Global, regional, and national burden of ischaemic heart disease and its trends, 1990-2019.

OBJECTIVES: Ischemic heart disease (IHD) has high morbidity, disability, and mortality rates and is a major contributor to the global disease burden. This study aimed to obtain a more detailed description of the burden of IHD through secondary analysis of data from the Global Burden of Disease (GBD) 2019. STUDY DESIGN: This is an epidemiological study. METHODS: Data for this study were obtained from the GBD 2019 database. Annual average percentage change (AAPC) was calculated to assess trends in IHD prevalence, morbidity, mortality, and disability-adjusted life years (DALYs). Regional and national burden of IHD was assessed by stratifying by sex, age, and socio-demographic index (SDI). RESULTS: From 1990 to 2019, the global prevalence of IHD, morbidity cases, deaths, and DALYs increased, but the age-standardized rates of IHD burden decreased. Morbidity, mortality, and DALY rates for IHD in both sexes increased with age. The prevalence, incidence, mortality, and DALY rates were higher in men than women in all age groups. In particular, the male-to-female ratios for mortality and DALY rates peaked among 35-39 year olds, while the male-to-female ratios for prevalence and morbidity peaked among 55-59 year olds. Age-standardized prevalence, incidence, and DALY rates were higher in low- and middle-income regions than in other SDI regions. CONCLUSION: Although age-standardized prevalence, morbidity, mortality, and age-standardized DALY rates due to IHD decreased globally from 1990 to 2019, age-standardized prevalence and morbidity of IHD increased in Low SDI, Low-middle SDI, and Middle SDI regions.

Does controlling shareholders' share pledge exacerbate excessive financialization of enterprises?-Evidence from performance pressure perspective.

Based on the perspective of performance pressure, we explore the influence of controlling shareholders' share pledge on excessive financialization behavior of enterprises and its internal mechanism. The results show that the share pledge of controlling shareholders is positively correlated with the excessive financialization behavior of enterprises. After the controlling shareholder's share pledge, the actual performance of the enterprise is lower than expected, causing the short-sighted behavior of the management, which makes the management willing to conspire with the controlling shareholder to cause the excessive financialization of the enterprise. The results are especially evident among the uncertainty of economic policy is low, the industry competition is not fierce and the executives have overseas experience.

Brand Equity, Tourist Satisfaction and Travel Intentions in a UNESCO Creative City of Gastronomy: A Case Study of Yangzhou, China.

Food is an indispensable part of destination tourism resources and attractions, playing a vital role in the marketing and promotion of the destination. Food can also be viewed as an important brand that the destination can develop. Yangzhou has been listed as a UNESCO Creative City of Gastronomy since 2019, and the government aims to enhance the food brand for the city. This study attempts to assess the impact of a destination's food brand equity on tourist satisfaction and travel intentions, and to evaluate the potential of developing food tourism. Questionnaires were conducted with 481 tourists, followed by semi-structured interviews with 29 tourists. A structural equation modelling analysis addressed the positive relationships among destination food brand equity, tourist satisfaction and travel intentions. A qualitative analysis contributes to further clarifying the relationships of the model. Implications for theory, research and practice are discussed.

Determination of Flavonoid Compounds in Shanxi Aged Vinegars Based on Hydrophobic Deep Eutectic Solvent VALLME-HPLC Method: Assessment of the Environmental Impact of the Developed Method.

This research presents a novel, eco-friendly, vortex-assisted liquid-liquid microextraction (VALLME) approach, integrating hydrophobic deep eutectic solvents (DESs) with HPLC for the identification and quantification of nine specific flavonoids in Shanxi aged vinegar (SAV). The parameters of DES-VALLME, including the ratio of trioctylmethylammonium chloride to 1,4-butanediol (1:6), DES volume (150 µL), vortex duration (5 min), the concentration of NaCl (0.40 g), and centrifugation time (10 min), were optimized to achieve the maximum extraction efficiency of target substances. Under these optimal conditions, quantitative analyses performed via HPLC demonstrated a broad linear range of 0.20-50.00 µg/mL and correlation coefficients (r2) greater than 0.9944 for all nine calibration curves. The limits of detection (LOD) and limits of quantitation (LOQ) were 0.09-0.18 µg/mL and 0.30-0.60 µg/mL, respectively, ensuring high sensitivity. The relative standard deviations for intra-day and inter-day variability were within the acceptable range, 2.34-3.77% and 3.04-4.96%, respectively, demonstrating the method's reliability. The recovery rates ranged from 85.97% to 108.11%, underscoring the method's precision. This technique exhibited a significant enrichment effect (enrichment factor: 43 to 296) on SAV flavonoids. Notably, the eco-friendliness of this procedure was evaluated using the Analytical Eco-Scale, Green Analytical Procedure Index, and Analytical Greenness Metric. The results suggested that this technique is a viable green alternative to traditional flavonoid determination methods in SAV. In summary, this novel method provides a theoretical basis for assessing flavonoid content in SAV samples and tracing SAV products. This contribution has significant implications for enhancing analytical techniques in food chemistry and environmental science and the sustainable development of the food industry.

