A Preliminary Investigation on the Acceptance and Feasibility of Acupuncture in the Intensive Care Unit

Objective. Acupuncture has been shown to decrease opioid requirements and respiratory distress in selected patients, and it may be helpful as an adjunctive therapy to sedatives and analgesics in the ICU. This preliminary study investigated the acceptance and feasibility of acupuncture in the ICU. Design. Forty-eight patients in a 12-bed medical–surgical ICU at Cedars-Sinai Medical Center who met eligibility criteria were offered the opportunity to receive free-of-charge daily acupuncture treatments during their time in the ICU. Primary endpoints were percentage of patients offered acupuncture who accepted treatment, the percentage of eligible days acupuncture therapy was received, and the incidence of adverse events related to acupuncture treatment. Main Results. Of the 48 patients who were eligible and offered acupuncture therapy, 20 (41%) patients enrolled in the study with an average age of 56 years (range = 18-91 years). The median and average number of days which patients received acupuncture was 2 and 3, respectively (range = 0-11 days), and a majority of patients (13/20) received acupuncture for each of the days for which they were eligible. One patient reported dizziness, which resolved spontaneously and was not associated with hemodynamic changes. No other adverse effects occurred in a total of 64 acupuncture treatments. Conclusions. This preliminary study demonstrates that acupuncture therapy in the ICU is a feasible treatment modality. Further clinical trials are warranted to determine the efficacy of acupuncture therapy as an adjunct to sedative and analgesics in critically ill patients.

Innovative use of a magnetized pick for removal of an intraocular foreign body with 25-gauge transconjunctival sutureless vitrectomy

BACKGROUND

Since being introduced in 2002, 25-gauge transconjunctival sutureless vitrectomy techniques continue to gain popularity among vitreoretinal surgeons and are being used in the management of increasingly complex surgical patients.

METHODS

In this report, we report a patient in whom a magnetized 25-gauge intraocular pick was used to facilitate removal of a metallic intraocular foreign body with 25-gauge transconjunctival sutureless vitrectomy without enlarging a sclerotomy wound.

RESULTS

The magnetized 25-gauge intraocular pick allowed for removal of the intraocular foreign body through a posterior capsulorhexis and a standard cataract wound. "In the bag" placement of the posterior chamber intraocular lens resulted in a perfectly reconstructed pseudophakic anterior segment.

CONCLUSION

The authors suggest that a magnetized 25-gauge pick may be a useful adjunct in the management of selected patients with a magnetic intraocular foreign body.

Construction of penP delta 1, Bacillus licheniformis 749/C beta-lactamase lacking site for lipoprotein modification. Expression in Escherichia coli and Bacillus subtilis

Membrane-bound penicillinases in Gram-positive bacteria are glyceride-cysteine lipoproteins (Nielsen, J. B. K., and Lampen, J. O. (1982) J. Biol. Chem. 257, 4490-4495) that can be, but are not necessarily, intermediates in formation of exocellular enzymes. We have now deleted from the signal region of the Bacillus licheniformis 749/C beta-lactamase gene (penP) 15 base pairs that code for Ala-Leu-Ala-Gly-Cys. This sequence includes the Cys residue that undergoes lipophilic modification and the site of cleavage by signal peptidase and is well conserved in diverse prokaryotic lipoproteins. In the deletion gene, penP delta 1, the remaining Cys is preceded by 8 hydrophobic residues instead of 14 for the original modification site. PenP delta 1 has been cloned in Escherichia coli and Bacillus subtilis and its expression and products compared with penP. Penicillinase synthesis by penP delta 1 clones was greater than or equal to amounts formed by penP clones or B. licheniformis. Lipoprotein production from penP delta 1 was very low in either host and appears physiologically insignificant. In E. coli carrying penP delta 1, 25% of the penicillinase was released into the periplasm as a processed form. The remainder was a membrane-associated form of translation product size and was oriented to the periplasm. In mid-log cultures of B. subtilis carrying penP delta 1, the translation product and 2 protease-shortened species were present both in the cytoplasm and on the outer surface of the membrane. Release began at stationary phase and was dependent on the presence of enzyme processing to exo-small and a pH value greater than 7.5. We conclude that the shortened lipophilic sequence of the penP delta 1 prepenicillinase is adequate for transfer of the nascent chain through the membrane.