Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Butorphanol in epidural:Could this be the breakthrough solution for safe and effective labor analgesia that we've been waiting for?

The authors have conducted a comprehensive investigation into the safety and effectiveness of butorphanol for epidural analgesia during labor.Their critical analysis of the paper and discussion of the technique's advantages and disadvantages provide a thorough understanding of the topic.

Rural labor migration and farmers’arrangements of rice production systems in Central China:Insight from the intergenerational division of labor

Rice production is crucial for food security in China,and its relationship with rural labor migration has been studied extensively.Labor migration in rural China has taken new forms in recent years.There has been a discernible trend wherein adult children have started migrating to cities while their elderly parents return to villages to re-engage in on-farm work.The phenomenon has notably shaped the intergenerational division of labor(IDL)within households.However,it remains to be seen how farmers adjust their rice production systems in response to the IDL.The age of 60 years for employment injury insurance is the eligibility threshold for off-farm employment and is used to obtain a source of exogenous variation in the IDL.Based on a representative household survey of 1,752 rice farmers in the Hubei Province of Central China,our fuzzy regression discontinuity analysis reveals that farmers in IDL households are more likely to adopt ratoon rice(RR)than single cropping rice(SR)or double cropping rice(DR).The effect of the IDL varies under different levels of operational scales and specialized agricultural service availability.Further analysis suggests that farmers’arrangements are associated with two potential mechanisms of downward intergenerational transfer.Monetary transfer for urban housing purchases increases RR in IDL households,and time transfer for intergenerational childcare significantly promotes SR in IDL households.This study enhances the understanding of the relationship between rural labor migration and rice production in China,providing a reference for adjusting rice production systems to ensure food security.

Addressing Japan’s disposal of nuclear-contaminated water from the perspective of international human rights law

The discharge of nuclear-contaminated water containing radionuclides into the ocean by Japan will lead to its integration into the entire ecosystem through processes of circulation and biomagnification,eventually entering the human body via the food chain.This poses a substantial risk of irreversible damage to both the ecosystem and human health,a situation that will worsen with the ongoing discharge of such water.The respect and protection of human rights represent an international consensus,and safeguarding fundamental human rights is a substantial obligation that states must undertake in accordance with both international and domestic law.Since the Fukushima nuclear disaster,Japan has continuously violated its international legal obligations to protect human rights in several areas,including the resettlement of disaster victims,the reduction of nuclear radiation levels,and the handling of contaminated water.Such actions have compromised and will continue to compromise the basic human rights of not only its citizens but also those of people worldwide,including environmental rights,the right to life,development rights,and food rights.In the aftermath of the Fukushima meltdown,the public and workers involved in handling nuclear contaminants have been continually exposed to high radiation levels,endangering their rights to life,development,and health.Japan’s inadequate efforts in victim resettlement and environmental restoration have jeopardized the environmental and food rights of its citizens to live healthily and access food in an environment unaffected by nuclear radiation.The release of nuclear-contaminated water poses a risk of Japan’s nuclear pollution to the people of neighboring countries and the global population at large.The principle of human rights underpins the theory of a community with a shared future for humanity,and human rights are a crucial area of China’s active participation in United Nations affairs and global governance.By voicing concerns over Japan’s potential human rights violations globally,China demonstrates its role as a responsible major country.In response to Japan’s breach of legal obligations and human rights violations,China can adopt a reasoned and beneficial approach,including calling on the international community to hold Japan criminally accountable for crimes against humanity under the Rome Statute and advancing scholarly discussions on ecocide and crimes against the marine environment.Furthermore,China should persist in seeking advisory opinions from the International Court of Justice and strive for substantive accountability,utilizing the mechanisms of international human rights organizations to make its voice heard.

