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We report a case of bispectral index (BIS) falling to zero during absolute alcohol embolization of an intracranial arteriovenous malformation (AVM) under anesthesia. This case highlights the unusual effect of a therapeutic dose of parenteral alcohol on the central nervous system using BIS monitoring.A 29-yr-old male with a left parieto-occipital arteriovenous malformation underwent neuroendovascular embolization under general anesthesia. During injection of absolute alcohol injection into the AVM nidus, the patient developed hypertension and tachycardia coincident with a profound and sustained reduction of BIS values to zero, despite a stable level of anesthesia. Immediate angiography revealed no evidence of hemorrhage or new changes in the patient's cerebral vasculature. Post-procedure, the patient remained drowsy for several hours with signs of alcohol intoxication. He had full neurological recovery.In the presence of normal cerebral angiographic findings, suppression of BIS values may serve as an early indicator of CNS responses to intracranial injection of absolute alcohol for embolization of an arteriovenous malformation.

While the harmful effects of alcohol abuse are well documented, experimental and clinical data support a potential benefit of light to moderate alcohol consumption. Cross-sectional studies have suggested an association between alcohol consumption and multiple sclerosis (MS) disability. In the absence of prospective, longitudinal studies, the causal nature of this relationship cannot be established. It remains possible that patients with increased disability progression reduce their alcohol intake. Even though there is substantial evidence for anti-inflammatory effects of low-to-moderate doses of alcohol, the associations need to be interpreted very cautiously. This study discusses the current state of knowledge about MS and alcohol consumption, and the limitations in conducting research with retrospective data in patients with MS.

Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects.To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research.A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion.The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain.Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.

Diabetes mellitus is a metabolic disease that raises the odds of developing stroke. Candesartan has been used to prevent stroke due to its inhibitory effects on blood pressure, angiogenesis, oxidative damage, and apoptosis. However, oral candesartan has very limited bioavailability and efficacy due to its weak solubility and slow release. The study aimed to develop a nasal formulation of candesartan-loaded liposomes containing ethanol and propylene glycol (CLEP) to improve candesartan's delivery, release, permeation, and efficacy as a potential diabetes-associated stroke treatment. Using design expert software, different CLEP formulations were prepared and evaluated in vitro to identify the optimum formulation, which. The selected optimum formulation composed of 3.3% phospholipid, 10% ethanol, and 15% propylene glycol significantly increased the release and permeation of candesartan relative to free candesartan by a factor of 1.52 and 1.47, respectively. The optimum formulation significantly reduced the infarction after stroke in rats; decreased flexion, spontaneous motor activity, and time spent in the target quadrant by 70%, 64.71%, and 92.31%, respectively, and enhanced grip strength by a ratio of 2.3. Therefore, nasal administration of the CLEP formulation could be a potential diabetes-associated stroke treatment.

1. A contracting muscle resists stretching with a force greater than the force it can exert at a constant length, T(o). If the muscle is kept active at the stretched length, the excess tension disappears, at first rapidly and then more slowly (stress relaxation). The present study is concerned with the first, fast tension decay. In particular, it is still debated if and to what extent the fast tension decay after a ramp stretch involves a conservation of the elastic energy stored during stretching into cross-bridge states of higher chemical energy. 2. Single muscle fibres of Rana temporaria and Rana esculenta were subjected to a short ramp stretch (approximately 15 nm per half-sarcomere at either 1.4 or 0.04 sarcomere lengths s(-1)) on the plateau of the force-length relation at temperatures of 4 and 14 degrees C. Immediately after the end of the stretch, or after discrete time intervals of fixed-end contraction and stress relaxation at the stretched length (Delta t(isom) = 0.5-300 ms), the fibre was released against a force ~T(o). Fibre and sarcomere stiffness during the elastic recoil to T(o) (phase 1) and the subsequent transient shortening against T(o) (phase 2), which is expression of the work enhancement by stretch, were measured after different Delta t(isom) and compared with the corresponding fast tension decay during Delta t(isom). 3. The amplitude of fast tension decay is large after the fast stretch, and small or nil after the slow stretch. Two exponential terms are necessary to fit the fast tension decay after the fast stretch at 4 degrees C, whereas one is sufficient in the other cases. The rate constant of the dominant exponential term (0.1-0.2 ms(-1) at 4 degrees C) increases with temperature with a temperature coefficient (Q(10)) of approximately 3. 4. After fast stretch, the fast tension decay during Delta t(isom) is accompanied in both species and at both temperatures by a corresponding increase in the amplitude of phase 2 shortening against T(o) after Delta t(isom): a maximum of approximately 5 nm per half-sarcomere is attained when the fast tension decay is almost complete, i.e. 30 ms after the stretch at 4 degrees C and 10 ms after the stretch at 14 degrees C. After slow stretch, when fast tension decay is small or nil, the increase in phase 2 shortening is negligible. 5. The increase in phase 2 work during fast tension decay (Delta W(out)) is a constant fraction of the elastic energy simultaneously set free by the recoil of the undamped elastic elements. 6. Delta W(out) is accompanied by a decrease in stiffness, indicating that it is not due to a greater number of cross-bridges. 7. It is concluded that, during the fast tension decay following a fast ramp stretch, a transfer of energy occurs from the undamped elastic elements to damped elements within the sarcomeres by a temperature-dependent mechanism with a dominant rate constant consistent with the theory proposed by A. F. Huxley and R. M. Simmons in 1971.

We studied the involvement of cocaine- and amphetamine-regulated transcript peptide (CART) in the central nucleus of amygdala (CeA), lateral bed nucleus of the stria terminalis (BNSTl) and nucleus accumbens shell (AcbSh) in generation of ethanol withdrawal symptoms, with particular focus on anxiety-like behavior using a social interaction test. Administration of CART (54-102) into the lateral ventricle (50 and 100 ng) and bilaterally in the CeA (10 and 20 ng) caused a significant reduction in social interaction, suggesting an anxiogenic action of the peptide. Chronic ethanol treatment for 15 days followed by withdrawal precipitated an anxiogenic response at 24 h that was attenuated by intracerebroventricular (5 mul) and intra-CeA (1 mul) administration of antibodies against CART (1 : 500 dilution). An immunocytochemistry protocol was employed to study the response of the endogenous CART system in the CeA following chronic ethanol withdrawal. At 0 h ethanol withdrawal, CART immunoreactivity was apparent in few fibers and the profile was similar to that in the pair-fed control rats. Twenty-four hours following ethanol withdrawal, a highly significant increase (P<0.001) in CART immunoreactivity was noticed in the CeA, which returned to normal 48 and 72 h post-withdrawal. Similar doses of CART or CART antibody injected bilaterally into the BNSTl or AcbSh produced no response in the social interaction test. Furthermore, the CART immunoreactivity profile did not change at the post-withdrawal time points in each of these brain sites. We suggest that CART may mediate the early signs of anxiety-like behavior induced by ethanol withdrawal within the neuroanatomical framework of the CeA.