Summer’s brutal heat brings with it the dangers of skin-scorching sunburn, heartbreaking accidents and deadly dehydration. Summer is also the time when travel season peaks, as people journey to various locations for rest and relaxation, to enjoy water activities and take a “time out.” Healthcare specialists from The University of Texas Health Science Center at Houston offer advice and tips to beat the heat and stay safe this summer.

Hydrate

Richard N. Bradley, M.D., associate professor of emergency medicine at The University of Texas Medical School at Houston, can address summertime dangers involving heat-related illnesses such as dehydration, heat stroke, heat exhaustion and heat cramps. “Don’t push it too hard due to the soaring temperatures we are seeing this summer. When possible, stay inside your air-conditioned homes or go to places that have A/C,” said Bradley.

Heat versus hydration tips:

• Drink plenty of water – the amount of water people should drink depends on how much water they are losing through sweat and other sources. Bradley suggests people who do not have kidney failure should drink at least a pint per hour if outdoors and during heavy exertion in hot weather..
• Do not drink alcohol, which accelerates dehydration.
• Drink water throughout the day, even when you are not thirsty. Healthy people should drink one pint per hour.
• If you notice someone acting confused and they have been out in the hot sun, seek help immediately and call 911.
Bradley also suggests you be alert to the symptoms of heat-related illnesses such as cramps, heat exhaustion and heat stroke.
• Heat cramps are painful, brief muscle cramps that occur during exercise or work in a hot environment. The cramps are usually felt in the calves, thighs, abdomen or shoulders.
• Heat exhaustion occurs when the body is not able to maintain normal functions because of the excessive loss of body fluids and salts. In effect, the body is trying to protect itself from a greater rise in body temperature. The symptoms include: heavy sweating, intense thirst, dizziness, nausea and a weak or rapid pulse.
• Heat stroke is a life-threatening emergency. It is the result of the body’s inability to regulate its core temperature. As the body’s water and salt supplies dwindle, its temperature rises to extreme levels. The symptoms include: a body temperature above 104 degrees (although heat stroke can occur at lower body temperatures), disorientation, confusion or coma. The skin may be hot and dry or sweaty.

Tan Ban

Overexposure to the sun can damage the skin, causing painful sunburns and heat rash. According to the American Academy of Dermatology Association, ultraviolet (UV) radiation is considered the single largest environmental contributor to skin cancer. “Minimize your exposure in the sun during the hottest hours of the day, which are usually between 10 a.m. and 2 p.m.,” said Adelaide Hebert, M.D., professor of dermatology at UT Medical School at Houston. The rates of skin cancer in the United States have significantly increased; over a million new cases are diagnosed each year. Melanoma is now the second most common cancer in women ages 20 to 29.

Summer sun advice:

• Wear sunscreen with an SPF of 30 or higher.
• Wear protective tightly woven clothing and hats.
• Wear wraparound sunglasses to protect eyes.
• Reapply sunscreen every two hours if you have sweated or been exposed to water, wind or high altitudes.
• Protect your lips, ears and tops of your feet.

Swim Safely

Brent R. King, M.D., professor of emergency medicine and pediatrics at UT Medical School at Houston, stresses the importance of supervision of minors and inexperienced swimmers. “Young children can drown in just a few minutes, so the supervising adult should pay full attention to the swimmers,” King said, “However, supervision can be ineffective if those watching the swimmers do not know how to swim or safely rescue a drowning person.” Basic water safety and lifesaving classes are available through the American Red Cross, the YMCA and other organizations, King said, and everyone should learn basic CPR.

Water safety tips:

• Designate a responsible adult, who will not be involved in any other distracting activity, to watch young children.
• Always swim with a buddy. Select swimming sites that have lifeguards whenever possible.
• Avoid drinking alcohol before or during water activities or while supervising children swimming.
• Learn to swim.
• Constant and careful supervision and barriers such as pool fencing are necessary even when children have completed swimming classes. Do not use air-filled or foam toys in place of U.S. Coast Guard approved life jackets (personal flotation devices). Toys are not designed to keep swimmers safe.
• Know the local weather conditions and forecast before swimming or boating. Strong winds and thunderstorms with lightning strikes are dangerous.
• Watch for dangerous waves and signs of rip currents. If you are caught in a rip current, swim parallel to shore; once free of the current, swim toward shore.

