Eosinophilic fasciitis in a pair of siblings

Two siblings, a 38-year-old woman and a 33-year-old man, developed eosinophilic fasciitis within a period of 6 months. They were found to have identical HLA-A, B, DR, and DQ antigens, raising the possibility of a genetic influence in the development of this disease. No common environmental factors close to the time of onset were identified; however, the possibility of a common, remote environmental factor cannot be discounted.     

Staff nurses'' attitudes toward nursing research: a descriptive survey

Staff nurse involvement in clinical nursing research is dependent on the attitudes nurses hold toward research. An exploration of these attitudes was undertaken in a 464-bed midwestern teaching hospital as it developed its nursing research procedures. A questionnaire was developed which incorporated the Boothe Attitudes on Nursing Research Scale. All registered nurses (n = 925) at the facility were surveyed with a response rate of 77.8% (n = 720). Findings indicated that many nurses were interested in research and believed that the institution would support research activities and the implementation of research findings. Some deterrences to conducting research included: time, lack of knowledge, and the nurses's perception of the supervisory support and the research support services.     

Thrombotic arm edema as a complication of subclavian vein catheterization and arteriovenous fistula formation for hemodialysis

We report a case of persistent tense edema of the upper extremity following the surgical creation of an arteriovenous fistula for hemodialysis access. This was the result of poor venous return secondary to thrombosis of the subclavian vein. The thrombosis occurred after previous subclavian vein cannulation for hemodialysis.     

COVID-19 Repeated Convalescent Plasma Collection: Analysis of 149 Donations from 88 French Military Health Workers

BackgroundPassive therapy with convalescent plasma (CP) could be an effective and safe treatment option in COVID-19 patients. Neutralizing antibodies present in CP generated in response to SARS-CoV-2 infection and directed against the receptor-binding domain of the spike protein are considered to play a major role in the viral clearance. CP infusion may also contribute to the modulation of the immune response through its immunomodulatory effect. We describe for the first time the effectiveness of a CP collection protocol from repeated donations in young patients.Materials and MethodsWe enrolled health service workers who experienced mild to moderate COVID-19 and from whom several donations have been collected. No minimal severity threshold and no biological cure criteria were required. Donors could return to a second plasma donation 14 days after the first donation. A minimal neutralizing antibody titer of 1:40 was considered for clinical use.ResultsEighty-eight donors were included (median age 35 [28–48] years, 41 women), and 149 plasma products were collected. COVID-19 were mainly WHO stage 2 infections (96%). Among the 88 first donations, 76% had neutralizing antibody titers higher than or equal to 1:40. Eighty-eight percent of donors who came for a second donation had a neutralizing antibody titer of 1:40. Median durations were 15 (15–19) and 38 (33–46) days from the first to the second donation and from recovery to the second donation, respectively. Sixty-nine percent of donors who came for a third donation had a neutralizing antibody titer of 1:40. Median durations were 16 (13–37) and 54 (49–61) days from the second to the third donation and from recovery to the third donation, respectively. No significant difference was observed between the IgG ratio and the age of the donors or the time between recovery and donation. The average IgG ratio did not significantly vary between donations. When focused on repeated blood donors, no significant differences were observed either.ConclusionThe recruitment of young patients with a mild to moderate CO­VID-19 course is an efficient possibility to collect CP with a satisfactory level of neutralizing antibodies. Repeated donations are a well-tolerated and effective way of CP collection.     

Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review

Purpose

The goal of this study was to perform a comparative review to determine whether there is a significant difference in the rate of repeat dislocation and clinical outcome between surgical and conservative management of acute patellar dislocation in children and adolescents.

Methods

A systematic review of the MEDLINE database was performed. English-language clinical outcome studies with a primary outcome/treatment specific to acute patella dislocation in a paediatric population were included. Eleven studies met inclusion criteria; Chi-square analysis, independent t tests and weighted mean pooled cohort statistics were performed where appropriate.

Results

A total of 470 conservatively managed and 157 operatively treated knees were included. Conservatively managed patients were on average 17.0 years and had a mean follow-up of 3.9 years; surgically managed patients were on average 16.1 years and had a mean follow-up of 4.7 years. Conservatively managed knees had a 31 % rate of recurrent dislocation rate compared to 22 % in surgical knees (p = 0.04). Trochlear dysplasia and skeletal immaturity confer greater risk for recurrent instability. Surgical treatment may provide clinically important quality of life and sporting benefit.

Conclusions

Surgical treatment of first time patella dislocation in children and adolescents is associated with a lower risk of recurrent dislocation and higher health-related quality of life and sporting function. There is a paucity of evidence on MPFL reconstruction for first time traumatic patella dislocation in this population.

Level of evidence

IV.

     

Strength training effects in prepubescent boys

Possible changes in muscle size and function due to resistance training were examined in prepubertal boys. Thirteen boys (9-11 yr) volunteered for each of the training and control groups. Progressive resistance training was performed three times weekly for 20 wk. Measurements consisted of the following: 1 repetition maximum (RM) bench press and leg press; maximal voluntary isometric and isokinetic elbow flexion and knee extension strength; evoked isometric contractile properties of the right elbow flexors and knee extensors; muscle cross-sectional area (CSA) by computerized tomography at the mid-right upper arm and thigh; and motor unit activation (MUA) by the interpolated twitch procedure. Training significantly increased 1 RM bench press (35%) and leg press (22%), isometric elbow flexion (37%) and knee extension strength (25% and 13% at 90 degrees and 120 degrees, respectively), isokinetic elbow flexion (26%) and knee extension (21%) strength, and evoked twitch torque of the elbow flexors (30%) and knee extensors (30%). There were no significant effects of training on the time-related contractile properties (time to peak torque, half-relaxation time), CSA, or %MUA of the elbow flexors or knee extensors. There was, however, a trend toward increased MUA for the elbow flexors and knee extensors in the trained group. Strength gains were independent of changes in muscle CSA, and the increases in twitch torque suggest possible adaptations in muscle excitation-contraction coupling. Improved motor skill coordination (especially during the early phase of training), a tendency toward increased MUA, and other undetermined neurological adaptations, including better coordination of the involved muscle groups, are likely the major determinants of the strength gains in this study.