Objective Applying diffusion weighted image (DWI) and apparent diffusion coefficient (ADC) to analyze brain injury caused by hypoxic-ischemic encephalopathy (HIE) in term neonates.Methods From June 1,2010 to January 5,2011,thirty-eight full term neonates with HIE were hospitalized in the Second Hospital of Tianjin Medical University.Those with nervous system diseases were excluded.The 38 cases were divided to mild HIE group (n=24) and moderate-to-severe HIE group (n=14).The control group included 10 normal full term neonates without history of asphyxia.All babies were scanned by magnetic resonance imaging (MRI).Spin echo-echo planar imaging sequence was used for DWI images.ADC values of nine regions (frontal lobe gray matter,frontal white matter,parietal gray matter,parietal white matter,corona radiata,caudate nucleus,putamen,posterior limb of the internal capsule and thalamus) were measured.MRI and DWI images were compared.ADC values were compared by analysis of variance and Student-Newman-Keuls test.Results ADC values of the nine indicated regions (frontal lobe gray matter,frontal white matter,parietal gray matter,parietal white matter,corona radiata,caudate nucleus,putamen,posterior limb of the internal capsule and thalamus) were (1.37±0.07),(1.81±0.12),(1.35±0.10),(1.84±0.09),(1.23±0.11),(1.28±0.09),(1.18±0.08),(1.05±0.07) and (1.15±0.08) ×10-3 mm2/s in control group,(1.28±0.11),(1.60±0.15),(1.27±0.09),(1.59±0.20),(1.19±0.15),(1.19±0.13),(1.11±0.09),(0.97±0.11) and (1.06±0.12) ×10-3 mm2/s in mild HIE group,and (1.18±0.14),(1.51±0.22),(1.19±0.09),(1.56±0.19),(1.03±0.16),(1.08±0.07),(1.02±0.07),(0.87±0.09) and (0.96±0.12) × 10-3 mm2/s in moderate-to-severe HIE group.ADC values among the three groups had statistical difference (F=3.89,3.21,4.05,3.30,3.28,3.27,4.12,4.75and 4.72,all P＜0.05).ADC values of frontal lobe gray matter,frontal white matter,parietal gray matter,parietal white matter,putamen,posterior limb of the internal capsule and thalamus in mild HIE group were lower than those in control group (all P＜0.05).All of the ADC values of nine regions in moderate-to-severe HIE group were lower than those in control group (all P＜0.05).ADC value of frontal lobe gray matter,parietal gray matter,corona radiata,caudate nucleus,putamen,posterior limb of the internal capsule and thalamus in moderate-to-severe HIE group were lower than those in mild HIE group (all P＜0.05).Conclusion DWI and ADC values could reflect brain injury caused by HIE,and ADC values can be used to quantitatively analyze the degree of hypoxic-ischemic injury.

OBJECTIVE:To establish a method for the concentration determination of gabapentin (GBP) in human plasma.METHODS:After precipitated by methanol,using sulfamethoxazole as intemal standard,LC-MS/MS method was adopted.The determination was performed on Diamonsil C18 column with mobile phase consisted of water (containing 0.05％ formic acid)-methanol using a gradient elution program at the flow rate of 1 mL/min.The column temperature was 30 ℃,and sample size was 20 μL.The ESI was equipped and quantitative analysis was operated in positive ion and MRM mode.The mass transition ion-pairs were followed as m/z 172.0→154.1(GBP) and m/z 279.0→124.0 (internal standard).RESULTS:The linear range of GBP was 13.4-10 720.4 ng/mL (r=0.992 3,n=5).The limit of quantitation was 13.4 ng/mL,and the minimum detection limit was 4.0 ng/mL.RSDs of inter-day and intra-day were all lower than 10％.Relative errors ranged-4.93％-5.10％.The recoveries ranged 86.2％-90.3％ (RSD＜5％,n=6),and matrix effects ranged 87.6％-92.1％.The plasma concentration of GBP in 10 epileptic patients ranged 2 075.19-4 078.87 ng/mL (n=20).CONCLUSIONS:The method is proved to be sensitive,specific,practical and suitable for plasma concentration monitoring and pharmacokinetic study of GBP in epileptic patients.