A Leading Role of Water Resources and Animal Husbandry in Environmental Sustainability: A Case Study of China.

Animal husbandry is an important emission source of greenhouse gas. In order to discover the real situation of carbon emission in China's animal husbandry scientifically, the paper measured and calculated carbon emission in China's animal husbandry from 1997 to 2017 on the basis of soil and water resources. In addition, analyzing its time-order characters, structural characters, driving factors and decoupling relationships are all done in this treatise. Major findings are as follows: (1) The carbon emission of China's animal husbandry in 2017 was 374.3528 million tons, an increase of 17.8066 million tons over 1997, with the average annual growth rate of 0.24% and the average annual carbon emission of 398.7817 million tons; (2) There was a decreasing trend in carbon emission of intestinal fermentation in China's animal husbandry while there was an increasing trend in carbon emission of manure emission in China's animal husbandry; (3) The carbon emission of China's animal husbandry peaked in 2006 and went through three phases of up-down-steady between 1997 and 2017; (4) The contribution of cattle, pig, sheep, other large livestock, poultry and rabbits to China's animal husbandry carbon emissions decreased in turn, and the average contribution of cattle, pigs and sheep to China's animal husbandry carbon emissions was as high as 98.15%. (5) Five factors reducing carbon emission of China's animal husbandry were carbon intensity, agricultural industrial structure, agricultural population-water resources matching degree, agricultural water-soil resources and per capita cultivated land area. Two factors increasing carbon emission of China's animal husbandry were population and economic benefits of agriculture per unit agricultural population; (6) There was a generally weak decoupling between carbon emission in China's animal husbandry and animal husbandry's economic growth from 1997 to 2017.

Rheumatic heart disease burden, trends, and inequalities in Asia, 1990-2019.

BACKGROUND: Rheumatic heart disease (RHD) is a serious global public health problem. OBJECTIVES: This study aims to characterise the regional burden, trends, and inequalities of RHD in countries and territories in the Asian Region. METHODS: The RHD disease burden was measured in terms of the numbers of cases and deaths, prevalence, disability-adjusted life years (DALYs), disability-loss healthy life years (YLDs), and years of life lost (YLLs) in 48 countries in the Asian Region. Data on RHD were extracted from the 2019 Global Burden of Disease. This study analysed changing trends in the burden between 1990 and 2019, quantified regional inequalities in mortality, and classified countries by 2019 YLLs. RESULTS: There were an estimated 22 246 127 cases of RHD in the Asian Region in 2019 and 249 830 deaths. The prevalence of RHD in the Asian Region in 2019 was 9% lower than the global estimate, while mortality was 41% higher. The mortality rate for RHD in the Asian Region trended downwards from 1990 to 2019, with an average annual percentage change of -3.2% (95% UI -3.3 to -3.1). From 1990 to 2019, absolute inequality in RHD-related mortality decreased in the Asian Region while relative inequality increased. Of the 48 countries studied, twelve had the highest level of RHD YLLs in 2017 and the smallest reduction in YLLs from 1990 to 2019. CONCLUSION: Although the burden of RHD in the Asian Region has steadily decreased since 1990, it remains a serious public health issue requiring greater attention. In the Asian Region, inequalities in the distribution of the RHD burden remain significant, with economically deprived countries typically bearing a greater share of the load.

Initial ecological restoration assessment of an urban river in the subtropical region in China.

