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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.

Systemic delivery of therapeutic agents remains ineffective against diffuse intrinsic pontine glioma (DIPG), possibly due to an intact blood-brain-barrier (BBB) and to dose-limiting toxicity of systemic chemotherapeutic agents. Convection-enhanced delivery (CED) into the brainstem may provide an effective local delivery alternative for DIPG patients.The aim of this study is to develop a method to perform CED into the murine brainstem and to test this method using the chemotherapeutic agent carmustine (BiCNU). To this end, a newly designed murine CED catheter was tested in vitro and in vivo. After determination of safety and distribution, mice bearing VUMC-DIPG-3 and E98FM-DIPG brainstem tumors were treated with carmustine dissolved in DW 5% or carmustine dissolved in 10% ethanol.Our results show that CED into the murine brainstem is feasible and well tolerated by mice with and without brainstem tumors. CED of carmustine dissolved in 5% DW increased median survival of mice with VUMC-DIPG-3 and E98FM-DIPG tumors with 35% and 25% respectively. Dissolving carmustine in 10% ethanol further improved survival to 45% in mice with E98FM-DIPG tumors.Since genetically engineered and primary DIPG models are currently only available in mice, murine CED studies have clear advantages over CED studies in other animals.CED in the murine brainstem can be performed safely, is well tolerated and can be used to study efficacy of chemotherapeutic agents orthotopically. These results set the foundation for more CED studies in murine DIPG models.

The hollow-fibre oxygenator is a key component of any extracorporeal circuit used to provide cardiopulmonary bypass (CPB) during open-heart surgery. Since the oxygenator is placed downstream of the pump, the energy losses over it have a direct impact on the quality of pulsatile pressure and flow waveforms. The objective of this study was to describe the effects of hydrodynamic characteristics of the oxygenator on energy transfer during pulsatile, normothermic CPB. Twenty-three adult patients scheduled for coronary bypass surgery were divided randomly into two groups, using either an oxygenator (Group 1) with a relatively high-resistance and low-compliance (2079 ± 148 dyn.s.cm-5 and 0.00348 ± 0.00071 ml.mmHg-1, respectively) or an oxygenator (Group 2) with a relatively low-resistance and high-compliance (884 ± 464 dyn.s.cm-5 and 0.01325 ± 0.00161 ml .mmHg-1, respectively). During perfusion, pre- and post-oxygenator pressures, radial artery pressure, and blood flow were recorded simultaneously. A 32% decline of mean pressure was observed in Group 1 and a 16% decline in Group 2 (p<0.0001). Another decrease by approximately 73% in mean pressure in the rest of the perfusion system was noted in both groups. The mean radial artery pressure did not differ between the groups (74 ± 6 mmHg in Group 1 and 73 ± 6 mmHg in Group 2, p=0.608). Although lower total energy transfer indices were noticed through the low-resistance oxygenator (Group 2), both oxygenators showed a decrease of the generated pump oscillatory energy of approximately 50%. Despite the differences in resistance and compliance of the hollow-fibre oxygenators used, both oxygenators cause a comparable loss of generated oscillatory energy. Exclusion of the oxygenator downstream of the pulsatile pump would improve energy transfer during CPB.

Walking is most efficient when the least energy is spent over a certain distance. In six normal male subjects and 11 males with above-knee amputation the comfortable self-selected walking speeds and the most metabolically efficient walking speeds were determined. For that purpose energy expenditure was measured per second and per meter at six incremental walking speeds. Heart and step rate were registrated also at each walking speed. The results showed that in subjects who have not undergone amputation the comfortable walking speed is the same as the most efficient walking speed. However, in the above-knee amputee group, the comfortable walking speed is lower than the most efficient walking speed. When both groups walked at their own efficient walking speed they had the same energy expenditure per second.

Recent evidence from animal research and in vitro experiments indicates that changes in dietary calcium intake could cause changes in lipolysis through alterations of the intracellular calcium concentration in adipocytes. The objective of the study was to examine whether the calcium antagonist hydralazine affects blood flow and lipolysis in subcutaneous abdominal adipose tissue in vivo in humans. Three different concentrations of hydralazine (12.2, 24.4, and 48.8 micromol/L) were locally administered in adipose tissue using the microdialysis technique to assess effects on lipolysis and blood flow in subcutaneous adipose tissue in the abdominal region. Subjects from the general community were studied ambulatorily at a university hospital. Eight healthy men (age, 33.1 +/- 3.3 years; body mass index, 24.2 +/- 0.2 kg/m(2)) were recruited by local announcement. Subcutaneous adipose tissue in the abdominal region was perfused with increasing concentrations of hydralazine. The main outcome measures were adipose tissue lipolysis and blood flow. Hydralazine had no effect on ethanol outflow-inflow ratios, but significantly increased interstitial glycerol concentration at the highest concentration (P < .05). The present results indicate that hydralazine increases lipolysis in abdominal subcutaneous adipose tissue in healthy lean subjects, but hydralazine had no significant effects on local blood flow in adipose tissue.

China has achieved impressive rapid economic growth over the past 30 years but accompanied by significant extreme weather events and environmental changes caused by global change and overfast urbanization. Using the absolute hazards index (AHI), we assessed the spatial distribution patterns and related health effects of 4 major extreme natural disasters, including drought, floods (landslides, mudslides), hails, and typhoons from 2000 to 2011 at the provincial level in China. The results showed that (1) central and south China were the most affected by the 4 natural disasters, and north China suffered less; (2) the provinces with higher AHI suffered most from total death, missing people, collapse, and emergently relocated population; (3) the present health emergency response system to disasters in China mainly lacks a multidisciplinary approach. In the concluding section of this article, suggestions on preparedness and rapid response to extreme health events from environmental changes are proposed.

In the literature, it is well established that subjects are able to jump higher in a countermovement jump (CMJ) than in a squat jump (SJ). The purpose of this study was to estimate the relative contribution of the time available for force development and the storage and reutilization of elastic energy to the enhancement of performance in CMJ compared with SJ. Six male volleyball players performed CMJ and SJ. Kinematics, kinetics, and muscle electrical activity (EMG) from six muscles of the lower extremity were monitored. It was found that even when the body position at the start of push-off was the same in SJ as in CMJ, jump height was on average 3.4 cm greater in CMJ. The possibility that nonoptimal coordination in SJ explained the difference in jump height was ruled out: there were no signs of movement disintegration in SJ, and toe-off position was the same in SJ as in CMJ. The greater jump height in CMJ was attributed to the fact that the countermovement allowed the subjects to attain greater joint moments at the start of push-off. As a consequence, joint moments were greater over the first part of the range of joint extension in CMJ, so that more work could be produced than in SJ. To explain this finding, measured and manipulated kinematics and electromyographic activity were used as input for a model of the musculoskeletal system. According to simulation results, storage and reutilization of elastic energy could be ruled out as explanation for the enhancement of performance in CMJ over that in SJ. The crucial contribution of the countermovement seemed to be that it allowed the muscles to build up a high level of active state (fraction of attached cross-bridges) and force before the start of shortening, so that they were able to produce more work over the first part of their shortening distance.