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@#Two Hofmann-Martius-like rearrangement products generated in the production of duloxetine hydrochloride were studied. The structures and generation mechanism of the two Hofmann-Martius rearrangement products were analyzed by LC-MS and NMR. The results showed that under the acidic conditions, the naphthol ether bond of duloxetine would break down and the intermediates of naphthol and the alkyl thiophene cation was generated; the two Hofmann-Martius-like rearrangement products were proven to be a pair of isomers produced by nucleophilic substitution between the naphthol intermediate state and the alkyl thiophene cation intermediate state at the ortho or the para position, respectively. The production of two isomers was related to the strong acidic and protic solvent environment. Therefore, in the salting process of duloxetine hydrochloride, the pH value should be controlled in the range of 3-7 and temperature should be maintained below 50 °C, as well as the nonprotic solvent acetone is chosen to avoid generation of the two isomers.
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Objective To investigate the effect of pre- hospital emergency care programs in children with febrile seizures,in order to reduce damage by febrile seizures and obtain the best firstaid effect. Methods 112 cases of children with febrile seizures were treated in pediatric department of our hospital from April 2009 to February 2011.The parents of 75 children patients were given guidance of prehospital emergency care,they were set as the pre-hospital emergency care group.The other 37 cases were set as the non-pre-hospital emergency care group,routine emergency care was given until the medical personnel arrived at the spot.The conditions of aspiration,tongue bite injury,another episode of febrile seizures and brain damage were recorded in two groups of children. Results Only one case of aspiration and three cases of febrile seizures occurred in the pre-hospital emergency care group by misoperation of parents.Non brain damage and tongue bite injury occurred.The incidence rate of improper consequences was 5.3％in the pre-hospital emergency care group,lower than that of the non-pre-hospital emergency care group,51.4％. Conclusions To give pre-hospital emergency care guidance to parents of children patients by mobile phones before the health care workers reach the spot can significantly reduce accidental injury of children,stabilize the emotion of parents,decrease the impact of seizures on children,all the above has a positive effect on follow-up treatment.
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Objective To explore the influence of health education on patients with dysphgia and related complications.Methods Different methods of health education were used with 87 patients with different dysphagia conditions and their earegivers.The health education was oriented to dysphgia evaluation and appropriate functional training to improve deglutition.The severity of dysphgia and related complications were observed before and after the health education. Results Health education combined with functional training could reduce the possibility of pul-monary infection,misaspiration and malnutrition for post-stroke dysphagic patients,and the difference was statistical-ly significant. Conclusions Health educmion combined with functional training is effective in reducing the possi-bility of pulmonary infection and malnutrition and preventing misaspiration in stroke patients with dysphgia.It can help such patients regain the independent deglutition ability in the short term.