Rivers in urbanised cities are often polluted, black, and odorous, with poor water quality and deteriorated ecology. Despite many river restoration studies, assessments of ecological responses to river restoration practices remain scant. Benthic animals are useful biological indicators showing the change and succession of river ecosystems; however, previous studies have mainly focussed on a few target species without considering overall ecosystem integrity. Here, we used a multi-index biological assessment method, benthic index of biological integrity (B-IBI) to assess ecological responses to river restoration of the Shahe River in subtropical region of China. Spatiotemporal changes in the macrobenthos community structure after restoration were monitored to explore species succession. We found that the number of macrobenthos species increased from 16 to 42, with the emergence of some pollution-sensitive species during the restoration period. Molluscs showed widespread recovery, and their relative proportions almost doubled from 12.5% to 24.4%. Oligochaetes and chironomids were the pioneer species in the recovering communities, while gastropod molluscs and pollution-sensitive aquatic insects were transitional species that first settled during the initial recovery period. Based on our survey data, 25 candidate metrics were selected, and five core metrics (total taxa, Simpson diversity index, percentage of crustaceans and molluscs, percentage of predators, and percentage of collector-gatherers) were identified after screening to establish the B-IBI. Our analysis revealed a distinct improvement in the overall health of the river, with the proportions of "excellent" and "good" sites increasing from zero to 28.6% and from 14.3% to 42.9%, respectively. A correlation analysis indicated that water flow, molluscs, and total phosphorus content were the three drivers of ecological recovery in the Shahe River. Overall, our study demonstrates the importance of governance and restoration of rivers in tropical and subtropical cities, and provides valuable evidence that can guide the design and evaluation of river restoration works.

Global burden of rheumatic heart disease and its association with socioeconomic development status, 1990-2019.

AIMS: Rheumatic heart disease (RHD) remains an important health issue, yet global attention to RHD is diminishing. This study aimed to investigate the global burden of RHD and its relationship with socioeconomic development status. METHODS AND RESULTS: Data were obtained from the Global Burden of Disease (GBD) 2019 database. Incidence, prevalence, disability-adjusted life years (DALYs), and mortality numbers and rates for RHD were extracted and stratified by sex, level of socio-demographic index (SDI), country, and territory. In addition, the burden of RHD was compared across age groups. From 1990 to 2019, the age-standardized incidence and prevalence rates of RHD increased by 14.4% (11.2-17.0%) and 13.8% (11.0-16.0%), respectively. Incidence and prevalence rates showed an increasing trend in low SDI and low-middle SDI locations, while high-middle SDI and high SDI locations showed a decreasing trend. The age-standardized DALYs and mortality rates of RHD decreased by 53.1% (46.4-60.0) and 56.9% (49.8-64.7%), and this downward trend was more prominent in high-middle SDI and middle SDI locations. In addition, the age of incidence and prevalence rates were concentrated between 5-24 years and 15-49 years, predominantly in poor regions, and RHD appeared to be more common in women than in men. CONCLUSION: The burden of RHD is negatively correlated with socioeconomic development status. In particular, the burden of RHD among children, adolescents, and women of childbearing age in poorer regions requires more attention. Policymakers should use the 2019 GBD data to guide cost-effective interventions and resource allocation for RHD.

To establish a model for the prediction of initial standard and maintenance doses of warfarin for the Han Chinese population based on gene polymorphism: a multicenter study.

PURPOSE: The purpose of this paper is to study the correlation between demographic and clinical factors and warfarin dose of patients in Chinese Han population taking warfarin and study gene polymorphisms impact of related gene loci (CYP2C9*3, VKORC1-1639G > A) on warfarin doses, to establish a model to predict initial standard dose and maintenance dose based on CYP2C9*3, VKORC1-1639G > A genotype. METHODS: The study collects the data of patients in our hospital and other subcenters which incorporates 2160 patients to establish the initial dose model and 1698 patients for the stable dose model, and sequences 26 multigene sites in 451 patients. Based on the patient's dosage, clinical data, and demographic characteristics, the genetic and non-genetic effects on the initial dose and stable dose of warfarin are calculated by using statistical methods, and the prediction model of initial standard dose and maintenance dose can be established via multiple linear regression. RESULTS: The initial dose of warfarin (mg/day) was calculated as (1.346 + 0.350 × (VKORC1-1639G > A) - 0.273 × (CYP2C9*3) + 0.245 × (body surface area) - 0.003 × (age) - 0.036 × (amine-iodine) + 0.021 × (sex))2. This model incorporated seven factors and explained 55.3% of the individualization differences of the warfarin drug dose. The maintenance dose of warfarin (mg/day) was calculated as (1.336 + 0.299 × (VKORC1-1639G > A) + 0.480 × (body surface area) - 0.214 × (CYP2C9*3) - 0.074 × (amine-iodine) - 0.003 × (age) - 0.077 × (statins) - 0.002 × (height))2. This model incorporated six factors and explained 42.4% of the individualization differences in the warfarin drug dose. CONCLUSION: The genetic and non-genetic factors affecting warfarin dose in Chinese Han population were studied systematically in this study. The pharmacogenomic dose prediction model constructed in this study can predict anticoagulant efficacy of warfarin and has potential application value in clinical practice.

