The prognostic value of facial nerve conduction velocity in patients with Bell's palsy

The facial nerve conduction velocity was measured in 30 healthy subjects (60 sides) and in 51 patients with a unilateral Bell's palsy. The normal value was 47.8 ± 5.1 m/s. Incomplete recovery was common in Bell's palsy when the velocity was below 30 m/s. Mild synkinesis was observed in only one patient when the nerve conduction velocity was above 30 m/s. When the degree of degeneration revealed by electroneuroneography did not exceed 60%, the conduction velocity was in the normal range. For degrees of degeneration in excess of this, the conduction velocity decreased in parallel with the increase in the degree of degeneration.     

Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children

OBJECTIVE: We have used the combination of midazolam, a short-acting benzodiazepine, and ketamine, a "dissociative anesthetic," to provide conscious sedation for invasive or lengthy procedures. METHODS: A total of 350 procedures (74 lumbar punctures, 97 bone marrow aspirations or biopsies, 84 radiotherapy sessions, and 95 imaging studies) were performed on 68 children, 4 months to 17 years of age, in both inpatient and ambulatory settings. All patients had an intravenous line in place and were monitored for heart rate and O2 saturation by pulse oximetry for the duration of the procedure and recovery time. Blood pressure was monitored periodically (every 5 to 30 minutes). Oxygen and suction equipment was available during the procedure. In addition to the individual performing the procedure, a second staff member trained in airway management (eg, physician, nurse practitioner, or registered nurse) was present to monitor vital signs and respiratory status. Patients were sedated initially with midazolam (0.05 to 0.1 mg/kg intravenously; maximum single dose of 2 mg, maximum total dose of 4 mg), followed by ketamine (1 to 2 mg/kg intravenously). During lengthy procedures, additional doses of ketamine (0.5 to 1 mg/kg) were given as necessary. Effectiveness of the sedation, recovery time, and adverse events associated with the sedative regimen were documented. RESULTS: All patients were effectively sedated with this regimen. Four patients experienced transient decrease in O2 saturation (<85%) requiring temporary interruption of the procedure and oxygen by blow-by; the procedure was subsequently completed without incident in each case. Two patients experienced significant agitation during recovery from sedation. This side effect resolved spontaneously after 5 to 10 minutes in one patient and was effectively treated with diphenhydramine hydrochloride in the other. Twenty-four lumbar punctures were associated with transient decrease in O2 saturation (88% to 92%), which improved by relief of neck flexion and/or blow-by oxygen. No hypotension, bradycardia, or respiratory depression requiring respiratory support or reversal of sedation was noted. Anesthesia recovery time ranged from <15 minutes to 120 minutes with >70% of patients recovering within 30 minutes. Most patients demonstrated an increase in oral secretions requiring occasional suctioning. Transient sleep disturbances were reported in only two patients. CONCLUSIONS: This sedative regimen of intravenous midazolam and ketamine was found to be safe and effective. Its use has greatly reduced patient and parent anxiety for diagnostic and therapeutic procedures.     

A system for adaptive transportation

In our society, we take for granted the ability to travel with few restrictions. For most travelers, the major factor that limits travel is cost. However, for a significant number of Americans, the phrase "freedom to travel" is meaningless. These are the physically handicapped, a group with special needs that has long been denied what every American assumes to be a natural right.     

A theory of wheelchair wheelie performance

The results of this analytical study of wheelchair wheelie performance can be summarized into two wheelchair design equations, or rules of thumb, as developed in the paper. The equation containing the significant parameters involved in popping a wheelie for curb climbing is: fh = 0.8 mg theta c.g. [A] where fh is handrim force, m is the mass of the wheelchair + user less rear wheels, g is acceleration of gravity (9.807 m/s2), and theta c.g. is "c.g. angle," i.e., the angle between the vertical through the rear axle and a line connecting the rear axle and the system center-of-gravity. Equation [A] shows that reducing the mass and/or the c.g. angle will make it easier to pop a wheelie. The c.g. angle is reduced by moving the rear axle position forward on the wheelchair. Wheelie balance is the other aspect of performance considered; where the user balances the wheelchair on the rear wheels for going down curbs or just for fun. The ease with which a system can be controlled (balanced) is related to the static stability of the system. The static stability is defined as: omega 2 = mgl/J [B] where J is the mass moment of inertia at the center of gravity of the system about the direction perpendicular to the sideframe. For better wheelchair control during wheelchair balance the static stability should be reduced. Measurements of the value for the polar mass moment of inertia for a typical wheelchair + user of m = 90 kg was found to be J = 8.7 kg-m2. In order to decrease the value of the static stability, Equation [B], one can increase J or decrease m and/or l, where l is the distance from the rear axle to the c.g. of the system. It is also shown that balancing a rod in the palm of the hand (inverted pendulum) is a mathematical problem similar to the wheelie balance problem, and a rod of length 1.56 meters is similar to a wheelchair + user system mass of 90 kg. However, balancing a rod is done primarily by using visual perception, whereas wheelie balance involves human joint proprioceptors and visual plus vestibular (inner ear) perception. Thus, a simple test of determining the shortest length of rod one can balance in the palm of the hand (plus measuring handrim force capability and simple reaction time) may indicate if a wheelchair user will find it easy to do a wheelie balance.     

Revolutionary Advances in the Management of Traumatic Wounds in the Emergency Department During the Last 40 Years: Part I

Background and Objectives: This report provides an overview of advances in wound repair devised by our research team during the last four decades. This collective review is presented in two parts. Discussion: The following components are included in Part I: 1) search and treat life-threatening trauma; 2) conduct a thorough history; 3) examine the wound using aseptic technique; 4) anesthetize the wound before cleansing; 5) hair removal, skin disinfection, hemostasis, surgical debridement, and mechanical cleansing; 6) antibiotics, drains, and open wound management. Conclusion: On the basis of these comprehensive research studies, we have noted a marked reduction in the incidence of wound infection in traumatic wounds.     

Targeting the unfolded protein response,XBP1, and the NLRP3 inflammasome in fibrosis and cancer

Increasing health care costs in the US are due in a large part to the increasing prevalence of chronic diseases in an aging population. Current therapeutic strategies for treating chronic diseases alleviate symptoms allowing patients to live longer with these diseases, but they do little, however, to alter the underlying disease course. Recent advances in molecular biology are revealing new drug targets that may significantly alter the course of these diseases and, as a result, offer economic relief from burgeoning health care costs. Endoplasmic reticulum (ER) stress has been implicated as an underlying pathology in many chronic diseases, and, therefore, the development of therapies designed to ameliorate ER stress may yield novel, effective treatment strategies. Herein, we report that X-box binding protein 1 (XBP1) may be one of the earliest proteins engaged in response to ER stress. We show that a new signaling peptide derived from the ER-embedded transient receptor potential calcium channel protein 1 (TRPC1) engages XBP1 upstream of NLRP3 inflammasome-mediated maturation and secretion of IL-1β/IL-18. Moreover, we show that a synthetic homolog of this signaling peptide (Naclynamide™) administered intravenously twice weekly over a 4-week treatment course induced suppuration and evoked partial or complete resolution of lesions associated with a fibrotic granuloma, a lymphosarcoma, and a colo-rectal carcinoma in canine patients. The mode of action for Naclynamide™ as a first-in-class anti-cancer drug candidate is discussed.