Advances in epidural labor analgesia:Effectiveness and treatment strategies of butorphanol

In this editorial,we provide a critical review of the article by Tang et al published in the World J Clin Cases,focusing on the utilization of butorphanol for epidural analgesia during labor.Our discussion encompasses recent research developments in epidural labor analgesia,specifically highlighting the current status of clinical applications of butorphanol and associated treatment approaches.Epidural analgesia is widely acknowledged as the primary method for pain management during labor,offering effective and prolonged pain relief while allowing mothers to remain alert and actively participate in the delivery process.Among the various drugs utilized for epidural labor analgesia,butorphanol has received increasing attention due to its potential efficacy and distinctive pharmacological properties.As a synthetic opioid analgesic,butorphanol exhibits both agonistic and antagonistic activity on opioid receptors,striking a balance between analgesia and minimizing side effects.Nevertheless,the safety and efficacy of butorphanol in epidural labor analgesia remains controversial.While certain studies have reported positive outcomes with butorphanol,including effective pain relief and a reduced incidence of side effects,others have raised concerns about its safety and efficacy compared to traditional opioids or alternative analgesics.In addition,the optimal dosing strategy and regimen of butorphanol as an adjuvant in epidural labor analgesia still need to be verified.Through comprehensive synthesis and analysis of existing literature,we aim to evaluate the current evidence regarding the use of butorphanol for epidural labor analgesia,delineate areas of consensus and controversy,and propose future avenues for research and clinical practice in this domain.

Association of Squatting Activities of Pregnant Women during the Antenatal Period and Labor Outcomes

Aim: To investigate impact of antenatal squatting activities on labour outcomes. Methods: All eligible primigravida women, with singleton cephalic fetuses, who presented to ward 18 of Colombo South Teaching Hospital, Sri Lanka, during the period 1st of February to 28th of May 2017 were invited into the study. Those who were already in active stage of labor (at least more than two moderate contractions per 10 minutes) on admission were excluded. Demographic data such as age, ethnicity, religion, educational level, occupation, latrine type in use, and booking Body mass index (BMI) were collected via an interviewer administered questionnaire. Data related to labor (modified Bishop score at onset of active labor, labor augmentation, pain relief, labor duration, mode of delivery, episiotomy or tears) and neonatal outcome (birth weight, APGAR score at 1, 5, 10 minutes) were collected from delivery notes. A pre tested interviewer administered questionnaire was used to obtain data regarding routine squatting activities during the previous 6 months. Pain visual analogue scale was used on day after delivery to assess the degree of labour pain. Duration of each squatting activity per day and number of days engaged with the activity per week;were used to calculate total squatting hours per week. In the absence of an accepted threshold for adequate squatting, we employed the sample mean as an operational data-driven threshold to define “more” against “less” squatting activities. Women who did not have squatting activities were considered as the controls. We used chi-square and Fisher’s exact tests to compare characteristics and outcomes between those engaging in more and less levels of squatting activity. We fitted a series of logistic regression models with each dichotomized outcome as the dependent variable, more/less squatting activity as the main independent variable of interest, and age, gestation period, BMI and patient’s occupation as covariates. The resulting adjusted odds ratios (AOR) and their 95% confidence intervals (CI) and statistical significance (p < 0.05) were used to draw conclusions of adjusted associations. Results: We recruited 430 women into this study. Overall, 68% of the women were of 20 - 30 years old, 47% had normal body mass index and 65% were housewives. The most frequent squatting activities were for urination/defecation and clothes washing (146 and 62 minutes/week, respectively). Mean total time was 246 minutes per week, of which more than 147 women (34%) achieved above this level of squatting activities. Those with more squatting activities had a greater modified Bishop Score ≥ 6/10 (92% vs 82%;p < 0.01);labor duration of <6 hours (82% vs 56%;p < 0.01), less likely for labour augmentation (39% vs 51%;p < 0.01) and pain relief (53% vs 65%;p = 0.013). Similar results were obtained after adjustments for maternal age, BMI, gestational age and occupation. However, there were no significant differences in the mode of delivery (normal vaginal vs instrumental vs caesarean), episiotomy rate, birth weight and neonatal Apgar scores. Conclusion: Squatting activities of more than 246 minutes per week may improve labor outcome. Women should be encouraged to increase squatting exercises or incorporate more habitual squatting activities antenatally.

