BACKGROUND In acute respiratory failure elevated intraabdominal pressure aggravates lung collapse, tidal recruitment, and ventilation inhomogeneity. Low positive end-expiratory pressure (PEEP) may promote lung collapse and intrapulmonary shunting, whereas high PEEP may increase dead space by inspiratory overdistension. The authors hypothesized that an electrical impedance tomography-guided PEEP approach minimizing tidal recruitment improves regional ventilation and perfusion matching when compared to a table-based low PEEP/no recruitment and an oxygenation-guided high PEEP/full recruitment strategy in a hybrid model of lung injury and elevated intraabdominal pressure. METHODS In 15 pigs with oleic acid-induced lung injury intraabdominal pressure was increased by intraabdominal saline infusion. PEEP was set in randomized order (1) guided by a PEEP/inspired oxygen fraction table, without recruitment maneuver; (2) minimizing tidal recruitment guided by electrical impedance tomography after a recruitment maneuverONS When compared to table PEEP without a recruitment maneuver, both minimal tidal recruitment PEEP and maximal oxygenation PEEP following a recruitment maneuver decreased shunting and dead space ventilation, and the effects of minimal tidal recruitment PEEP and maximal oxygenation PEEP were comparable.BACKGROUND Neurocognitive investigations suggest that conscious sensory perception depends on recurrent neuronal interactions among sensory, parietal, and frontal cortical regions, which are suppressed by general anesthetics. The purpose of this work was to investigate if local interactions in sensory cortex are also altered by anesthetics. The authors hypothesized that desflurane would reduce recurrent neuronal interactions in cortical layer-specific manner consistent with the anatomical disposition of feedforward and feedback pathways. METHODS Single-unit neuronal activity was measured in freely moving adult male rats (268 units; 10 animals) using microelectrode arrays chronically implanted in primary and secondary visual cortex. Layer-specific directional interactions were estimated by mutual information and transfer entropy of multineuron spike patterns within and between cortical layers three and five. The effect of incrementally increasing and decreasing steady-state concentrations of desflurane (0 to 8ration as a mechanism of anesthetic-induced unconsciousness.OBJECTIVES To investigate whether the clinical impression of vulnerability and the Dutch Safety Management Program (VMS), a screening instrument on four geriatric domains (activities in daily living, falls, malnutrition, delirium) are useful predictors of 1-year mortality in older patients in the emergency department. METHODS This was a prospective observational study in the emergency department of a tertiary care teaching hospital. Patients aged 65 years and older visiting the emergency department, and their attending physicians and nurses were included. Clinical impression of vulnerability appraised by physician and nurse and the VMS-screening were recorded.  https://www.selleckchem.com/products/BIBF1120.html  RESULTS We included 196 patients of whom 64.8%, 61.7%, and 52.6% were considered vulnerable based on the clinical impression of vulnerability of physicians, nurses, and VMS-screening, respectively. Agreement between clinical impression of vulnerability of physicians and nurses, and VMS-screening were both fair (overall agreement 63.3% for both, and respectively kappa 0.32 and kappa 0.31). Clinical impression of vulnerability of physicians, nurses, and VMS-screening had a sensitivity of respectively 94%, 86%, and 73% for predicting 1-year mortality. A positive clinical impression of vulnerability was associated mostly with factors which can be observed directly during first patient contact after arrival to the emergency department, such as age, nutritional status, and functional impairment. CONCLUSION The clinical impression of vulnerability is a simple dichotomous question which can be used as a first step in the identification of vulnerable older emergency department patients, whereas the more time-consuming VMS-screening is more specific for detection of vulnerability. The clinical impression of vulnerability is therefore useful in a busy emergency department environment where time and resources are limited.OBJECTIVES Numerous adverse drug events (ADEs) are not identified by doctors in medical emergencies, and they are a barrier to optimal treatment of patients. Identification of the factors that influence awareness of ADEs by doctors could allow events that compromise patient safety to be avoided. The aims of this study were to quantify the recognition of ADEs by emergency room (ER) doctors and to identify the factors associated with the lack of identification of drug-related risks. METHODS This study was carried out at the ER of a French teaching hospital between January 1, 2014, and the December 31, 2017. A previously used form was administered to the patients being treated in the ER, and it was completed using medical files to identify ADEs. The ADEs were then validated by a doctor and a senior pharmacist. RESULTS Of the 1870 included patients, 279 (14.9%) exhibited an ADE. Of these 279 ADEs, 201 (72%) had been identified by the doctor. The probability of an ADE being identified was higher when the drug was directly linked with the main ailment of the patient (odds ratio, 1.72; 95% confidence interval, 1.01-2.97). Adverse drug events were identified less well when their severity was limited (spontaneous regression without treatment) (odds ratio, 0.5; 95% confidence interval, 0.27-0.93). CONCLUSIONS This study showed that ADEs are identified less well when their severity is limited, as well as when the ADE is not directly linked with the main ailment of the patient.The neurophysiological basis of spontaneous low-frequency brain activity has become a major theme in the study of neural function in both humans and animal models. In such studies, the anesthesia model was generally adopted. However, the effects of anesthesia on spontaneous activity remain unclear. In this work, we explored the characteristics of cerebral spontaneous low-frequency activities at different depths of anesthesia in mice. Using Fourier transformation and the multitaper analysis methods, spontaneous low-frequency oscillations (LFOs) in the intrinsic signals of different cerebral regions (artery, vein, and cortex) were extracted and analyzed. Under different concentrations of anesthetic, the frequency of spontaneous LFO signals remained stable, while LFO amplitudes increased with the depth of anesthesia. The results imply that the anesthetic impacts the amplitude of spontaneous LFOs but does not alter the oscillation frequency.