Travel Tips

Pre-travel planning is important to ensure safe and healthy travel. “Travelers, especially those with chronic illnesses, should take precaution and locate travel clinics and medical facilities ahead of time in the area they plan to visit. It is also important for travelers to pack a mobile personal pharmacy,” said Herbert DuPont, M.D., professor and director of The Center for Infectious Disease at The University of Texas School of Public Health. DuPont suggests…

Building a medicine kit for the trip:

• Place two sets of prescription and over-the-counter medications in two different pieces of luggage in original labeled containers.
• Carry medications and a small first aid kit for common complaints that may arise, such as headaches, heartburn, cuts and scratches and colds.
• Bring specialized items geared for travel to developing tropical or semi-tropical regions. Those include medication for treatment and possible prevention of traveler’s diarrhea and malaria; antibiotics for infections; and compression stockings for lengthy air travel to reduce the risk of forming blood clots in the legs.

DuPont advises travelers to use caution while eating and drinking in developing regions of Latin America, Southern Asia and Africa. Safe foods include those served steaming hot, carbonated drinks, those containing high amounts of sugar such as (syrups, jellies, jams), dry items such as bread and any item that has been peeled. Potentially unsafe foods include those served with moisture at room temperature and fruits and vegetables served with intact skins, DuPont said.

Avoid alcohol

Whether you are attending a party, cookout or an evening at the game, many people think of summer as a “time out” from normal routines and they tend to drink more, according to UT School of Public Health associate professor Scott Walters, Ph.D. Unfortunately, people are also more likely to experience drinking related problems during the summer, such as hangovers, assaults and intoxicated driving. Walters advises people to be careful with not only how much they’re drinking, but also how they drink. “Our research has suggested that people can reduce the amount of problems they encounter by adopting simple drinking strategies to slow or spread out their drinking,” said Walters.

Summer drinking strategies to improve safety:

• Decide ahead of time how many drinks you will have or when you will stop drinking.
• Alternate between alcoholic and non-alcoholic drinks.
• Avoid doing “shots” of liquor.
• Drink plenty of water and put extra ice in your drink.
• Don’t mix different types of alcohol.
• Drink slowly, rather than gulp or chug, and don’t try to keep up with other’s drinking.
• Eat before or during drinking.
• Keep track of the number of drinks.

According to Walters, research shows that people who use strategies like these tend to have fewer problems, even when they are drinking the same amount.

ATV Safety

Every year, all-terrain vehicle riders – many of them children – wind up in hospital emergency rooms with serious and sometimes fatal injuries. According to James McCarthy, M.D., an assistant professor of emergency medicine at the UT Medical School at Houston and medical director of the Emergency Center at Memorial Hermann-Texas Medical Center, the accidents can be reduced by following basic safety rules.

McCarthy says all riders should wear protective gear, especially a good helmet, and stick to designated trails. He says young riders should stay off adult-sized ATVs and that young riders require adult supervision. Young children probably should not be on them at all, he said.

“ATVs are vehicles – not toys,” said McCarthy, whose ER has already treated multiple ATV accident victims this summer. “All-terrain vehicles need to be driven responsibly. Alcohol and ATVs definitely do not mix.”

In 2006, there were about 150,000 injuries and 555 fatalities involving ATVs and more than a 100 of those fatalities were children under the age of 16, according to the U.S. Consumer Product Safety Commission (Newswise).

Nutrition experts at The University of Texas M. D. Anderson Cancer Center offer advice this week on how to barbecue the healthy way.

M. D. Anderson dietitian, Vicki Piper, R.D., L.D., encourages cookout fans to grill plenty of fruits and vegetables, and less meat. Diets high in plant foods can lower your chances of developing several cancers, including breast and colon cancers.

“You can still have a barbeque without letting your health go up in flames,” Piper said. “Aim for a meal made up of two-thirds vegetables, fruits, whole grains or beans, and one-third animal protein.”

Grill plant-based foods

Eating mostly plant-based foods provides a range of nutrients that protects the body from cancer. And it is a great way to manage weight, which is important because there is evidence that excessive body fat increases cancer risks.

“Try a new vegetable every week, one that you have not tried in many years,” Piper said. “My family favorites are grilled onions, zucchini, asparagus and pineapple.”