Pragmatist View of Human Rights:Theoretical Explanations of China’s Human Rights Practice

The pragmatist view of human rights represents a the-oretical condensation of the Chinese practice in human rights devel-opment.In view of the problem of circular idling between rights and claims caused by the traditional view of human rights of focusing on contents and not valuing implementation,social segmentation caused by empty talks on interests and claims while ignoring social develop-ment,and the phenomenon of the issue of human rights completely becoming empty and useless political rhetoric,the pragmatic view of human rights,based on the fact that there is a gap between the claims and realization of human rights,emphasizes that instead of blindly ex-panding the types of rights in term of text,it is better to base on prac-tice and promote the maximum realization of existing rights through development.The pragmatist view of human rights attaches impor-tance to relevant economic,social and cultural basis to promote the realization of human rights,rather than only focusing on the claims themselves;it pays greater attention to enhancing the realization of rights,rather than the distribution of rights under the total limit;it ad-vocates more for cooperativism in the realization of rights,rather than confrontation.The pragmatic concept of human rights takes Marxism as its theoretical basis and the gene of practice and the dimension of development as its theoretical characteristics,and promotes the devel-opment of human rights through the realization of rights.

Is Induction of Labor with Early Rupture of Membranes Associated with an Increased Rate of Clinical Chorioamnionitis?

Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.

Twenty Years of the Implementation of the Human Rights Clause in the Constitution:Achievements,Implications,and Research Topics

On March 14,2004,the Second Session of the 10th National People’s Congress of China adopted the fourth amendment to the Chinese Constitution,the most noticeable highlight of which is the addition of the paragraph“the state respects and protects human rights”as the third clause in Article 33 of Chapter II“Basic Rights and Obligations of Citizens”in the Constitution.The inclusion of the clause of human rights in the Constitution is considered an important milestone in the history of human rights development in the People’s Republic of China.The implementation of the human rights clause not only showcases the values of the Party and the state in respecting and protecting human rights,but also promotes the development of human rights,shapes the culture of human rights,and endows the rule of law with a rich humanistic spirit.Over the past 20 years,the publicity,research and practice of the human rights clause have made the Chi-nese people realize that human rights are not only a“great term”,but also a common value shared by mankind.Amid the once-in-a-century changes of the world,although the development of human rights is facing various challenges,the humanistic spirit contained in the hu-man rights clause has become the internal driving force for building consensus in the whole of society.Reinterpreting the significance and value of the human rights clause can help us conscientiously draw on the experience in the implementation of the clause over the past 20 years and contribute Chinese wisdom and experience to global human rights governance with a more open mind and inclusive attitude.

From the Subjectivity of Human Rights to the Universality of Human Rights——A Preliminary Interpretation of the Theory on the Subjectivity of Human Rights

Universality is one of the essential characteristics of human rights, but there is a substantive difference between idealism and realism in understanding the concept of universality of human rights. The concepts of radical universality and strong universality based on the concept of natural human rights are too idealistic and thus have a high risk of being alienated into a tool of international re-pression in practice. On the contrary, the theory on the subjectivity of human rights can effectively defuse this risk brought about by radical universality and strong universality. Advocating a transition from the universality of human rights to the subjectivity of human rights not only keeps in line with the actual construction process of international human rights, but can also effectively interpret the practical difficul-ties in the realization process of international human rights. Therefore, it can be used as another alternative theory on human rights beyond the theory of natural human rights.

The Historical Position and Value Dimensions of Human Rights Civilization

Human beings are the mainstay and the ultimate goal of civilization.The history of human civilization is a continuous struggle to realize the respect,liberation,protection,and development of humanity.Human rights are an achievement of humanity and a symbol of progress,and the human rights civilization is an important component of human civilization.Understanding and interpreting human rights from the perspective of human rights civilization means that human rights are not only a concept or an idea but also a grand historical and long-term social practice.Up to now,the development of human rights civilization has roughly experienced four awakening eras:initialization,revolution,popularization,and globalization.In terms of its value dimensions,it has the characteristics of progressiveness,diversity,commonality,inclusiveness,indivisibility,openness,and so on.The historical position of human rights civilization and the development of its value dimensions have shown to the world that human rights are the common wealth of humanity,and human rights belong to all mankind;human rights are historical,concrete,and developmental;the concept of human rights is constantly evolving,and its connotations and categories are constantly expanding;achieving the free and well-rounded development of every person is the highest value realm of human rights civilization.The Chinese modernization endows Chinese civilization with modern strength and opens up new horizons for human rights civilization.The new pattern of human rights civilization to be created by Chinese modernization not only possesses the common characteristics of human rights civilization but also enjoys Chinese characteristics based on its own national conditions,enriching and developing the diversity of human rights civilization for all mankind.

