Matthew Links's Bookmarks

The East Timor Project involves the placement of a full-time anaesthetist and general surgeon in Dili, as well as specialist surgical visits.

The College has an Asia Pacific Committee, with members from PNG, Fiji, Malaysia, Singapore, Hong Kong and Thailand. The committee promotes links with the Asia Pacific region, contributes to development projects, undertakes educational initiatives, and maintains a database of activities and College Fellows in the region.

Tom Wolfe’s “The Right Stuff” tells the story of our first astronauts, and charts the demise of the maverick, Chuck Yeager test-pilot culture of the nineteen-fifties. It was a culture defined by how unbelievably dangerous the job was. Test pilots strapped themselves into machines of barely controlled power and complexity, and a quarter of them were killed on the job. The pilots had to have focus, daring, wits, and an ability to improvise—the right stuff. But as knowledge of how to control the risks of flying accumulated—as checklists and flight simulators became more prevalent and sophisticated—the danger diminished, values of safety and conscientiousness prevailed, and the rock-star status of the test pilots was gone.

Something like this is going on in medicine. We have the means to make some of the most complex and dangerous work we do—in surgery, emergency care, and I.C.U. medicine—more effective than we ever thought possible. But the prospect pushes against the traditional culture of medicine, with its central belief that in situations of high risk and complexity what you want is a kind of expert audacity—the right stuff, again. Checklists and standard operating procedures feel like exactly the opposite, and that’s what rankles many people.

Alpha-Lipoic acid, which plays an essential role in mitochondrial
dehydrogenase reactions, has recently gained considerable attention as an
antioxidant. Lipoate, or its reduced form, dihydrolipoate, reacts with ROS such
as O₂⁻, hydroxyl radicals, hypochiorous acid, peroxyl
radicals, and singlet oxygen. It also protects membranes by interacting with
vitamin C and glutathione, which may in turn recycle vitamin E. In addition to
its antioxidant activities, dihydrolipoate may exert prooxidant actions through
reduction of iron. Alpha-Lipoic acid administration has been shown to be
beneficial in a number of oxidative stress models such as ischemia-reperfusion
injury, diabetes (both α-lipoic acid and dihydrolipoic acid exhibit hydrophobic
binding to proteins such as albumin, which can prevent glycation reactions),
cataract formation, HIV activation, neurodegeneration, and radiation injury.
Furthermore, lipoate can function as a redox regulator of proteins such as
myoglobin, prolactin, thioredoxin and NF-κB transcription factor [211].