Optimal timing for intubation in patients on non-invasive ventilation: A retrospective cohort study.

Background and Aims: The timing of transition from non-invasive ventilation (NIV) to invasive ventilation in the intensive care unit (ICU) is uncertain due to a lack of clinical evidence. This study aimed to identify the optimal timing of intubation in patients with respiratory failure managed with NIVs. Methods: A single-center observational study was conducted in Tokyo, Japan. Patients in the ICU managed with NIV between 2013 and 2022 were screened. The primary outcome was 28-day invasive ventilator-free days. Statistical analyses used locally estimated scatter plot smoothing (LOESS) and generalized linear mixed models to estimate the association between the timing of transition and prolonged intubation duration. Results: During the study period, 139 of 589 adult ICU patients receiving NIV transitioned to invasive ventilation. The LOESS curve indicated the longest 28-day ventilator-free days around 24 h after NIV initiation, after which the primary outcome decreased linearly. Late intubation after 24 h of NIV initiation was associated with fewer 28-day ventilator-free days (adjusted mean difference: -0.22 days [95% confidence interval: -0.31, -0.13]). Conclusion: We identified a non-linear association between the timing of intubation and 28-day invasive ventilator-free days. The critical 24-h time window for patients on NIV was associated with longer 28-day invasive ventilator-free days.

Update on the management of acute respiratory failure using non-invasive ventilation and pulse oximetry.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2023. Other selected articles can be found online at  https://www.biomedcentral.com/collections/annualupdate2023 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from  https://link.springer.com/bookseries/8901 .

The incidence and outcome of hyperlactatemia in patients admitted to the intensive care unit after elective surgery.

BACKGROUND: Although hyperlactatemia is often developed in critically ill patients, it is unclear whether hyperlactatemia is associated with poor prognosis for surgical ICU (SICU) patients. METHODS: We performed a retrospective analysis in an academic hospital in Tokyo. The maximum lactate was defined as the highest value within the SICU stay. The primary outcome was the composite outcome of in-hospital mortality, re-admission to the SICU or admission to the general ICU and emergency reoperation. RESULTS: There were 3421 patients with normal lactate (<2 mmoL/L), 1642 with moderate hyperlactatemia (2-3.9 mmoL/L) and 299 with severe hyperlactatemia (≥4 mmoL/L). The composite outcome occurred in 6.2%. In multivariable logistic regression analysis, the odds ratio for the composite outcome was 1.49 for moderate hyperlactatemia and 1.42 for severe hyperlactatemia. CONCLUSIONS: The odds ratio was similar between moderate and severe hyperlactatemia, so the cause and meaning of hyperlactatemia might be different among patients with elective surgery.

Linear measurement accuracy of dental CT images obtained by 64-slice multidetector row CT: the effects of mandibular positioning and pitch factor at CT scanning.

PURPOSE: To evaluate whether the measurement accuracy of dental CT images is affected by the mandibular positioning and the pitch factor at CT scanning. MATERIALS AND METHODS: Three dry mandibles were scanned by 64-slice multidetector row CT (MDCT) and micro-CT. For MDCT scanning, 7 different mandibular positioning and 3 different pitch factors were applied. After reformatting dental CT images, the bone height was measured on these images. It was also measured on the corresponding micro-CT image, which was defined as the actual value. The difference of the measurement values between these 2 was defined as the measurement error. RESULTS: There was no significant difference in the measurement errors due to either the mandibular positioning or the pitch factor. CONCLUSION: The measurement accuracy of dental CT images obtained was not affected by either mandibular positioning or pitch factor at CT scanning.

[Analysis and classification of Latin anatomical names of skeletal fossa in Terminologia Anatomica, and comparison with corresponding Japanese anatomical names].

For a better understanding of the structures comprising the human body and in view of the possible need for future revision of anatomical nomenclature, Latin anatomical names of skeletal fossa in Terminologia Anatomica were analyzed and classified, and compared with the corresponding Japanese anatomical names. The words following Fossa indicated: 1) the form of the fossa, 2) the structure to which the fossa belongs, 3) the position of the fossa, 4) the structure that exists near the fossa, 5) the structure that the fossa contains, 6) the structure attached to the fossa, 7) the structure that transmits the fossa, or 8) the structure with which the fossa articulates. The analysis of Latin names and comparison with Japanese names clarified some characteristics of both names and revealed some problems in them.

[Analysis and classification of Latin anatomical names of skeletal canals in Terminologia anatomica, and comparison with corresponding Japanese anatomical names].

For a better understanding of the structures comprising the human body and in view of the possible need for future revision of anatomical nomenclature, Latin anatomical names of skeletal canals (including canaliculi) in Terminologia Anatomica were analyzed and classified, and compared with the corresponding Japanese anatomical names. The words following Canalis or Canales indicated: (1) the structure to which the canal belongs, (2) the structure to which the opening of the canal belongs, (3) the position of the canal, (4) the structure to which the canal leads, (5) the structure that exists near the opening of the canal, (6) the structure that transmits the canal, (7) the structure that is a component of the canal, or (8) the function of the canal. The analysis of Latin names and comparison with Japanese names clarified some characteristics of both names and revealed some problems in them.