Use a light brushing of canola or olive oil on vegetables and fruits to help prevent sticking to the grill. Sprinkle vegetables with pepper, a small amount of salt and vinegar to bring out their taste. Using non-stick grates, foil packets or a grilling basket lightly coated with oil also can be helpful when grilling plant-based foods. As a general rule, don’t peel vegetables before grilling. You’ll get more nutrients and enjoy a smokier flavor if they aren’t peeled.

Where’s the beef?

Diets high in red meat (beef, pork and lamb), and especially processed meats (such as hot dogs), have been reported to be a convincing cause of colorectal cancer, according to the American Institute for Cancer Research. Fatty red meat is high in saturated fat, which is the most damaging type of fat.

“You do not need to give up red meat to be healthy, but the evidence suggests you would be wise to limit how much you eat,” Piper said. “Experiment with other healthier sources of protein, such as fish, chicken, beans, edamame or tofu. My red meat-loving husband has grown to enjoy more grilled salmon, marinated chicken and even hummus!”

Grill fish and skinless chicken breasts are much leaner than most red meat. If you are going to grill red meat, look for those with “loin” in the name, such as beef tenderloin, pork tenderloin and lamb loin chops. For beef, also look for round steaks and roasts, and choose ground beef labeled at least 95 percent lean. Finally, beef labeled “prime” is the top grade but also is the highest in fat. For the leanest red meat, look for a “select” grade at your supermarket.

Keep meat portions small by cutting them in chunks and removing excess fat. Combine them with vegetables and make kabobs. Serve any kind of meat as an accent to a meal rather than the main dish.

Where there’s smoke, there’s cancer risk

Grilling any type of meat, even chicken or fish, until it’s charred or burned can increase your chances of getting cancer, according to the American Institute for Cancer Research. Grilling vegetables and fruits does not create carcinogens (sources that cause cancer) so there is no cancer risk, which is just one more reason to add them to your shopping list.

If you do choose to barbeque meat, stay clear of burning it, and…

Follow these barbecue grilling tips:

• Grill fish instead. Fish contains less fat than meat and poultry do, making it less likely to create carcinogens and cause flare-ups caused by dripping fat. Fish also requires less time on the grill, reducing its exposure to carcinogens.
• Precook your foods. The higher the temperature at which food cooks and the longer it stays on the grill, the more carcinogens develop. Partially cooking meat or poultry indoors draws out most of the potentially harmful chemicals without sacrificing moistness.
• Lightly oil your grill. A little oil keeps charred material from sticking to the food. It also helps keep fish and chicken in one piece.
• Lower the heat. On charcoal grills, increase the distance between the food and the hot coals by spreading the coals thin or by propping the grill rack on bricks. On gas grills, just lower the settings.
• Stick to charcoal and hardwood. Barbecue briquettes and hardwood products, such as hickory and maple burn at lower temperatures than softwood (pine) chips.
• Clean your grill. Scrub your grill thoroughly after every use to avoid a buildup of carcinogens that can be transferred to your food the next time you grill.
• Spread aluminum foil on the grill. This will reduce flare-ups. Just make sure to make small holes in the foil to allow fat to drain.
• Flip meat frequently. This reduces the amount of carcinogens that arise.
• Marinate your food. Marinating not only makes grilled foods taste better, but makes them safer because marinades draw out chemical precursors of carcinogens (Newswise).

The-APS.org - Exercise and electro-acupuncture treatments can reduce sympathetic nerve activity in women with polycystic ovarian syndrome (PCOS), according to a new study. The finding is important because women with PCOS often have elevated sympathetic nerve activity, which plays a role in hyperinsulinemia, insulin resistance, obesity and cardiovascular disease

The study also found that the electro-acupuncture treatments led to more regular menstrual cycles, reduced testosterone levels and reduced waist circumference.

Exercise had no effect on the irregular or non-existent menstrual cycles that are common among women with PCOS, nor did it reduce waist circumference. However, exercise did lead to reductions in weight and body mass index.

“The findings that low-frequency electro-acupuncture and exercise decrease sympathetic nerve activity in women with PCOS indicates a possible alternative non-pharmacologic approach to reduce cardiovascular risk in these patients,” said one of the researchers, Dr. Elisabet Stener-Victorin of the University of Gothenburg, Sweden. The findings regarding menstrual cycles and decrease in testosterone levels in the low-frequency electro-acupuncture are also of interest, according to the researcher.

