ABSTRACT
Objectives To investigate the association of fluid overload (FO) with the development and mortality of acute kidney injury (AKI) and to evaluate the predictive value of FO in mortality of critically ill children. Method A prospective study was conducted among critically ill children who were admitted to the children's intensive care unit (PICU). FO levels were assessed during the course of the disease and PRISM Ⅲ scores were evaluated within 24 hours of admission. Binary logistic regression analyses were conducted to evaluate the association of FO with the development and mortality of AKI after adjusting for confounding factors. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive value of FO for mortality. Results In 362 children included, there were 26 children (7.18%) having average FO≥5%, and AKI in 24 children (6.63%) and 18 children (5.0%) died. The mean FO (OR=1.26, 95%CI: 1.10～1.43, P=0.001) and the maximum FO (OR=1.12, 95%CI: 1.02～1.23, P=0.018) were significantly correlated with the development of AKI in critically ill children within 7 days of admission to PICU. However, after adjusting for age and PRISM Ⅲ, both factors had no association with AKI (all P>0.05). After adjusting for the potential confounders such as AKI and the severity of disease, the average FO was significantly associated with mortality (AOR=1.34, 95%CI: 1.12～1.60, P=0.002). The AUC of mean FO that predicted mortality risk was 0.801 (P<0.001). Conclusion Fluid overload is associated with the development and the prognosis of AKI in critically ill children, and has important predictive value for mortality.
ABSTRACT
BACKGROUND:Though the high-resolution CT(HRCT)could identify the inner structures of temporal bone.its tiny parts could hardly be observed accurately and clearly by the imaging examinations of auriculotemporal portion,with the influence of scanning layers as well as the partial volume phenomenon.However,it could be easily identified by the combination of thin sections and HRCT images.OBJECTIVE:To introduce a method which could locate the posterior tympanum and its neighboring structures using HRCT images and to provide an anatomical base for the imaging diagnosis and operative treatment on this area.DESIGN,TIME AND SETTING:The observations between the auriculotemporal sections and CT images were finished both in thc Department of Sectional and Imaging Anatomy,Medical College,Nanchang University and the Center of Medical lmageology.Jiangxi Provincial People's Hospital from July 2004 to June 2007.MATERIALS:Fifteen normal adult cadaveric heads(30 sides)which fixed by 100 g/L formaldehyde were scanned,with all the samples provided by the Department of Anatomy,Medical College,Nanchang University.The main equipment was GE Hi-speed Nx/i Sys CT equipment (GE Company,USA).METHODS:Tb obtain CT images of temporal bone(depth 1.00 mm,thickness 1.00 mm),15 normal adult cadaver heads were scanned by CT method taking callthomeatal line(CML)as the baseline.After that,specimens of auriculotemporal portion from temporal bone were taken,decalcified,desiccated and embedded.Sequential sections(thick 1.00 mm)were made.MAIN OUTCOME MEASURES:Comparing sequential sections with CT image,identified respectively the fossa incudis,chorda eminence,styloid eminence,tacial recess,sinus tympanl,ponticulus promontoni,suprameatal spine,etc.RESULTS:The depth of fossa incudas was about(1.49±0.05)mm,the distance from the fossa to pyramid segment of facial nerve was(5.67±0.1 4)mm.The distance from the medial wall of posterior tympanic sinus to the horizontal segment of facial nerve was(3.1 2±0.1 5)mm.The average distance from suprameatal spine to the vertical segment of facial nerve was (16.73±1.24)mm,to chorda tympani nerve(15.87±1.14)mm,to promontory(21.84±2.43)mm.CONCLUSION:Comparing the sectional antomy and CT image of auriculotemporal potion of temporal bone is valuable for the diagnosis and treatment of otopathy.