Objective: To explore the dynamic variation trend of bronchial wall thickness (BWT) in severely burned patients combined with inhalation injury, and to determine the value of BWT to prognosis of patients. Methods: Forty-three severely burned patients with inhalation injury hospitalized in Intensive Burn Department of the Affiliated Hospital of Nankai University (Tianjin No.4 Hospital) from July to November 2016, conforming to the study criteria, were divided into survival group (n=27) and death group (n=16) according to the prognosis of patients within 14 days after admission. All patients underwent fiberoptic bronchoscopy and inhalation injury rating based on abbreviated injury scale at admission. High resolution CT examination was performed in patients of two groups at admission and 24 h post admission, 3, 7, and 14 d post admission to measure the BWT of right superior lobar bronchus trunk opening. Receiver operating characteristic curves of rating of inhalation damage at admission and BWT at admission were drawn to evaluate the predictive value for death of 43 patients. Data were processed with chi-square test, independent sample t test, Wilcoxon rank sum test, analysis of variance for repeated measurement and least-significant difference-t test. Results: (1) The numbers of patients rated as 0, 1, 2, 3, and 4 grade for inhalation injury in survival group and death group were 0, 19, 6, 2, and 0, and 0, 2, 7, 7, and 0, respectively. There were statistically significant differences between the two groups (Z=-3.79, P<0.01). (2) BWT of patients in death group at admission and 24 h post admission, 3, 7, and 14 d post admission was respectively (2.72±0.26), (3.18±0.22), (2.98±0.18), (2.29±0.17), and (1.45±0.21) mm, which was significantly larger than (2.24±0.15), (2.49±0.15), (1.51±0.17), (1.04±0.16), and (1.01±0.13) mm in survival group (t=7.55, 12.14, 27.11, 19.99, 7.11, P<0.01). BWT of patients in survival group and death group at 24 h post admission, 3, 7, and 14 d post admission showed statistically significant difference when compared with that at admission within the corresponding group (t=5.97, 16.63, 28.21, 38.57, 5.34, 3.31, 4.39, 6.48, P<0.01). BWT of patients in survival group and death group on 3, 7, and 14 d post admission was significantly smaller than that at 24 h post admission within the corresponding group (t=22.27, 34.02, 45.03, 2.77, 10.53, 10.59, P<0.01). BWT of patients in survival group and death group on 7 and 14 d post admission was significantly smaller than that on 3 d post admission within the corresponding group (t=10.49, 18.26, 9.57, 11.44, P<0.01). BWT of patients in survival group and death group on 14 d post admission was significantly smaller than that on 7 d post admission within the corresponding group (t=6.97, 6.15, P<0.01). (3) The total areas under ROC curves of inhalation injury rating at admission and BWT at admission for predicting death of 43 patients were 0.880 and 0.956, respectively (with 95% confidence intervals 0.768-0.991, 0.882-1.000, P<0.05). Grade 1.5 and 2.75 mm were respectively chosen as the optimal threshold values of inhalation injury rating at admission and BWT at admission, with sensitivity of 87.50%, 83.33% and specificity of 77.78%, 96.00%, respectively. Conclusions The BWT of survived and dead patients with severe burn and inhalation injury increases significantly post burn, while the BWT of survived patients restores to normal level faster. BWT can be used to assess the severity of inhalation injury and to predict death in severely burned patients combined with inhalation injury.

Objective To identify prognostic factors ofmotorfunctionafter surgery of metastatic spinal cord compression (MSCC).Methods The clinical data of 681 patients with spinal metastases from January 2008 to December 2017 were retrospectively analyzed.According to inclusion and exclusion criteria,a total of 206 patients with spinal metastatic were included.Postoperative neurological function was assessed using Frankel classification.The influence of age,gender,preoperative status,number of spine metastases,location of spinal metastases,visceral metastases,bone metastases,primary tumor type,interval from symptom to surgery,time of developing motor deficits,interval from primary tumor diagnosis to MSCC,preoperativethe Eastern Cooperative Oncology Group performance status (ECOG-PS),Karnofsky Performance score (KPS) and surgical procedures on postoperative function outcomes were explored.Results 140 (68.0％) patients were able to walk postoperatively compared with 88 (42.7％) patients preoperatively.Moreover,in 89.8％ of all patients,79 ambulatory patients maintained ambulation after treatment.The univariate analysis according to Ordered-logit model showed thatnumber of spine metastases,location of spinal metastases,preoperative ECOG-PS,preoperative KPS,interval from symptom to surgery and time of developing motor deficits were related with posttreatment motor functions.The multivariable analysis showed that number of spine metastases (OR=2.03;95％CI:1.12-3.33;P=0.04),preoperative ECOG-PS (OR=4.84;95％CI:2.42-8.15;P=0.038),interval from symptom to surgery (OR=3.78;95％CI:3.12-9.15;P=0.024),time of developing motor deficits(OR=2.75;95％CI:1.22-3.89;P=0.01) were independent prognostic factors for function outcomes.Conclusion 1-2 levels of metastasis,Interval from symptom to treatment ≥ 48 h,time of developing motor deficits ≥7 d,and ECOG-PS 1-2 can be considered as the most significant positive prognosticfactors for post-treatment ambulatory status.Spinal metastasis should have a higher priority,and immediate intervention should be started before the development of irreversible neurologic deficits.Increasing awareness of early symptoms and earlier screeningwith regular outpatient review might make a difference for patients with MSCC.Consequently,the identified prognostic factors can be considered as apreoperative assessment tool to predict the neurologic outcomeand guide clinical treatment for individual patients with MSCC.