The mode of the atlanto-occipital fusion in 19 Chinese skulls was studied andanalysed. According to various degrees of fusion it may be divided into the following 5types: Type Ⅰ: The atlanto-occipital joints, anterior and posterior atlanto-occipital mem-branes of both sides were ossified (36.8%). Type Ⅱ: The atlanto-occipital joints, the anterior atlanto-occipital membrane andthe lateral parts of the posterior atlanto-occipital membrane were all ossified (21.1%). Type Ⅲ: The atlanto-occipital joints of both sides, the anterior and posterioratlanto-occipital membranes of one side were ossified (26.3%). Type Ⅳ: The atlanto-occipital joints and the lateral parts of the anterior atlanto-occipital membrane were ossified (5.3 %). Type Ⅴ: Only the atlanto-occipital joints were ossified (10.5%). In addition to the above, a case showing the atlanto-axial joints consisted of fivejoints and a case showing the anterior atlanto-axial joint and the lateral atlanto-axialjoints bounded by one articular capsule were found. The unusual courses of the vertebral artery to the cranial cavity was found eitherthrough the lateral part of the occipital bone, or the anterior condylar foramen and theposterior surface of the transverse process of the atlas.

Purpose To establish a HPLC method for determination of the content of trifluoroacetic acid in bivalirudin.Methods Kromasil 100-5 C_(18) column(4.6 mm×200 mm,5 μm)and 0.07% phosphoric acid solution(pH 3.0)-methanol(98:2)as the mobile phase at a flow rate of 1.0 mL/min were used with a column temperature of 30 ℃,a detection wavelength of 210 nm and a injection volume of 20 μL.Results The standard curve of trifluomacetic acid was linear in the range of 198.4-992.0 μg/mL,r=0.999 9.The detection limit Was 40 ng.The average recovery rate of method was 99.9%,and RSD was 0.41%.Conclusion The method of content determination was practicable and accurate.It can be used for content determination of trifluoroacetic acid in bivalirudin.

Objective To evaluate the optimum compatibility of nalbufine combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after cesarean section.Methods A total of 100 parturients who were at full term with a singleton fetus,aged 24-35 yr,with body mass index of 29-33 kg/m2,of American society of Anesthesiologists physical status Ⅱ,scheduled for elective cesarean section under combined spinal-epidural anesthesia,were divided into 4 groups (n =25 each) using a random number table method:sufentanil 0.5 μg/ml plus 0.15％ ropivacaine group (SR group),nalbufine at final concentration of 0.2 mg/ml plus 0.15％ ropivacaine group (N1 R group),nalbufine at final concentration of 0.4 mg/ml plus 0.15％ ropivacaine group (N2R group) and nalbufine at final concentration of 0.4 mg/ml plus 0.1％ ropivacaine group (N3Rgroup).PCEA solution was prepared correspondingly after surgery,and all the drugs were diluted to 100 ml in normal saline in each group.The PCA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analog scale scores of incisional pain and anduterine contraction pain were maintained＜4.Ramsay sedation scores were recorded at 8,12,24 and 48 h after surgery.The total pressing times of PCEA were recorded within 48 h after surgery.The development of adverse reactions such as nausea,vomiting,skin itching,numbness of lower extremity,urinary retention and respiratory depression was recorded in the analgesia period.Venous blood samples were collected before surgery and at 24 and 48 h after surgery for determination of plasma prolactin concentrations,and the time of colostrum was recorded.Neonatal nerve and adaptive capacity was assessed and scored.Results Compared with group SR,the total pressing times of PCEA were significantly reduced in N2R and N3R groups (P＜0.05),and no significant change was found in the total pressing times of PCEA in group N1R (P＞0.05).Compared with group N1R,the total pressing times of PCEA were significantly reduced in N2R and N3 R groups (P＜0.05).There was no significant difference in the total pressing times of PCEA between group N2R and group N3R (P＞0.05).The Ramsay sedation score was 2 in four groups.There was no significant difference in numbness of lower extremity,plasma prolactin concentrations or neonatal nerve and adaptive capacity scores among four groups (P＞0.05).Conclusion Nalbufine at final concentraction of 0.4 mg/ml mixed with 0.1％ ropivacaine is the optimum compatibility when used for PCEA after cesarean section.

Objective? To investigate the prevalence, characteristics and influencing factors of violent behaviors in patients with schizophrenia during the onset stage of the disease in the community, and to provide targeted guidance for community and family when delivering care and rehabilitation for the patients. Methods? From March to July in 2018, a total of 235 newly admitted schizophrenic patients in two specialized hospitals and one general hospital in Zhanjiang city were selected by convenience sampling. By the use of the self-designed questionnaire, the main caregivers were investigated directly about the patients＇ general information, patients factors,family factors and violent behaviors. The influences of the patients factors and family factors on the violent behaviors were analyzed. A total of 226 properly filled questionnaires were retrieved. Results? Among the 226 patients, a total of 161 cases (71.24%) committed violence one week before admission in which 129 cases(57.08%) were general attack, and 32 cases (14.16%) were dangerous violence, 65 patients (28.76%) did not committed any violent behaviors. Ordinal Logistic regression analysis showed that the risk factors of the violence were the presence of conduct disorder before illness, previous verbal attacks, destruction of property, or personal attacks against others, as well as emotional vulnerability , verbal stimulation or behavior/action stimulation from surrounding environments(P＜0.05). Harmonious family relations and the main Guardians' good execution of doctors' advice were the protective factors (P＜ 0.05). Conclusions? Patients who have previously had verbal attacks,property damage, physical attacks against others, and who have behavioral disorders before illness should be the focus of community and family care. Creating a harmonious family and rehabilitation environment in community should be an important part of family and community care for schizophrenic patients. Health education of mental illness for patients, primary caregivers and community should be strengthened.