enantiomer in rivaroxaban by HPLC. Methods:A Chiralpak IA column (250 mm × 4. 6 mm, 5 μm) was used with the mobile phase of 100% methanol. The flow rate was 1. 0 ml·min-1 . The detection wavelength was set at 250 nm and the column temperature was 40℃. Results:The resolution of rivaroxaban and the enanti-omer was above 2. 0. The linear range of them was 0. 5-1 000. 00 μg·ml-1(r=0. 999 9). The detection limit of the enantiomer was 0. 17ng and the average recovery was 102. 9% with RSD of 1. 54%(n=6). Conclusion:The method is accurate and rapid, and suit-able for the determination of the enantiomer in rivaroxaban.

Objective To investigate the effect of endothelial progenitor cells (EPCs) which complexed with neuron stem cells (NSCs) after transplanted into ischemia and reperfusion (I/R) rat model on the proliferation and apoptosis of the NSCs and vasal construction. Methods Totally 150 SD adult male rats were randomly and equally divided into 5 groups, sham-operation group, I/R group, I/R+NSCs group, I/R+EPCs group, and I/R+NSCs+EPCs group. The rats were further divided into 5 subgroups according to the time points of 3, 7, 14, 30 and 60 d after transplantation. I/R rat model was established by reversiblyligating middle cerebral artery occlusion. NSCs were derived from the hippocampus of SD rats born in 24 h and identified with Nestin staining. EPCs were obtained from the artery blood of SD rats and verified with immunocytochemical stainings of CD31, CD34 and KDR after culture. The complex of NSCs and EPCs was produced with aid of laminin. Then the complex were transplanted into the ischemia penumbra of corresponding model rat brain. The proliferation and apoptosis of NSCs, and the fomation of new vessels were observed through immunohistochemistry and double-labeled immunofluorescence staining. Results The proliferation of NSCs was increased, apoptosis cells were decreased and the new vessels were raised in the complex transplantation when compared with single NSCs or EPCs transplantation groups. Conclusion The complex of NSCs and EPCs transplantation improves the proliferation of NSCs, suppresses cell apoptosis and promotes the formation of new vessels.