Working for Global Progress in Human Rights

It should be ensured that all peoples enjoy human rights as equals by allowing them to follow their respective paths of modernization.DECEMBER 2023 marked the 75th anniversary of the Universal Declaration of Human Rights(UDHR).On December 10,1948,the United Nations General Assembly adopted the UDHR(General Assembly resolution 217 A),the first international document on this issue.Chang Peng Chun(P.C.Chang,1892-1957),vice chairman of the original UN Commission on Human Rights at the time.

Research on the Constitutional,Historical and Practical Logic of the Chinese Path of Human Rights Development——From the Perspective of the Inclusion of Human Rights Clause in the Constitution

The inclusion of the human rights clause in the Chi-nese Constitution is a concern and expression of the spirit of the Con-stitution,which has laid the institutional regulations of the fundamen-tal law for the development of human rights in China,provided the principles and value norms of the highest level of effectiveness for the legal protection of human rights,and built a profound constitutional basis for the formation and improvement of the Chinese path of human rights development.The human rights clause is not only a summariza-tion and affirmation of the historical practice of Chinese human rights development under the leadership of the Communist Party of China,but also a new starting point for the development of human rights in China under the leadership of the Communist Party of China.It marks that the development of human rights in China has entered a new era.The Party and the state have finally embarked on a path of human rights development with Chinese characteristics by formulating and implementing the Human Rights Action Plan of China,eliminating ab-solute poverty through the national poverty alleviation campaign,and promoting human rights protection through the rule of law.

Understanding the Human Rights of Modern Individuals—Revisiting Habermas’s Dual Critique and the Reconstruction of Intersubjectivity

Human rights are not only pivotal in depicting the relationship between individuals and communities but also a focal point of political philosophical concerns oriented towards reality. The inseparability of human rights from individual self-identity reveals a contradiction between practicality and historicity in understanding individuals, as highlighted in the debate between liberalism and communitarianism. In order to reconcile this contradiction, Habermas,drawing from German classical philosophy, examines practicality and historicity separately: while Fichte intertwines objectivity in self-identity, revealing the practicality of individuals but neglecting their real elements, Hegel interprets self-identity under the concept of unity,examining individuals from a historical dimension but letting rational rules dominate reality. Ultimately, Habermas reconstructs the process of modern individual self-identity from the theory of communicative action by critiquing the shackles of subjective philosophy. He not only reconciles the divergence between practicality and historicity in self-identity, but also elucidates the intersubjective core inherent in human rights.

Side Event"Human Rights Protection for the Next Generation:the Rights of Children and Youth"Held in Geneva

On January 23,as the UN Human Rights Council's Universal Periodic Review Working Group conducted its fourth review of China's human rights record,the side event"Human Rights Protection for the Next Generation:the Rights of Children and Youth",co-sponsored by the New Sunshine Charity Foundation and China NGO Network for International Exchanges,was held in Geneva.Experts and scholars representing dozens of civil society organisations from different countries exchanged their views around the topic.

Reaffirming the Significance of the Universal Declaration of Human Rights and Upholding the Highest Values of Human Rights in the New Era

It is of particular significance to commemorate the 75th anniversary of the Universal Declaration of Human Rights on the special occasion of the 10th National Constitution Day.In reviewing the Universal Declaration of Human Rights,I’ll share my insights and reflections in three aspects.

The Connotations of the Constitutional Clause on Human Rights Protection From the Perspective of Foreign-related Rule of Law

The inclusion of the human rights clause in the Chi-nese Constitution is the core normative manifestation of the constitu-tionalization of human rights,and points to the relationship between international law and the Constitution in the sense of positive law.The inclusion of the human rights clauses in the Chinese Constitution itself is an inherent part of the development of China’s socialist constitution,and socialism has already contributed valuable concepts and practices of human rights protection to the modern world in its early stage.The constitutionalization of human rights protection does not necessarily lead to the superiority of international law over the constitutional order of a country,but rather to the convergence of international law and domestic law through the constitutional order.The relevant rules of international law will be effective only when they are transformed into domestic law through the Constitution and the human rights clause in the Constitution.Correspondingly,the domestic legal order is brought into line with the international legal order through the Con-stitution and its human rights clause.Behind the system of fundamen-tal rights in the constitutional order is the value foundation of the en-tire legal system.The advancement of foreign-related rule of law has brought new opportunities for China’s judicial practice to further pro-mote the protection of human rights.In the future,we should further integrate the human rights values embedded in socialism into China’s constitutional practice,enhance human rights protection around the country,and take a more active part in global human rights gover-nance.

