Child birth is associated with severely painful experience for the parturient, and often exceeds one’s expectations. Even though, severe pain is non life-threatening condition in healthy parturient women, it may lead to undesired neuropsychological consequences. When no analgesia was used, postnatal depression may be more common, and this labour pain leads to the development of post-traumatic stress disorder. Epidural analgesia is now considered gold standard for effective pain relief during labour. We here report a case of a 37-year-old G1 P0 patient at term gestation who successfully used epidural analgesia for labour pain management.

We compared the analgesic profile between patient-controlled analgesia (PCA) using oxycodone and morphine in post total abdominal hysterectomy patients. Eighty-four ASA I or II patients, aged 18 to 65 years who underwent total abdominal hysterectomy were recruited into this prospective, double blind, randomised controlled study. They were randomised to receive either PCA oxycodone 0.7 mg per bolus or PCA morphine 1 mg per bolus for postoperative pain relief. At the end of surgery, all patients received IV morphine 0.1 mg/kg and skin incision was infiltrated with 20 mls of bupivacaine 0.25%. Post-operative pain scores, opioids consumptions, sedation scores and side effects were assessed upon arrival and at 30 minutes after arrival to recovery area, as well as at 6 hours and 24 hours after the operation in the ward. Patients’ overall satisfaction was also assessed 24 hours postoperatively.No significant differences were observed in terms of postoperative pain scores, opioids consumption, sedation scores, side effects as well as patient’s overall satisfaction between the PCA oxycodone and PCA morphine group. Oxycodone was comparable to morphine as PCA in terms of total opioid consumption, pain scores and satisfaction level for patients undergoing total abdominal hysterectomy and therefore may be an alternative to morphine in postoperative pain management as PCA
morphine ; oxycodone ; pain scores ; patient controlled analgesia ; total abdominal hysterectomy

OBJECTIVE: To investigate the prehospital intervention based on emergency medical services (EMS) in patients with acute ischemic stroke (AIS) for door-to-needle time (DNT) with intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) impact. METHODS: 112 emergency patients receiving rt-PA intravenous thrombolysis admitted to the First Hospital of Qinhuangdao City based on EMS from June 2016 to December 2017 were enrolled. According to whether or not to receive prehospital interventions, patients were divided into prehospital intervention group (n = 42) and routine treatment group (n = 70). Both groups followed the general principles of first aid, including assessment and support of the airway, respiration, and circulation, and blood glucose, electrocardiogram, and dynamic vital signs were monitored. Based on the general principle of EMS, first-aid personnel in the prehospital intervention group screened suspected acute stroke patients requiring prehospitalization according to Los Angeles prehospital stroke screening table (LAPSS), and established fluid ways, and got blood samples to evaluate rt-PA intravenous thrombolysis and risks. Factors influenced DNT compliance were analyzed through multivariate Logistic regression, which included the education level of the patient, whether there were risk factors related to cerebrovascular disease (hypertension, coronary heart disease, diabetes), visit time, National Institute of Health stroke scale (NIHSS) score, whether received EMS intervention or not. The average DNT, DNT ≤ 60 minutes compliance rate, communication time, and decision time for thrombolysis were compared between the two groups. NIHSS score was used to evaluate the effective rate of thrombolysis for 7 days. The modified Rankin score (mRs) was used to evaluate the neurological function after 3 months of thrombolysis (a mRs score of 0-2 was defined as a good nerve function). RESULTS: Univariate analysis showed that the DNT of patients with NIHSS score > 5 was significantly shorter than those with NIHSS score ≤ 5, and DNT in patients received EMS intervention was significantly shorter than the non-receiver; but education level, visiting time, and risk factors associated with cerebrovascular disease had nothing to do with DNT. Multivariate Logistic regression analysis showed that NIHSS score and EMS intervention were the influencing factors of DNT compliance [NIHSS score: odds ratio (OR) = 0.452, 95% confidence interval (95%CI) = 0.162-1.263, P = 0.030; EMS intervention: OR = 3.077, 95%CI = 1.260-7.514, P = 0.014]. Compared with conventional treatment group, DNT of intravenous thrombolytic in prehospital intervention group was significantly shortened (minutes: 62.00±11.07 vs. 78.03±21.04), DNT ≤ 60 minutes compliance rate was significantly increased [35.7% (15/42) vs. 12.9% (9/70)], communication time [minutes: 4 (3, 6) vs. 6 (5, 9)] and decision-making thrombolytic time (minutes: 5.81±2.48 vs. 6.70±2.15) were significantly shortened, the differences were statistically significant (all P < 0.05). The 7-day effective rate in the prehospital intervention group [33.3% (14/42) vs. 14.3% (10/70), χ² = 5.657, P = 0.017] and the 3-mouth good rate of nerve function [38.1% (16/42) vs. 14.3% (10/70), χ² = 10.759, P = 0.001] were significantly higher than those in the conventional treatment group. CONCLUSIONS Prehospital interventions based on EMS can shorten DNT of intravenous thrombolysis in the patients with AIS, improve treatment efficiency, and improve prognosis.
Brain Ischemia ; Emergency Medical Services ; Humans ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Treatment Outcome