The Value of Mobile Health in Improving Breastfeeding Outcomes Among Perinatal or Postpartum Women: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Breastfeeding is essential for maintaining the health of mothers and babies. Breastfeeding can reduce the infection rate and mortality in newborns, and can reduce the chances of overweight and obesity in children and adolescents. For mothers, a longer duration of breastfeeding can reduce the risk of breast cancer, ovarian cancer, and type 2 diabetes. Although breastfeeding has many benefits, the global breastfeeding rate is low. With the progress of time, the popularity of mobile devices has increased rapidly, and interventions based on mobile health (mHealth) may have the potential to facilitate the improvement of the breastfeeding status. OBJECTIVE: The main objective of this study was to analyze the existing evidence to determine whether mHealth-based interventions can improve the status of breastfeeding. METHODS: We systematically searched multiple electronic databases (PubMed, Web of Science, The Cochrane Library, Embase, CNKI, WanFang, and Vip ) to identify eligible studies published from 1966 to October 29, 2020. Included studies were randomized controlled trials (RCTs) studying the influence of mHealth on breastfeeding. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RevMan 5.3 was used to analyze the data. RESULTS: A total of 15 RCTs with a total sample size of 4366 participates met the inclusion criteria. Compared with usual care, interventions based on mHealth significantly increased the postpartum exclusive breastfeeding rate (odds ratio [OR] 3.18, 95% CI 2.20-4.59; P<.001), enhanced breastfeeding self-efficacy (mean difference [MD] 8.15, 95% CI 3.79-12.51; P=.002; I2=88%), reduced health problems in infants (OR 0.62, 95% CI 0.43-0.90; P=.01; I2=0%), and improved participants' attitudes toward breastfeeding compared with usual care (MD 3.94, 95% CI 1.95-5.92; P<.001; I2=0%). There was no significant difference in the initiation of breastfeeding within an hour of birth between the intervention group and the usual care group (OR 1.26, 95% CI 0.55-2.90; P=.59). In addition, subgroup analysis was carried out according to different subjects and publication times. The results showed that the breastfeeding rate was not limited by the types of subjects. The breastfeeding rate based on mHealth at 1 month and 2 months after delivery did not change over the time of publication (2009 to 2020), and the breastfeeding rate based on mHealth at 3 months and 6 months after delivery gradually increased with time (2009 to 2020). CONCLUSIONS: Interventions based on mHealth can significantly improve the rate of postpartum exclusive breastfeeding, breastfeeding efficacy, and participants' attitudes toward breastfeeding, and reduce health problems in infants. Therefore, encouraging women to join the mHealth team is feasible, and breastfeeding-related information can be provided through simple measures, such as text messages, phone calls, and the internet, to improve the health of postpartum women and their babies.

Epidemics, Public Sentiment, and Infectious Disease Equity Market Volatility.

Background: This article studies the relationship between the COVID-19 epidemic, public sentiment, and the volatility of infectious disease equities from the perspective of the United States. We use weekly data from January 3, 2020 to March 7, 2021. This provides a sufficient dataset for empirical analysis. Granger causality test results prove the two-way relationship between the fluctuation of infectious disease equities and confirmed cases. In addition, confirmed cases will cause the public to search for COVID-19 tests, and COVID-19 tests will also cause fluctuations in infectious disease equities, but there is no reverse correlation. The results of this research are useful to investors and policy makers. Investors can use the number of confirmed cases to predict the volatility of infectious disease equities. Similarly, policy makers can use the intervention of retrieved information to stabilize public sentiment and equity market fluctuations, and integrate a variety of information to make more scientific judgments on the trends of the epidemic.

The effect of online versus hospital warfarin management on patient outcomes: a systematic review and meta-analysis.