Comparative Analysis and Legal Reflection on the Boundaries of Human Rights Due Diligence in the Supply Chain

As global supply chains become increasingly lengthy and complex, human rights due diligence in the supply chain is becoming a controversial focal point in the accountability of multinational corporations. In recent years, legislative practices in the field of human rights due diligence have shown a trend from voluntary soft law toward mandatory hard law, and from corporate due diligence for their own operations towards extended due diligence for the entire supply chain. However, there is a divergence in national practices regarding the extent to which human rights due diligence should extend along the supply chain and the manner in which it should be incorporated into domestic legal policies. International soft law interpretations surrounding the boundaries of human rights due diligence in the supply chain are decentralized, posing risks of interpretation diversification, boundary blurring, and procedural formalization, as well as risks of misinterpretation and misuse. Meanwhile, some countries and regions are vigorously promoting mandatory legislation on human rights due diligence in the supply chain, which has profound implications for the stability of global supply chains and the international economic and trade order. Against this backdrop, it is crucial to explore the reasonable boundaries of human rights due diligence in the supply chain. Instead of applying a one-size-fits-all approach,the rationality of legal factors and the complexity of practical factors should be considered, applying context-specific measures based on the varying degrees of linkage between companies and negative human rights impacts in the supply chain. China should be particularly wary of the “chilling effect” of mandatory legislation on human rights due diligence in the supply chain, attaching great importance to national supply chain security and international supply chain competitiveness.Additionally,China should actively promote the implementation of voluntary human rights due diligence under the United Nations framework, and accelerate the enhancement of China's discourse power in the international rule-making process in the fields of industry and commerce as well as human rights.

Revisiting the Spirit of the UDHR and Discussing Human Rights Development——Summary of Views from the Seminar Commemorating the 75th Anniversary of the Universal Declaration of Human Rights

On December 4,2023,the China Society for Human Rights Studies hosted a seminar in Beijing commemorating the 75^(th) Anniversary of the Universal Declaration of Human Rights.Participants discussed topics such as the significance of the Universal Declaration of Human Rights,China’s theories and practices in respecting and safeguarding human rights,the three global initiatives and global human rights governance,human rights protection in the digital age,and telling Chinese stories of human rights in the new era.The discussions led to a broad consensus and achieved positive results.

Research on the Reform of"Separation of Three Rights"for Rural Homesteads in Juancheng County,Shandong Province

In order to realize rural revitalization in an all-round way and promote the sustainable and healthy development of the economy and society,China is committed to deepening the pace of building a new countryside with Chinese characteristics.The reform of the"Separation of Three Rights"of rural homesteads is a key measure,which aims to activate rural resources,enhance the vitality of rural economic development,and then promote the overall process of rural revitalization.This study selects Juancheng County,Heze City,Shandong Province as a typical case.Through an in-depth analysis of the relevant policy orientation of the national homestead reform and the specific practice of local promotion work,it systematically sorts out the registration of homestead rights,transfer of use rights and relevant policy measures adopted in paid use,qualification conversion,policy publicity and system establishment.After in-depth research on the system reform practice of the"Separation of Three Rights"of homesteads in Juancheng County,this paper reveals the main problems existing in the current reform,including the lack of clear policy support for the mechanism of paid use of homesteads,difficulties in the process of identifying qualification rights and challenges,the imperfection of the transfer mechanism of use rights,and the lack or lag of relevant policies.A series of problem-oriented policy suggestions are put forward,including establishing and improving the system of paid use of rural homesteads,improving the income distribution mechanism,promoting the innovation of the mortgage guarantee system for the right to use homesteads,and optimizing the homestead qualification certification procedures.These suggestions aim to provide a useful reference for the Juancheng County Government in promoting the reform of"Separation of Three Rights"of homesteads,and then promote the rational allocation and efficient utilization of rural homestead resources.