[Analysis and classification of Latin anatomical names of skeletal foramina in Terminologia Anatomica, and comparison with corresponding Japanese anatomical names].

For better understanding of the structures comprising the human body and in view of the possible need for future revision, Latin anatomical names of skeletal foramina in Terminologia Anatomica were analyzed and classified, and compared with the corresponding Japanese anatomical names. The words following Foramen or Foramina indicated:1) the form of the foramen, 2) the state of the foramen, 3) the absolute size of the foramen, 4) the structure to which the foramen belongs, 5) the position of the foramen in the skeletal system, 6) the part of the human body in which the foramen exists, 7) the structure that transmits the foramen, or 8) the function of the foramen. Analysis of Latin names and comparison with Japanese names clarified some characteristics of both names and revealed some problems in them.

Immunohistochemical localization of syndecan-1 in the dental follicle of postnatal mouse teeth.

BACKGROUND: Syndecans are cell surface heparan sulfate proteoglycans that modulate the action of growth factors and extracellular matrix components. Syndecan-1 plays important roles during early tooth development, and it is expressed in the dental follicle of fetal tooth germ. However, no studies have followed its expression in the dental follicle during the postnatal period. We hypothesized that syndecan-1 protein expression in the dental follicle may be important for postnatal tooth development, and, thus, examined its expression patterns. METHODS: Syndecan-1 protein expression in the dental follicle of the lower first molar was investigated by immunohistochemistry using embryonic day (E) 18.5 to 21-day-old (d 21) mice. Immunoelectron microscopy was applied to the dental follicle and pulp cells to confirm its membrane localization in mesenchymal cells. RESULTS: Strong syndecan-1 immunostaining was maintained in the dental follicle and the adjacent dental pulp surrounded by the Hertwig's epithelial root sheath (HERS) from d 4 to d 14, but reduced staining was noted at d 21 with the near-completion of tooth eruption. Three dimensionally, syndecan-1-positive areas plugged the apical foramina surrounded by HERS. However, immunostaining was detected constantly in the dental follicle and the dental pulp of the lower incisor at d 21. In addition, membrane localization of syndecan-1 protein was confirmed for the first time in mesenchymal cells, including dental follicle and pulp cells, by immunoelectron microscopy. CONCLUSION: The spatial and temporal expression of syndecan-1 in the dental follicle suggests that this proteoglycan is important for the maintenance of proliferation and/or movement of cells in this region during tooth eruption.

Formation of acellular cementum-like layers, with and without extrinsic fiber insertion, along inert bone surfaces of aging c-Src gene knockout mice.

To investigate the long-term effects of c-src deficiency on skeletal and dental tissues, we examined the lower jaws and long bones of c-src gene knockout (c-src KO) mice by histological and histochemical methods. Numerous multinucleated osteoclasts were distributed throughout the mandible in 5-wk-old c-src KO mice, but by 14 wk they had almost completely disappeared from the alveolar bone, leaving tartrate-resistant acid phosphatase (TRAP)-positive layers along the bone surface. Deposition of osteopontin-positive mineralized tissue, reminiscent of acellular afibrillar cementum (AAC), was confirmed along the TRAP-positive bone surface at 14 wk. The layer progressively thickened up to 21 months. A comparable mineralized layer was noted along the trabeculae of long bones as thickened cement lines. In the periostin-rich areas of jaw bones, but not in the long bones, portions of AAC-like mineralized layers were often replaced with and/or covered by acellular extrinsic fiber cementum (AEFC)-like tissue. These data suggest that the deposition of AAC-like mineralized tissue is a general phenomenon that may occur along inert or slowly remodeling bone surfaces under conditions characterized by reduced bone-resorbing activity, whereas the induction of AEFC-like tissue seems to be associated with the expression of certain molecules that are particularly abundant in the microenvironment of the periodontal ligament.

Structural features of incremental line-like striations in mandibular condylar cartilage of c-src-deficient mice.

Mandibular condylar cartilage is sensitive to masticatory force, while mice lacking the c-src gene (c-src-deficient mice) have osteopetrosis and tooth eruption failure. The purpose of this study was to investigate the morphology of the mandibular condyle in these mice, which were maintained with a soft-food diet for 240 days after birth. The condylar head in the c-src-deficient mice showed slight deformity in shape before weaning, but showed remarkable undergrowth after weaning. No significant morphological or histological differences were detected between the mandibular condyle in wild-type mice fed soft food and those fed hard food, indicating that osteopetrosis, as well as abnormal masticatory force, influences the morphology of the mouse mandibular condyle, and that malocclusion rather than dietary consistency may have greater influence. After 70 days, incremental line-like striations consisting of cartilaginous and non-cartilaginous layers were detected in the mandibular condyle of the c-src-deficient mice, but not in the tibial growth plate. Immunostaining of aggrecan, collagen types II and X, and osteopontin was detected in the cartilaginous layers, but not in the non-cartilaginous layers showing collagen type I immunostaining. Chondrocyte lacunae were not eroded in the cartilaginous layers, and complete circumferential mineralisation around the lacunae and impaired osteoclast (chondroclast) function can account for this phenomenon. However, repeated cessation of chondrocyte differentiation may be required to completely explain the formation of the striations. These results indicate that the mandibular condyle in the c-src-deficient mice has unique structural features, adding to its deformity.