The study, “Low-frequency electro-acupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome” was conducted by Elisabet Stener-Victorin, et al, of the Sahlgrenska Academy, University of Gothenburg, Sweden and the Karolinska Institute, Stockholm, Sweden. The study is in the online edition of the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology.

PCOS - Common endocrine disorder

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting an estimated 10% of women of reproductive age. Among the problems associated with the condition are elevated levels of androgens (such as testosterone, the ‘male’ hormone found in both sexes), ovarian cysts, irregular menstrual cycles and infertility.

PCOS is associated with increased sympathetic nerve activity in the blood vessels, part of the ‘fight or flight’ response that results in blood vessel constriction. Chronic activation of the sympathetic nervous system increases the risk of diabetes, high blood pressure, heart attack and stroke.

The Swedish researchers had previously found that PCOS is associated with increased sympathetic nerve activity and said it may arise from the elevated testosterone level that is characteristic of PCOS.

Three groups

The researchers wanted to find a long-lasting treatment for PCOS that would have no adverse side effects, and so they looked at whether acupuncture or exercise could decrease the sympathetic nerve activity in women with PCOS. The study included 20 women, average age of 30 years, divided into the following groups:

• low-frequency electro-acupuncture (9)
• exercise (5)
• untreated controls, (6)

The acupuncture group underwent 14 treatments during the 16-week study. Acupuncture points were located in abdominal muscles and back of the knee, points thought to be associated with the ovaries. The needles in the abdomen and leg were stimulated with a low-frequency electrical charge, enough to produce muscle contraction but not enough to produce pain or discomfort.

The exercise group received pulse watches and were told to take up regular exercise: brisk walking, cycling or any other aerobic exercise that was faster than walking but that they could sustain for at least 30 minutes. They exercised at least three days per week for 30-45 minutes, maintaining a pulse frequency above 120 beats per minute.

The researchers instructed the control group in the importance of exercise and a healthy diet, the same instructions the experimental groups received, but were not specifically assigned to do anything differently.

Key Findings

The researchers measured the muscle sympathetic nerve activity before and after the 16-week study. Following treatment, the study found the following:

• Both the acupuncture and exercise groups significantly decreased muscle sympathetic nerve activity compared to the control group.
• The acupuncture group experienced a drop in waist size, but not a drop in body mass index or weight.
• The exercise group experienced a drop in weight and body mass index but not in waist size.
• The acupuncture group experienced fewer menstrual irregularities but the exercise group’s irregularities did not change.
• In the acupuncture group, there was a significant drop in testosterone. This is an important indicator because the strongest independent predictor of high sympathetic nerve activity in women is the level of testosterone.

“This is the first study to demonstrate that repeated low-frequency electro-acupuncture and physical exercise can reduce high sympathetic nerve activity seen in women with PCOS,” according to the authors. “Furthermore, both therapies decreased measures of obesity while only low-frequency electro-acupuncture improved menstrual bleeding pattern.”

The abstract of the study is available here:

Electro-Acupuncture, Physical Exercise Help Polycystic Ovary Syndrome

UTSouthwestern.edu - UT Southwestern Medical Center researchers are conducting two pilot clinical trials to determine whether a single, early dose of estrogen can improve survival and neurological outcomes after severe traumatic brain injury or traumatic hemorrhagic shock.

In these double-blind studies, male patients transported to Parkland Memorial Hospital following severe traumatic brain injury or severe blood loss associated with a traumatic injury will be assigned randomly to receive either Premarin (estrogen) or a placebo intravenously after arriving in the emergency department.

Estrogen or a placebo will be administered as a single-dose within two hours of injury. The researchers will measure biomarkers of injury and repair in different body fluids during the first few days after injury, and also will evaluate survival and neurological outcomes.

Despite advances in surgical interventions and intensive care management, about 35 percent of patients with severe traumatic brain injury and hemorrhagic shock die. Many survivors do not fully recover and are left with permanent disability.

