Axonal degeneration is a major cause of permanent disability in multiple sclerosis (MS). Recent observations from our and other laboratories suggest that sodium accumulation within compromised axons is a key, early step in the degenerative process, and hence that limiting axonal sodium influx may represent a mechanism for axonal protection in MS. Here we assess whether lamotrigine, a sodium channel-blocking agent, is effective in preventing axonal degeneration in an animal model of MS, namely chronic-relapsing experimental autoimmune encephalomyelitis (CR-EAE). When administered from 7 days post-inoculation, lamotrigine provided a small but significant reduction in the neurological deficit present at the termination of the experiments (averaged over three independent experiments; vehicle: 3.5+/-2.7; lamotrigine: 2.6+/-2.0, P<0.05) and preserved more functional axons in the spinal cord (measured as mean compound action potential area; vehicle: 31.7 microV.ms+/-23.0; lamotrigine: 42.9+/-27.4, P<0.05). Histological examination of the thoracic spinal cord (n=71) revealed that lamotrigine treatment also provided significant protection against axonal degeneration (percentage degeneration in dorsal column; vehicle: 33.5 %+/-38.5; lamotrigine: 10.4 %+/-12.5, P<0.01). The findings suggest that lamotrigine may provide a novel avenue for axonal protection in MS.

Behavioral and industrial relations literature on grievances were reviewed. As a result, serious methodological, theoretical, and ethical questions were raised. Fundamental research is required to establish the reliability of grievance phenomena. Further, the use of grievance data as criteria is dubious because of conceptual problems of deficiency and contamination. Given existing threats to traditional grievance systems, basic research, especially program evaluation, on proposed structural and behavior variants of grievance procedures is necessary.

This paper describes two new educational programs at Stanford that address some of the unique issues in teaching medical technology innovation and design. The first is a team-based medical device design and prototyping course that is based on clinical immersion and "hands-on" device prototyping. Medical device innovation at Stanford is further encouraged by means of a series of university-wide competitions, called Invention Challenges, to invent solutions to defined clinical problems with the potential for real-world impact.