医用退热贴冷敷治疗产后生理性乳房胀痛的效果观察

目的 比较医用退热贴冷敷及卷心菜叶外敷2种方法对缓解产后生理性乳房胀痛的疗效。方法 选取2018年3-12月在产科住院的产后生理性乳房胀痛的患者100例为研究对象,将其随机分为对照组和观察组,各50例。对照组采用卷心菜叶外敷,观察组采用医用退热贴冷敷。结果 观察组产后生理性胀痛乳房评分低于对照组(Z=-2.568,P=0.010),乳房硬度优于对照组(Z=-4.361,P<0.001),使用维持时间长于对照组(t=19.804,P＜0.001)。结论 医用退热贴冷敷用于产后生理性乳房胀痛效果理想,操作方法简单易行,实施方便,易被产妇接受,值得临床推广应用。     

Successful treatment of a recurrent post-dural puncture headache with an epidural blood patch 18 months after the initial dural puncture

Inadvertent dural puncture is a recognised complication of epidural insertion. Parturients are at increased risk of developing a post-dural puncture headache, which can be debilitating for a mother caring for a newborn infant. Epidural blood patch is an effective treatment in patients presenting acutely with post-dural puncture headaches but its efficacy in those with delayed presentation or with late recurrent post-dural puncture headache is less clear. We present the case of a woman with a recurrent post-dural puncture headache who was successfully treated with an epidural blood patch 18 months after the initial dural puncture. Patients who develop post-dural puncture headaches may remain symptomatic for some time and an epidural blood patch may be beneficial, following appropriate investigation.     

Nicotine smoking concentrations modulate GABAergic synaptic transmission in murine medial prefrontal cortex by activation of α7* and β2* nicotinic receptors

Nicotine is the major addictive component of cigarettes, reaching a brain concentration of ~300 nM during smoking of a single cigarette. The prefrontal cortex (PFC) mechanisms underlying temporary changes of working memory during smoking are incompletely understood. Here, we investigated whether 300 nM nicotine modulates γ‐aminobutyric acid (GABA) ergic synaptic transmission from pyramidal neurons of the output layer (V) of the murine medial PFC. We used patch clamp in vitro recording from C57BL/6 mice in the whole‐cell configuration to investigate the effect of nicotine on pharmacologically isolated GABAergic postsynaptic currents (IPSCs) in the absence or presence of methyllycaconitine (MLA) or dihydro‐β‐erythroidine (DHβE), selective antagonists of α7‐ and β2‐containing (α7* and β2*) nicotinic acetylcholine receptors (AChRs), respectively. Our results indicated that nicotine, alone or in the presence of MLA, decreases electrically evoked IPSC (eIPSC) amplitude, whereas in the presence of DHβE, nicotine elicited either an eIPSCs amplitude increase or a decrease. In the presence of DHβE, nicotine increased membrane conductance leaving the paired pulse ratio unchanged in all conditions, suggesting a non‐β2* mediated effect. In the presence of MLA, nicotine decreased the mean spontaneous IPSC (sIPSC) frequency but increased their rise time, suggesting a non‐α7* AChR‐mediated synaptic modulation. Also, in the presence of DHβE, nicotine decreased both eIPSC rise and decay times. No receptors other than α7* and β2* appear to be involved in the nicotine effect. Our results indicate that nicotine smoking concentrations modulate GABAergic synaptic currents through mixed pre‐ and post‐synaptic mechanisms by activation of α7* and β2* AChRs.     

Utility of heavily T2-weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches

Heavily T2-weighted MR myelography (HT2W-MRM) is emerging as an alternative approach for detection and follow up of CSF leaks. We aimed to assess epidural blood patch (EBP) treatment outcome when using HT2W-MRM as the primary modality for detecting CSF leak and planning EBP placement in routine clinical practice. Since 2018, patients at our institute suspected of having CSF leak, routinely HT2W-MRM instead of CT myelography to determine presence of the leak and identify the EBP target site. Fifty-nine consecutive patients suspected of having a CSF leak underwent HT2W-MRM. After excluding patients with subdural hematoma and poor image quality, 26 (10 men, 16 women; mean age 44.92 ± 12.6 years) patients were included in this study. Patients received EBP on the basis of HT2W-MRM assessments and clinical assessment. Imaging findings and clinical outcome were evaluated. CSF leak was identified in 21 patients (80.8%, 21/26) based HT2W-MRM. Most cases were graded on a confidence scale as CSF leak definitely (n = 13) or probably (n = 3) present. Successful clinical EBP treatment was achieved in 14 of 17 patients (82.4%) after first targeted EBP, and patient symptoms significantly improved after treatment (numerical rating score 6.4 before EBP, 1.3 after EBP, P < 0.001). HT2W-MRM based EBP are the rational and effective choices for CSF leak treatment in routine clinical practice.     

Hidden risks in toys: A systematic review of pediatric toy contact dermatitis

Toys are a reflection of the compounds used frequently in manufacturing. Allergic contact dermatitis to potties, metal toys, and children's jewelry is well known, however, there is a broad range of skin risks in toys. With the objective to identify and publicize the associated risk of contact dermatitis in children's toys, we have searched the PubMed database from creation to September 9, 2019. Studies were eligible if they reported a new case of contact dermatitis secondary to interaction with a toy in patients from birth to 18 years of age. A toy was defined as something children interact with for entertainment during leisure time. In this review of the PubMed database we filtered by age and language which may have prevented us from detecting cases in adults that could be extrapolated to children. In addition, several articles were excluded based on title alone. A total of 1312 articles were identified and reviewed manually for inclusion criteria. Review of the articles found 25 original articles for consideration. Several toys were found to be associated with contact dermatitis. These included electronics, toy cars, costume jewelry, bicycles, sqwish balls, slime, Play-Doh, and plasticine. Electronics such as video game controllers, cellphones, iPads, and computers were implicated. In conclusion, there is still an unmet need for observation of this segment of industry for labeling of contents and ongoing surveillance.