“Following traumatic brain injury or hemorrhagic shock, secondary injury, such as inflammation, begins rapidly and greatly worsens the initial injury,” said Dr. Jane Wigginton, assistant professor of emergency medicine at UT Southwestern and the trials’ principal investigator. “Hundreds of animal studies have shown that estrogen significantly reduces secondary injury. Those studies give us hope that this new therapy offers considerable promise and minimal risk following one dose in patients with life-threatening traumatic injuries.”

Dr. James Simpkins, chair of pharmacology and neuroscience at the University of North Texas Health Science Center at Fort Worth, initially discovered in 1994 in animals that estrogens protect brains from damage.

“There are now several hundred high-quality animal studies demonstrating the effectiveness of estrogens in protecting the brain from the damaging effects of traumatic brain injury, stroke, hemorrhagic shock and chemical injury,” said Dr. Simpkins. “These trials will be the first ever critical assessment of the effects of rapid intervention with estrogen on the outcome of traumatic brain injury in a human population.”

Intravenous estrogen has been used safely for decades in both men and women to treat excessive bleeding of the uterus and prostate cancer. While animal studies have found that estrogen reduces inflammation and minimizes secondary injury, the effects of estrogen have not been tested in patients with traumatic brain injury and severe bleeding after a traumatic event.

Dr. Wigginton said for this study, only men are being given a dose of estrogen; 70 percent of trauma patients with severe brain injury or blood loss are young males. Limiting the study to men, who represent the most frequently affected population, also will remove the confounders of potentially high estrogen levels that might occur naturally in women, or be caused by birth control pills or hormone replacement therapy.

Because patients will be critically ill and the drug needs to be given rapidly following trauma, they will not be able to give informed consent for the study. Area residents who want to be excluded can opt out by calling 214-648-6726. Those individuals will be given a special wristband to alert doctors in the emergency department that they don’t want to participate in the study. Researchers anticipate enrolling 50 patients in each study.

“We are highly enthusiastic about the evaluation of estrogen as an acute treatment in patients with traumatic brain injury and severe blood loss, given the significant benefit demonstrated in animal studies and safety data in humans prescribed intravenous estrogen for other indications,” said Dr. Ahamed Idris, professor of emergency medicine at UT Southwestern. “It is our greatest hope that these groundbreaking studies will soon translate into improved survival and neurological outcomes in trauma patients around the world.”

Alcohol’s intoxicating effects are familiar to everyone. But the molecular details of alcohol’s impact on brain activity remain a mystery. A new study by researchers at the Salk Institute for Biological Studies brings us closer to understanding how alcohol alters the way brain cells work.

Their findings, published in the current advance online edition of Nature Neuroscience, reveal an alcohol trigger site located physically within an ion channel protein; their results could lead to the development of novel treatments for alcoholism, drug addiction, and epilepsy.

Ethanol, the alcohol in intoxicating beverages, is known to alter the communication between brain cells. “There’s been a lot of interest in the field to find out how alcohol acts in the brain,” says Paul A. Slesinger, Ph.D., an associate professor in the Peptide Biology Laboratory at the Salk Institute, who led the study. “One of several views held that ethanol works by interacting directly with ion channel proteins, but there were no studies that visualized the site of association.”

Slesinger and his team now show that alcohols directly interact with a specific nook contained within a channel protein. This ion channel plays a key role in several brain functions associated with drugs of abuse and seizures.

Previous research by Slesinger and his group focused on the neural function of these ion channels, called GIRK channels. GIRK channels, short for G-protein-activated inwardly rectifying potassium channels, open up during periods of chemical communication between neurons and dampen the signal, creating the equivalent of a short circuit.

“When GIRKs open in response to neurotransmitter activation, potassium ions leak out of the neuron, decreasing neuronal activity,” says UCSD Biology graduate student and first author Prafulla Aryal. Alcohols had been previously shown to open up GIRK channels but it was not known whether this was a direct effect or whether this was the by-product of other molecular changes in the cell.

Having the location of a physical alcohol-binding site important for GIRK channel activation could point to new strategies for treating related brain diseases. Using this protein structure, it may be possible to develop a drug that antagonizes the actions of alcohol for the treatment of alcohol dependence. Alternatively, “If we could find a novel drug that fits the alcohol-binding site and then activate GIRK channels, this would dampen overall neuronal excitability in the brain and perhaps provide a new tool for treating epilepsy,” says Slesinger.

