A greater number of patients experienced a quicker onset of headache relief, without any new complications, from treatment with SPGB versus EBP. We believe that SPGB is a safe, inexpensive, and well-tolerated treatment. We hope that clinical trials will be conducted in the future that will confirm our findings and allow us to recommend SPGB for PDPH treatment prior to offering patients EBP.

(Reg Anesth Pain Med. 2018;43(8):880–884) Postdural puncture headache (PDPH) is a severe and debilitating complication after regional anesthesia in the obstetric population. Approximately 80% of patients suffer from this type of headache after an accidental dural puncture. A PDPH can limit postpartum mother-baby interactions, extend hospital stays, and raise health care costs. The gold standard treatment for postpartum PDPH is an epidural blood patch (EBP). This retrospective study aimed to compare the effectiveness of treatment with EBP to treatment with a sphenopalatine ganglion block (SPGB).

Abstract—Activation of the mammalian target of rapamycin (mTOR) leads to cell growth and survival. We tested the hypothesis that inhibition of mTOR would increase infarct size and decrease microregional O2 supply/consumption balance after cerebral ischemia–reperfusion. This was tested in isoflurane-anesthetized rats with middle cerebral artery blockade for 1 h and reperfusion for 2 h with and without rapamycin (20 mg/kg once daily for two days prior to ischemia). Regional cerebral blood flow was determined using a C14-iodoantipyrine autoradiographic technique. Regional small-vessel arterial and venous oxygen saturations were determined microspectrophotometrically. The control ischemic-reperfused cortex had a similar blood flow and O2 consumption to the contralateral cortex. However, microregional O2 supply/consumption balance was significantly reduced in the ischemic-reperfused cortex. Rapamycin significantly increased cerebral O2 consumption and further reduced O2 supply/consumption balance in the reperfused area. This was associated with an increased cortical infarct size (13.5 ± 0.8% control vs. 21.5 ± 0.9% rapamycin). We also found that ischemia–reperfusion increased AKT and S6K1 phosphorylation, while rapamycin decreased this phosphorylation in both the control and ischemic-reperfused cortex. This suggests that mTOR is important for not only cell survival, but also for the control of oxygen balance after cerebral ischemia–reperfusion.

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Varicella zoster virus causes varicella (chickenpox). It can be reactivated endogenously many years later to cause herpes zoster (shingles). Although varicella is usually a benign disease in healthy children, it resulted in over 11 000 hospitalizations and over 100 deaths every year, in all ages, in the United States. Morbidity was considerably worse in older teenagers and adults. Between 5% and 15% of cases of adult chickenpox will produce some form of pulmonary illness. Progression to pneumonia risk factors include pregnancy, age, smoking, chronic obstructive pulmonary disease, and immunosuppression. Typically, pulmonary symptoms occur 1 to 6 days after varicella zoster infection. They often include cough, fever, and dyspnea. Treatment is a 7-day course of intravenous acyclovir for varicella pneumonia. Early intervention may modify the course of this complication. This review illustrates practical features with a case of a 34-year-old female with severe varicella pneumonia. Despite the lack of significant past medical history and absence of immunosuppression, her pneumonia worsened and by using continuous positive airway pressure mask, intubation was avoided. More important, the radiographic progression of severe varicella pneumonia is shown. This highlights how a common disease of varicella can progress in an adult and manifest with significant organ malfunction.

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Residues 75-78 form a tight turn within Omega-loop D in Saccharomyces cerevisiae iso-1-cytochrome c. Directed, random mutagenesis of invariant residues proline 76 and glycine 77 in this turn were analyzed for the in vivo functionality and level of protein within the cell. All proteins, except Pro76Val, also exhibit a significant decrease in intracellular cytochrome c levels, ranging from 15% to 80% of wild type. Furthermore, all isolated mutant strains, except the one expressing Pro76Val, exhibit a significant decrease in growth on lactate medium, suggesting that the variant cytochromes are much less functional than wild type. This requirement for protein function is clearly the cause for the strict invariance of these residues in eukaryotic cytochromes c. Seven proteins with mutations just at Pro76 were purified and studied by circular dichroism spectroscopy. All proteins with mutations at Pro76 exhibit melting temperatures about 7 degreesC less than that of the wild-type protein, suggesting that mutation of Pro76 affects the entropy of the denatured state. It is proposed that the functional significance of Pro76 and Gly77 is the requirement for a type II (betagammaL) beta-turn in this loop, the conformation of which requires a glycine at the third position, and that a change occurs in this turn conformation upon a change in the redox state of the protein.

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