Noninvasive cortical stimulation Transcranial household power stimulation tDCS

tate while unresponsive under ketamine until its deeper stage with the slow-delta oscillations. Somatosensory processing is preserved during ketamine anesthesia, but multisensory processing appears to be diminished under ketamine and through recovery.BACKGROUND Mechanical ventilation with low tidal volumes has the potential to mitigate ventilation-induced lung injury, yet the clinical effect of tidal volume size on myocardial function has not been clarified. This cross-sectional study investigated whether low tidal volume ventilation has beneficial effects on myocardial systolic and diastolic function compared to intermediate tidal volume ventilation. METHODS Forty-two mechanically ventilated patients without acute respiratory distress syndrome (ARDS) underwent transthoracic echocardiography after more than 24 h of mechanical ventilation according to the Protective Ventilation in Patients without ARDS (PReVENT) trial comparing a low versus intermediate tidal volume strategy. The primary outcome was left ventricular and right ventricular myocardial performance index as measure for combined systolic and diastolic function, with lower values indicating better myocardial function and a right ventricular myocardial performance index greater than 0.54 regarded dal volume group, yet diastolic parameters did not differ between both groups. CONCLUSIONS In patients without ARDS, intermediate tidal volume ventilation decreased left ventricular and right ventricular systolic function compared to low tidal volume ventilation, although without an effect on diastolic function.PRéCIS Adjuvant diclofenac and apraclonidine eye drops given in conjunction with selective laser trabeculoplasty do not significantly impact medium-term intraocular pressure reduction compared to placebo, but apraclonidine can be used to blunt immediate post-laser pressure spikes. PURPOSE There is limited high-grade evidence guiding the choice of eye drops given before and after selective laser trabeculoplasty (SLT). We chose to measure intraocular pressure (IOP) during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. METHODS In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016-2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. RESULTS Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1- and 2-hours post-SLT in the placebo and diclofenac study arms (mean=+4.05±0.58▒mm Hg and +4.47±0.73, respectively, P less then 0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean=-2.41±0.88▒mm Hg, P less then 0.0001 vs. other study arms post-SLT). There were no significant differences between the three arms of the study on the long-term IOP reduction achieved by SLT (6▒wk P=0.51, 6▒mo P=0.42). CONCLUSIONS Neither the use of apraclonidine prior to SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.PRéCIS A modified CO2 laser-assisted sclerectomy surgery based on the characteristics of Chinese eyeball was carried out in Chinese patient, and was confirmed to be effective and safe during long term follow up. PURPOSE To study the long-term efficacy and safety of modified CO2 laser-assisted sclerectomy surgery in Chinese patients with primary open-angle and pseudoexfoliative glaucoma. METHODS We enrolled 25 medically uncontrolled primary open-angle and pseudoexfoliative glaucoma patients in this prospective, interventional case series. A combination of modified CO2 laser-assisted sclerectomy surgery and preoperative laser iris management was administered to 29 eyes . Visual acuity, intraocular pressure, slit-lamp examinations, visual field, and gonioscopy were carried out at baseline and until 24 months postoperatively. Ultrasound biomicroscopy examinations were repeated at 3, 12, and 24 months postsurgically. RESULTS Mean patient age was 53.92±12.08 years. Mean preoperative intraocular pressure was 30.66±10.41▒mmHg; and mean postoperative intraocular pressure was 8.17±3.76, and 13.25±2.73, 13.76±2.50, and 13.76±2.50▒mmHg at 1 day, and 6, 12, and 24 months, respectively. Proportional changes in intraocular pressure from baseline at 6, 12, and 24 months was 58.33%, 56.25%, and 58.97% (P less then 0.001), respectively. Complete postoperative success rates at 12 and 24 months were 62.07% and 48.28%. Eflornithine Qualified success rates at 12 and 24 months postoperatively were both 89.66%. Number of medications administered per patient reduced from 3 at baseline to 0 at 12 and 24 months (P less then 0.0001). Two patients demonstrated severe peripheral anterior synechiae (6.90%). Ultrasound biomicroscopy examination revealed a severe scleral lake diminution in 1 patient (3.40%) at 12 months and 2 patients (6.90%) at 24 months. CONCLUSION Combination of modified CO2 laser-assisted sclerectomy surgery and preventive laser iris management, was effective and safe in the long-term treatment of primary open-angle glaucoma patients.PRéCIS An SD-OCT based deep learning system detected glaucomatous structural change with high sensitivity and specificity. It outperformed the clinical diagnostic parameters in discriminating glaucomatous eyes from healthy eyes. PURPOSE To assess the performance of a deep learning classifier for detection of glaucomatous change based on spectral-domain optical coherence tomography (SD-OCT). METHODS Three hundred and fifty image sets of ganglion cell-inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) SD-OCT for 86 glaucomatous eyes and 307 SD-OCT image sets of 196 healthy participants were recruited and split into training (197 eyes) and test (85 eyes) datasets based on a patient-wise split. The bottleneck features extracted from the GCIPL thickness map, GCIPL deviation map, RNFL thickness map, and RNFL deviation map were used as predictors for the deep learning classifier. The area under the receiver operating characteristic curve (AUC) was calculated and compared with those of conventional glaucoma diagnostic parameters including SD-OCT thickness profile and standard automated perimetry (SAP) to evaluate the accuracy of discrimination for each algorithm.