Background Patients using oral anticoagulants are prone both to thrombus from insufficient anticoagulant therapy and to bleeding by overmedication, so there is a need for further exploring. Aim of the review To assess the effect of online management (using electronic communication such as smartphone), and hospital management on the outcome of patients on long-term anticoagulant therapy, and to explore an appropriate anticoagulation management model. Method Studies published in English prior to July 2017 were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library. Two researchers screened the literature independently, extracted the data and evaluated the methodological quality of the included studies. Meta-analysis was conducted using RevMan 5.3 software. The publication bias analysis was evaluated. Results A total of ten studies met the inclusion criteria, covering 16,915 patients. Of these, 8260 cases formed the online anticoagulation management group, and the other 8655 cases the hospital anticoagulant management group. There were no significant differences between the management models for time in therapeutic range, incidence of major or minor bleeding events, thromboembolic events, or warfarin-related emergency department visits. However, online management was associated with fewer warfarin-related hospital admissions than hospital management (odds ratio: 0.47, 95% confidence interval [0.30, 0.73]; P = 0.0009). Conclusion The online management of anticoagulant therapy was not inferior to hospital management, and may provide more convenient, higher quality anticoagulant therapy services for patients.

Outcomes of an online computerized cognitive behavioral treatment program for treating chinese patients with depression: A pilot study.

OBJECTIVE: This pilot study examined the feasibility, safety, and effectiveness of using an online computerized cognitive behavioral therapy (CBT) for treating Chinese patients with depression. METHODS: Seventy-five Chinese patients with depression in outpatient clinics were randomized into a 5-week intervention. The intervention group received the Chinese translated version of MoodGYM in addition to usual treatment, and the control group continued with usual treatment. Participants completed the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) pre- and post-intervention. RESULTS: We conducted multivariate linear regression analyses to compare the change in CES-D scores for completers after the intervention. Seventy-eight percent (n=29) of participants in the intervention group and 84% (n=32) of patients in the control group completed the post-treatment assessments, and no serious adverse events were reported. Results indicated that while both groups significantly improved at post test, the intervention group improved significantly more than the control group (t(59)=2.37, p=0.02). CONCLUSION: Computerized CBT can be a cost-effective adjunct to medication treatment, particularly in areas with limited access to mental health services. The use of online computerized CBT has been found to be effective in many studies in Western countries, but has not been studied among Chinese outpatients. This study suggests that online computerized CBT is acceptable, and that MoodGYM is a feasible and efficacious augmentative treatment, specifically when used within an outpatient clinic population. With this small sample size we were able to demonstrate that the addition of MoodGYM to usual care improved treatment outcomes for outpatients with depression in China.

[Evaluation on the validity and reliability of the Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale (DSKAB)].

OBJECTIVE: To evaluate the validity and reliability of Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale (DSKAB). METHODS: We selected 460 patients with diabetes in the community, used the scale which was after two rounds of the Delphi method and pilot study. Investigators surveyed the patients by the way of face to face. by draw lots, we selected 25 community diabetes randomly for repeating investigations after one week. The validity analyses included face validity, content validity, construct validity and discriminant validity. The reliability analyses included Cronbach's α coefficient, θ coefficient, Ω coefficient, split-half reliability and test-retest reliability. RESULTS: This study distributed a total of 460 questionnaires, reclaimed 442, qualified 432. The score of the scale was 254.59 ± 28.90, the scores of the knowledge, attitude, behavior sub-scales were 82.44 ± 11.24, 63.53 ± 5.77 and 108.61 ± 17.55, respectively. It had excellent face validity and content validity. The correlation coefficient was from 0.71 to 0.91 among three sub-scales and the scale, P<0.001. The common factor cumulative variance contribution rate of the scale and three sub-scales was from 57.28% to 67.19%, which achieved more than 50% of the approved standard, there was 25 common factors, 91 items of the total 98 items held factor loading ≥0.40 in its relevant common factor, it had good construct validity. The scores of high group and low group in three sub-scales were: knowledge (91.12 ± 3.62) and (69.96 ± 11.20), attitude (68.75 ± 4.51) and (58.79 ± 4.87), behavior (129.38 ± 8.53) and (89.65 ± 11.34),mean scores of three sub-scales were apparently different, which compared between high score group and low score group, the t value were - 19.45, -16.24 and -30.29, respectively, P<0.001, and it had good discriminant validity. The Cronbach's α coefficient of the scale and three sub-scales was from 0.79 to 0.93, the θ coefficient was from 0.86 to 0.95, the Ω coefficient was from 0.90 to 0.98, split-half reliability was from 0.89 to 0.95.Test-retest reliability of the scale was 0.51;the three sub-scales was from 0.46 to 0.52, P<0.05. CONCLUSION: The validity and reliability of the Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale are excellent, which is a suitable instrument to evaluate the self-management for patients with diabetes.