Epilepsy is a neurological disease characterized by episodic, abnormal electrical activity that affects more than 3 million Americans. Current medications have serious side effects and the search for new, specific mechanisms of treatment is an area of intense research across the globe.

To gain more insight into how alcohols work, Slesinger and Aryal teamed up with Salk colleagues Senyon Choe, Ph.D., a professor in the Structural Biology Laboratory, and Hay Dvir, Ph.D., a postdoctoral researcher in Choe’s lab, to determine whether tiny pockets found in a high resolution, three-dimensional structure of a potassium channel were, in fact, the sites of alcohol action in GIRK channels. The Salk researchers noted the similarity of these candidate alcohol-binding sites with alcohol pockets visualized in two other alcohol-binding proteins: alcohol dehydrogenase, the enzyme that breaks down alcohol in the body, and a fruit fly protein, LUSH, that senses alcohol in the environment.

When Aryal systematically introduced amino acid substitutions that denied alcohol molecules access to the potential alcohol binding site, alcohol could no longer efficiently activate the channel, confirming that they had hit upon an important regulatory site for alcohol. The team further established that this pocket is a trigger point for channel activation since G protein activation was also altered. “We believe alcohol hijacks the intrinsic activation mechanism of GIRK channels and stabilizes the opening of the channel,” says Aryal. “Alcohol may accomplish this by lubricating the activation gears of the channel,” adds Slesinger (Courtesy of EurekAlert!, a service of AAAS).

Uni-Heidelberg.de - Just one drink can quickly go to your head. Researchers in Heidelberg tested this well-known adage. Only six minutes after consuming an amount of alcohol (ethanol) equivalent to three glasses of beer or two glasses of wine, leading to a blood alcohol level of 0.05 to 0.06 percent, changes have already taken place in the brain cells, as the scientists in Heidelberg proved using magnetic resonance spectroscopy (MRS). Previously the only available data was from animal trials. The results of the study were published in the Journal of Cerebral Blood Flow and Metabolism.

Metabolism of brain cells affected quickly by alcohol

The brain reacts quickly to alcohol. “Our study provides evidence for alternative energy utilization upon alcohol ingestion, i.e. the brain uses an alcohol breakdown product instead of glucose for energy demands,” explains Dr. Armin Biller of the working group for cerebral metabolism at the Department of Neuroradiology at Heidelberg University Hospital (Medical Director: Prof. Dr. Martin Bendszus). The harmful effect also sets in quickly. During the experiment, the concentration of substances such as creatine (energy metabolism), which are attributed with protecting cells, decreases as the concentration of alcohol increases. Choline, a component of cell membranes, was also reduced. “That probably indicates that alcohol triggers changes in the composition of cell membranes,” says Dr. Armin Biller.

Is all consumption of alcohol harmful for the brain? “Our follow-ups on the next day showed that the shifts in brain metabolites after moderate consumption of alcohol by healthy persons are completely reversible,” says Dr. Armin Biller. “However, we assume that the brain’s ability to recover from the effect of alcohol decreases or is eliminated as the consumption of alcohol increases. The acute effects demonstrated in our study could possibly form the basis for the permanent brain damage that is known to occur in alcoholics. This should be clarified in future studies.”

Drinking for science - No differences between men and women

Eight male and seven female subjects participated in the alcohol experiment. While lying in the MRI scanner, they drank the specified amount of alcohol through a long straw. The goal was to reach a blood alcohol content of 0.05 to 0.06 percent – a level that impairs ability to drive, but does not induce severe intoxication. In the MRI scanner, the nuclei of atoms in brain tissue were stimulated by a high-frequency impulse and the signal transmitted during the return to the initial condition was received. The spectral properties of this signal can be analyzed, allowing conclusions to be made as to the contents of various products of metabolism in the tissue examined. This study found no differences between the results of male and female individuals – the brains of female and male subjects reacted to alcohol consumption the same way.

What substances cause a “hangover”?

In other studies, the researchers examined what a “hangover” does to the brain – magnetic resonance spectroscopy can possibly enable us to find out what substances in alcoholic beverages bring on the familiar “hangover”.

Reference: Armin Biller, et al. The Effect of Ethanol on Human Brain Metabolites Longitudinally Characterized by Proton MR-Spectroscopy, Journal of Cerebral Blood Flow and Metabolism 2009, in press.