Monitored anesthesia care (MAC) sedation: clinical utility of fospropofol

Fospropofol, a phosphorylated prodrug version of the popular induction agent propofol, is hydrolyzed in vivo to release active propofol, formaldehyde, and phosphate. Pharmacodynamic studies show fospropofol provides clinically useful sedation and EEG/bispectral index suppression while causing significantly less respiratory depression than propofol. Pain at the injection site, a common complaint with propofol, was not reported with fospropofol; the major patient complaint was transitory perianal itching during the drug’s administration. Although many clinicians believe fospropofol can safely be given by a registered nurse, the FDA mandated that fospropofol, like propofol, must be used only in the presence of a trained anesthesia provider

Controllable selective exfoliation of high-quality graphene nanosheets and nanodots by ionic liquid assisted grinding

Bulk quantities of graphene nanosheets and nanodots have been selectively fabricated by mechanical grinding exfoliation of natural graphite in a small quantity of ionic liquids. The resulting graphene sheets and dots are solvent free with low levels of naturally absorbed oxygen, inherited from the starting graphite. The sheets are only two to five layers thick. The graphene nanodots have diameters in the range of 9-29 nm and heights in the range of 1-16 nm, which can be controlled by changing the processing time.Comment: * Corresponding authors: [email protected]; [email protected]

Rheumatoid Meningitis Presenting With Acute Parkinsonism and Protracted Non-convulsive Seizures: An Unusual Case Presentation and Review of Treatment Strategies

Rheumatoid meningitis is a rare complication of rheumatoid arthritis (RA). It is associated with substantial morbidity and mortality. The condition may present in a variety of ways and is therefore diagnostically challenging. Uncertainty still exists regarding the optimal treatment strategy. Herein, we describe the case of a 74-year-old man with a history of well-controlled seropositive RA on low-dose prednisone, hydroxychloroquine, and methotrexate. The patient presented with a several-month history of multiple prolonged episodes of expressive aphasia, right hemiparesis, and encephalopathy. Although no epileptiform activity was recorded on repeated electroencephalography, the symptoms fully resolved following treatment with antiepileptic drugs. He subsequently developed acute asymmetrical parkinsonism of the right hemibody. Magnetic resonance imaging revealed subtle enhancement of the leptomeninges over the left frontoparietal convexity. Cerebrospinal fluid analysis revealed a mild lymphocytic pleocytosis and elevated proteins. Histopathologic analysis of a meningeal biopsy revealed nodular rheumatoid meningitis. The patient was treated with corticosteroids and cyclophosphamide, following which he incompletely recovered. This is the first description of rheumatoid meningitis manifesting with acute parkinsonism and protracted non-convulsive seizures. A summary of cases reported since 2005, including data on pathology, therapy and outcomes, along with a discussion on the efficacy of different treatment strategies are provided

Nurturing shared leaders through internship

The Faculty of Social Sciences (the Faculty) of the University of Hong Kong has offered the very first credit-bearing internships in social sciences amongst all local tertiary institutions. Since September 2009, all students in the discipline have to complete 24 credits (equivalent to 4 courses) of off-campus experiential learning, with 12 credits in local internships and another 12 credits in global internships. In June 2012, the Faculty launched the pilot project of Service Leadership Internship (SLI) under the funding of the Li & Fung Service Leadership Initiative, which supports service leadership training in all eight of Hong Kong’s tertiary institution. The SLI took place in the summer 2012 where student interns worked as a team (groups of 3 – 5) to initiate, develop and implement (a) service task(s). By making use of the interns’ multi-disciplinary knowledge, the student interns contributed as shared leaders and helped community partners to generate innovative solutions to authentic problems under different projects. The Faculty also provided a series of support mechanisms to prepare the interns for the SLI projects. For example, an academic tutor was assigned to take care of each SLI project. Also, a series of workshops using the social cognitive approach were organized so as to enhance the interns’ social and personal competence as shared leaders and at the same time understand the construct of leaderships and social responsibilities through experiential learning and discussions. By completing the pre-workshop readings and actively participating in the workshops, interns internalized the core values of leadership such as enhanced self-awareness, became more competent as shared leaders and developed social responsibilities as an active member of the society. Booster sessions were also provided as a platform for small group sharing and problem-solving. In this paper presentation, the overall structure of the SLI, an overview of the content of the internship training and some of the learning outcome of the interns will be shared. The learning experiences in the pilot project will also help us plan for the upcoming summer of SLI 2013. A revised approach on SLI with an expanded participation of community partners will also be shared with the audience

Effect of lipid-lowering medications in patients with coronary artery bypass grafting surgery outcomes

Background: Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups. Results: A total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P \u3c 0.05). Propensity weighted risk-adjustment showed that lipid-lowering medication reduced in-hospital total complications (odds ratio (OR) = 0.856; 95% CI 0.781-0.938; P \u3c 0.001); all neurologic complications (OR = 0.572; 95% CI 0.441-0.739; P \u3c 0.001) including stroke (OR = 0.481; 95% CI 0.349-0.654; P \u3c 0.001); in-hospital mortality (OR = 0.616; 95% CI 0.432-0.869; P = 0.006; P \u3c 0.001); and overall mortality (OR = 0.723; 95% CI 0.634-0.824; P \u3c 0.001). In addition, the results indicated postoperative lipid-lowering medication use was associated with improved long-term survival in this patient population. Conclusions: Perioperative lipid-lowering medication use was associated with significantly reduced postoperative adverse events and improved overall outcome in elderly patients undergoing CABG surgery with CPB