ABSTRACT
Objective To summary the clinical characteristics of acute necrotizing encephalopathy in childhood so as to estimate the prognosis and guide the therapy. Methods We collected and analyzed retro-spectively the data of 10 acute necrotizing encephalopathy cases hospitalized in the pediatric department of our hospital from January 2014 to April 2018. The clinical manifestations,laboratory examinations and imaging features were retrospectively analyzed. Results A total of 10 cases all had fever and convulsions (100％). There was no specific clinical manifestation in the early stage,always showing the symptoms of acute respira-tory infection or acute gastroenteritis. Mental malaise,lethargy,restlessness and frequent convulsions occured when the conditions aggravated. Nine patients had different degrees of consciousness disorder. It could be complicated by multiple organ dysfunction syndrome,hemophagocytic syndrome and so on. Eight patients un-derwent MRI. In acute phase, homogeneously prolonged T1 and T2 relaxation time of the brain lesions on MRI were found in most patients,and diffusion-weighted imaging ( DWI) and FLAIR showed high signal in-tensity. Six cases underwent head CT examination, hypodensities were seen on 4 cases. Cerebrospinal fluid (CSF) was detected in all patients,and the protein levels in CSF increased to varying degrees,while white blood cells did not increase. Of the 10 patients,3 died,1 was discharged normally,1 had hemophagocytic syn-drome,transferred to pediatric hematology department,and 5 patients were transferred to rehabilitation depart-ment. Conclusion Acute necrotizing encephalopathy in children always make progress rapidly, has high mortality,many survivors have severe neurological sequelae,which is worthy of being attention.
ABSTRACT
Objective To compare the predictive effect of Charlison's weighted index of comorbidities (WIC), the diagnostic criteria for emergency sepsis (MEDS) and combination of the two scoring systems to predict the emergency pulmonary infection prognosis. Methods A total of 327 patients with pulmonary infection admitted from January 2016 to January 2017 were enrolled in this study whose WIC score,MEDS score and risk stratification were recorded at admission.They were divided into survival group and death group according to the 28 d treatment outcome,the optimal cutoff of WIC score and MEDS score to predict the prognosis were found by ROC curve, and the prediction effect of WIC score, MEDS score, the combined use of both and APACHEⅡto predict the prognosis were compared. Results The mortality of low,middle and high risk of WIC score were 13.7%(29/212),48.7%(38/78)and 78.4%(29/37)with significant difference(χ2=82.097,P=0.000),mortality of low,middle and high risk of MEDS score were 11.3%(23/203),50.6%(40/77)and 73.3%(33/45)with significant difference(χ2=145.526,P=0.000).The WIC scores in survival group and death group were 1.3 ± 0.9 and 2.7 ± 1.1 with significant difference(t=11.030,P=0.000).The MEDS score of live group(6.1 ± 4.0) was significantly lower than death group(12.6 ± 4.9)(t=11.502,P=0.000).the optimal cutoff values of WIC and MEDS to predict prognosis were 1.7 points, 11.6 points, the ROC curve area between WIC, MEDS score and combined application to predict prognosis were 0.632, 0.798, 0.897, and the sensitivity and accuracy of the combined prediction[93.8%(212/226)/89.9%(294/327)] were significantly higher than those of the individual WIC[72.7%(168/231)/75.2%(246/327)] and MEDS[67.5%(156/232)/72.2%(236/327)] (χ2=0.562-42.594, P < 0.05). The sensitivity and accuracy of the combined application and APACHE Ⅱto predict of prognosis had no statistical significant difference(P>0.05).Conclusions The sensitivity and accuracy of WIC score combined with MEDS score to predict the prognosis of patients with acute lung infection is higher than the individual WIC score and MEDS score,and its prediction effect is more better.
ABSTRACT
Objective To study the pharmacokinetic parameters of riluzole tablets and commercial riluzole capsules in Beagle dogs,and evaluate the correlation between the release rate in vitro and the absorption in vivo, and calculate the relative bioavailability of riluzole tablets. Methods Six Beagle dogs were treated with 50 mg of riluzole tablets or capsules,and then cross-treated by the other drug after 14-days wash out period. Blood concentration of riluzole was measured by high performance liquid chromatography ( HPLC ) . The atrioventricular model was used to calculate the pharmacokinetic parameters and Wanger-Nelson method was applied to assess the correlation between the release rate in vitro and the absorption in vivo. Results The t1/2 ,tmax ,Cmax ,AUC0-72 and AUC0-∞ in the tablet and capsule groups were (12. 43±3. 87) and (12. 57±3. 25) h,(6. 00±2. 60) and (6. 23±2. 72) h,(56. 24±16. 51) and (60. 82±18. 13) ng·mL-1 ,(1 255. 83±311. 39) and (1 283. 50±313. 81) ng·mL-1 ·h, (1 282. 57±322. 64) and (1 297. 22±297. 39) ng·mL-1 ·h,respectively. The relative bioavailability of capsules versus tablets was (105. 9±30. 6 )%. Conclusion HPLC method can be applied to measure the concentration of blood riluzole with little interference and high levels of repeatability and accuracy. The absorption in Beagle dogs between riluzole tablets and capsules was equal,and a good correlation between the in vivo absorption and in vitro release has been found in this study.