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Background: Although apathy has been associated with fronto-striatal dysfunction in several neurological disorders, its clinical and magnetic resonance imaging (MRI) correlates have been poorly investigated in people with multiple sclerosis (PwMS)., Objectives: To evaluate clinical variables and investigate microstructural integrity of fronto-striatal grey matter (GM) and white matter (WM) structures using diffusion tensor imaging (DTI)., Methods: A total of 123 PwMS (age: 40.25 ± 11.5; female: 60.9%; relapsing-remitting multiple sclerosis: 75.6%) were prospectively enrolled and underwent neurological and neuropsychological evaluation, including Expanded Disability Status Scale (EDSS), Apathy Evaluation Scale (AES-S), Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS) and brain 3T-MRI volumes of whole brain, frontal/prefrontal cortex (PFC) and subcortical regions were calculated. DTI-derived metrics were evaluated in the same GM regions and in connecting WM tracts., Results: Apathetic PwMS (32.5%) showed lower education levels, higher HADS, MFIS scores and WM lesions volume than nonapathetic PwMS. Significant differences in DTI metrics were found in middle frontal, anterior cingulate and superior frontal PFC subregions and in caudate nuclei. Significant alterations were found in the right cingulum and left striatal-frontorbital tracts., Conclusions: Apathy in PwMS is associated with higher levels of physical disability, depression, anxiety and fatigue together with lower educational backgrounds. Microstructural damage within frontal cortex, caudate and fronto-striatal WM bundles is a significant pathological substrate of apathy in multiple sclerosis (MS)., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: M.I. received grants from NIH, NMSS and FISM; received fees for consultation from BMS; Janssen, Roche, Genzyme, Merck, Biogen and Novartis. M.C. received personal compensations from Novartis, Sanofi Genzyme and Teva and consulting fees from Zambon. G.B. was supported by a research fellowship FISM – Fondazione Italiana Sclerosi Multipla 2019/BR/016 and financed or co-financed with the ‘5 per mille’ public funding. He received personal fee from Novartis and Roche. C.L. received personal fee from Novartis, Roche, Sanofi, BMS and Janssen. All other authors declare no competing interests.

This is an assessment of the effect of propofol (Diprivan) as a hypnotic component of total intravenous anesthesia (TIVA) in conjunction with alfentanyl (Rapifen), securing the antinociceptive component, and atracurium (Tracrium) as myorelaxant. The aforementioned constellation is used with the goal to attain a much better control of TIVA, substantiated both pharmacokinetically and pharmacodynamically. This type of anesthesia is applied to 15 patients presenting acute surgical diseases, classified III-IV degree according to ASA. The technique used and the dosage of drugs, introduced by infusion, are described. The basic respiratory and cardiocirculatory parameters are evaluated. Assessment is done of the quality of analgesia with description of the character of the awakening and recovery phases in terms of time and quality. The preliminary study, covering patients with increased anesthesiological risk, shows that the doses given are appreciably reduced in the period of maintaining anesthesia (4-5 mg/kg/h Propofol, 1-1.5 mg/h Rapifen in patients with mean body weight 70 kg). The prophylaxis against operative stress is estimated as very good. TIVA with Diprivan/Rapifen/Tracrium lends itself readily to control.

Propofol is an anesthetic characterized by specific pharmacologic qualities, conditioning compliance of the clinical picture with the drug infusional rate, high-degree safety and facilitated anesthesia conduction--qualities by which it bears resemblance to inhalation anesthesia. This is an assessment of the qualities of TIVA with Propofol in poor-risk patients according to ASA, operated on an emergency basis. Proceeding from the obtained results, the inference is reached that continuous Propofol infusion provides for adequate anesthesia control and safety of the patients with heightened anesthesiologic and operative risk.

Continued sedation has important practical implications on overcoming the physical and psychic stress which in turn, has important practical implications on the well-being of patients in conditions of intensive care unit. It is the purpose of the study to assess the quality and characteristics of sustained sedation with constant propofol (Diprivan) and fentanyl infusion. As a result of the study the inference is reached that sedation with Diprivan and fentanyl, administered as constant infusion, lends itself readily to control, and what is more, it is free of noteworthy side effects. To secure permanent sedation it is necessary to adapt the infusional rate to the clinical signs in compliance with the concrete patient and individual needs.