[Assessment of the reliability and validity of the Sub-health Measurement Scale Version1.0].

OBJECTIVE: To assess the reliability and validity of the Sub-health Measurement Scale Version 1.0 (SHMS V1.0). METHODS: A spot trial sampling of 2000 individuals was conducted to study the test-retest reliability, Cronbach alpha coefficient, split-half reliability, contract validity, content validity and criterion-related validity of SHMS V1.0. RESULTS: The spot trial results indicated a test-retest reliability of SHMS V1.0 of 0.644 (P<0.001) with a Cronbach α coefficient of 0.917 and a split-half reliability of 0.831. The results showed a close correlation between each item of SHMS V1.0 and its dimension, but a low correlation between a particular item and other dimensions. The dimension score was significantly correlated to its subscale scores, but not to other subscale scores. The results of factor analysis matched the theoretical conception of SHMS V1.0. The correlation coefficient between SHMS V1.0 and SF-36 was 0.664 (P<0.001). CONCLUSION: SHMS V1.0 has a good reliability and validity, and is a reliable and valid measurement scale for sub-health evaluation.

Self-rated health of population in Southern China: association with socio-demographic characteristics measured with multiple-item self-rated health measurement scale.

BACKGROUND: Self-rated health (SRH) status has been increasingly acknowledged as a valid and appropriate indicator of public health and chronic morbidity. However, limited research was conducted in China due to the different culture and socioeconomic situations. The aim of this study is to assess the SRH status of the population in Southern China using multiple-item SRH measurement scale (SRHMS). Socio-demographic characteristics including sex, age, marital status, education, and income are considered variable in this survey. METHODS: A cross-sectional survey was conducted in a total of 8400 community residents of 14 years old and over in Southern China. SRH status was measured using SRHMS with a stratified sampling approach, and compared between different subgroups with t-test and one-way analysis of variance (ANOVA). RESULTS: Totally 8400 subjects were recruited in this study and 80.96% (6801) responded to the survey. The mean score for SRHMS dimensions ranged from 66.16 +/- 20.65 (mean +/- sd) for positive emotion (M2) to 92.14 +/- 14.06 for daily physical activities (B2). Results showed that SRHMS scores for women, elderly men, low education level, low income, divorced, separated or widowed and suburban residents in Southern China were significantly lower than other subgroups (P < 0.05). CONCLUSIONS: In this study, using SRHMS we assessed the association of SRH with socio-demographic characteristics including sex, age, marital status, education, and income in Southern China. The performance of the questionnaire in the large scale survey is satisfactory and provides a large picture of SRH status in Southern China. Our results indicate that women, elderly men, low education level, low income, divorced, separated or widowed and suburban residents in Southern China suffer from relatively poor SRH status.

[Detection of esophageal intubation-assessment of several methods in clinical anesthesia].

OBJECTIVE: To evaluate the sensitivity and reliability of several widely used tests for prompt detection of inadvertent esophageal intubation. METHODS: Both endotracheal and esophageal intubations were made on 40 adult patients undergoing general anesthesia. The tests such as auscultation of bilateral apex of lungs and epigastrium by inexperienced examiners, capnography, SpO2, chest and upper abdomen movements, and airway resistance were evaluated. RESULTS: 90% and 96.25% cases in esophageal intubation were correctly diagnosed via auscultation of bilateral apex of lungs or epigastrium respectively. During esophageal ventilation, abdominal distension was found in 87.5% of cases, but none of them showed chest movements. Meanwhile, PetCO2 fluctuated between 1-2 mmHg, in association with a quick decline of SpO2 in 156 +/- 11 seconds. The airway mean resistance increased, whereas the period of plateau decreased significantly. CONCLUSIONS: (1) Auscultation of epigastrium in combination with bilateral apex of lungs is recommended because of the improved accuracy in tube positioning. (2) Capnography is the most reliable technique for the prompt detection of esophageal intubation, whereas other parameters do not seem to be of comparable value.