OBJECTIV E To in vestigate the situation ，achievements and proble ms of consistency evaluation policy of generic medicines in China. METHODS The descriptive analysis was performed after collecting and sorting out the information of generic medicine passing consistency evaluation （GMPCE） published on the official website of the National Medical Products Administration. The basic information ，the distribution and changes of GMPCE were analyzed statistically in National Essential Medicine List （hereinafter refer to as “essential medicine list ”），Medicine List for National Basic Medical Insurance ，Industrial Injury Insurance and Maternity Insurance （hereinafter refer to as “medical insurance list ”）and the result of the successful selection of centralized medicine procurement organized by the state （hereinafter refer to as “centralized procurement list ”）. RESULTS From 2017 to 2021，415 chemical generic drugs had passed consistency evaluation in China ，including 309 varieties，1 822 specifications， 6 dosage forms ，and 17 pharmacological mechanisms ，basically belonging to 30 provinces，and 492 drug manufacturers （except 12 products had not been found the manufacturers ）；the proportion of GMPCE in essential medicine list increased from 0.96％ in 2012 edition to 25.40％ in 2018 edition；that of GMPCE in medical insurance list increased f rom 2.13％ in 2017 edition to 11.68％ in 2021 edition；in the first 5 batches of centralized procurement list，GMPCE accounted for 81.65％，and the maximum price drop after entering the list was 97.52％. CONCLUSIONS The policy linkage has been achieved with the continual increase of the number of GMPCE and their total amount in three lists in China. The accessibility and affordability of related medicines have been improved with the apparent decrease of the price of those medicines. H owever，total number of GMPCE is a little small，with the higher repetition rate of variety and the low proportion in the three lists ；the guarantee measures of those medicine supply need to be strengthened.

OBJECTIVE： To establish the separation and purification technology of sanguinarine from the extract of Macleaya cordata with ion exchang resin. METHODS： The content of sanguinarine from the extract of M. cordata was determined by HPLC， with  Cosmosil C18-R-Ⅱ column （250 mm×4.6 mm，5 μm）， mobile phase of acetonitrile-0.2％ acetic acid solution （25 ∶ 75，V/V）， the flow rate of 1 mL/min， detection wavelength of 270 nm， column temperature of 30 ℃， and sample size of 20 μL. Static adsorption and desorption tests were carried out to compare the adsorption and desorption properties of 8 ion exchange resins for sanguinarine. The optimum concentration of sample solution， pH value and volume of sample were investigated by optimum ion exchange resin. APPS 10D liquid phase preparation system was used to investigate the dynamic elution conditions and obtain M. cordata refined extract solution. The refined purified product of M. cordata was obtained by desalination， elution on a reversed-phase （RP） C18 column and drying.  The purity of the purified product was analyzed by HPLC. The structure of the purified product was confirmed by HPLC， UV spectrophotometry， MS and NMR. RESULTS： CM-FF resin was screened for the separation and purification of sanguinarine from M. cordata extract. It was eluted with 20 mmol/L ammonium acetate solution 100 mL containing 20％ methanol and 0.25 mol/L sodium chloride. The optimal dynamic absorption condition included that the concentration of sample was 6.0 mg/mL at pH 5.0，and the loading amount was 25 mL； after desalination and refinement， for the eluted refined extract， the purified product with 97％ purity （purified yield  of 71％） was obtained， and its structure was confirmed to be sanguinarine. CONCLUSIONS： The optimal separation and purification technology by ion exchange resin is green， safe， efficient and easy to operate， which can be used for the separation and purification of sanguinarine from M. cordata extract and is suitable for industrial production.