This study’s aim is to measure liver-type fatty acid-binding protein (L-FABP) levels in urine using a rapid semiquantitative assay kit in the emergency department and to investigate whether the onset of acute kidney injury (AKI) after hospitalization can be predicted. This was a prospective observation study. Patients transferred to the emergency and critical care center were divided into two groups: urinary L-FABP negative and positive groups. The status and severity of AKI were evaluated for the respective patients based on the Kidney Disease: Improving Global Outcome (KDIGO) classification. We compared the proportion of AKI patients in the two groups. In the urine L-FABP-positive group, many patients had a significant onset of AKI (p < 0.001). After excluding patients who were diagnosed as AKI for creatinine level at admission, urinary L-FABP could predict the onset of AKI after admission (p < 0.001). By measuring urinary L-FABP concentration using a rapid semiquantitative assay kit, there is the possibility that the onset of AKI after admission can be predicted from immediately after a patient is transported by ambulance.

Early provision of a high-protein nutrition improves the prognosis of patients in intensive care units (ICUs). However, high protein intake increases blood urea nitrogen (BUN). No study has compared outcomes according to protein intake, and the clinical significance of changes in BUN (ΔBUN) in ICU patients is unclear. Here, we investigated the association of high protein intake with outcomes and BUN and assessed the clinical significance of ΔBUN. This was a single-center retrospective cohort study. Between 1 January 2016 and 30 September 2019, 295 ICU patients received enteral nutrition for at least 3 days while undergoing mechanical ventilation. After applying the exclusion criteria of an age of 1.2 g/kg/day of protein (high-protein group; n = 111) and those receiving ≤1.2 g/kg/day of protein (non-high-protein group; n = 95). The groups were balanced by propensity score matching. The primary endpoint was 28-day mortality, and the secondary endpoints were 90-day mortality, length of ICU stay, number of ventilator-free days in the first 28 days, and ΔBUN. The high-protein group had significantly lower 28- and 90-day mortality and significantly greater ΔBUN, including after propensity score matching. ΔBUN might not be associated with outcomes. Provision of >1.2 g/kg/day of protein may be associated with lower mortality of tube-fed and mechanically ventilated patients. Furthermore, while high protein intake may be associated with higher BUN, these changes may not be adversely associated with outcomes.

Background: Tongue pressure values in patients with dysphagia are reported to be significantly lower than those in healthy controls. The aim of this study was to measure the maximum tongue pressure (MTP) values after extubation in order to assess the presence of post-extubation dysphagia for the safe initiation of oral intake in elderly patients. Methods: Data from 90 patients who were extubated after mechanical ventilation under tracheal intubation were collected retrospectively. The patients were divided into two groups as follows: normal group (those who did not develop aspiration pneumonia after extubation; median age 62 years) and aspiration group (those who developed aspiration during the evaluation period; median age 75 years). The MTP values were measured at 6 h, 24 h, 3 days, and 7 days after extubation. Results: The values were significantly increased 24 h after extubation in the normal group (p < 0.05). Alternatively, no increase was observed even after 1 week of extubation in the aspiration group, and the values were significantly lower than those in the normal group. The cutoff values at 6 and 24 h after extubation, which were measured using the receiver operator characteristic (ROC) curve, were 17.8 and 23.2 kpa, respectively; furthermore, the results of these assessments were strongly related to the development of aspiration 6 h after extubation (χ²-value: 6.125; p = 0.0133). Conclusions: The presence of post-extubation dysphagia in patients who are intubated for ≥24 h can be predicted based on age and the MTP values at 6 h after extubation.

If meningitis is suspected, head computed tomography is performed before cerebrospinal fluid collection. Crown dens syndrome can be diagnosed using simultaneous CT scans of the head and neck. Thus, unnecessary CSF tap test can be avoided.

High-pressure injection injuries, caused by forcefully injecting liquids or gases into the body, present significant challenges in diagnosis and treatment. Complications such as infection and compartment syndrome can occur, leading to various outcomes, including the possibility of amputation. Treatment approaches vary, with some cases undergoing surgery and others opting for conservative methods. However, due to the rarity of this injury, clear treatment guidelines are lacking. Consequently, there is insufficient data to establish specific guidelines, such as the duration of antibiotic treatment, necessity of surgery, and timing of rehabilitation intervention. While emergency surgery may be required, limited reports of detailed CT or MRI examinations being conducted before the surgical procedure are available. This case report involves an initial assessment, including physical examination, X-rays, CT scans, and MRI, to determine whether surgical or conservative treatment is appropriate. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score assists in evaluating the risk of infection, and MRI plays a crucial role in predicting complications.

Ryo Ichibayashi, Ginga Suzuki, Yoshimi Nakamichi, Yuka Masuyama, Saki Yamamoto, Hibiki Serizawa, Masayuki Watanabe, Koichi Aoyama, Mitsuru Honda; Management of