Therapeutic plasma exchange for exogenous insulin antibody syndrome in combined variable immunodeficiency: a case report.

A 32-year-old male with type I diabetes presented with profound hypoglycemia due to exogenous insulin antibody syndrome in the setting of newly-diagnosed common variable immunodeficiency. Immunomodulatory therapy was not initially effective, but after the initiation of plasma exchange hypoglycemia resolved, and glucose lability improved.

Foam rolling is an effective recovery tool in trained distance runners.

Purpose: Many endurance athletes use foam rolling (FR) to decrease muscle soreness, but it is unclear whether FR effectively treats soreness in this population. Moreover, the effects of FR in highly trained runners are unknown. The aim of this study was to use downhill running (DHR) to induce muscle soreness in runners and to determine the influence of FR on soreness and running performance when compared to sham compression tights. Methods: Participants performed a running economy (RE) test at 75% of 5-km race speed and a 3-km time trial (TT). In a crossover design, subjects then completed DHR followed by either a FR protocol or wearing sham compression tights. Two days post-DHR, subjects repeated the RE and TT tests. Crossover visits occurred 2-4 weeks later. During RE tests, VO2 and rating of perceived exertion (RPE) were recorded. Passive and active soreness were measured on a scale of 0 (no soreness) to 10 (extreme soreness). Results: Eight runners (aged 31 ± 7 years; four females; VO2peak 57 ± 7 ml kg-1 min-1) completed the study. Both treatment conditions experienced passive (p = 0.026) and active soreness (p = 0.012) induced by DHR. Active soreness 2 days postDHR was significantly lower after FR than after sham compression tights (p = 0.025). With tights, there was a trend for an increased RPE compared to pre-DHR (p = 0.056). Conclusions: Foam rolling decreases leg soreness in well-trained runners and attenuates soreness-related increases in perceived exertion during sub-maximal running.

Isokinetic Strength Deficit 6 Months After Adductor Canal Blockade for Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Recent evidence shows a delayed return to sport in children and delayed quadriceps recovery in both adults and children who have undergone anterior cruciate ligament (ACL) reconstruction with concomitant femoral nerve blockade (FNB) compared with those who had no blockade. We evaluated the use of adductor canal blockade (ACB), as an alternative to FNB, at the time of ACL reconstruction. HYPOTHESIS: Patients who receive ACB will have greater isokinetic strength at 6 months postoperative compared with patients who receive FNB at the time of ACL reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective record review was performed at a single academic medical center to identify all patients aged ≥16 years who had undergone ACL reconstruction with blockade between January 2010 and January 2015. Exclusion criteria included (1) non-sports medicine fellowship-trained surgeon performing the procedure, (2) continuous nerve catheter or concurrent epidural used, (3) revision ACL reconstruction or multiligament reconstruction as the index procedure, (4) previous contralateral ACL reconstruction, (5) concurrent microfracture, and (6) additional surgery within the 6-month outcome period that affected recovery. Isokinetic strength testing was performed using a computerized dynamometer, measuring total work at fast speed and peak torque at slow speed at 6 months; results were evaluated as a percentage of the nonoperative side. Multivariate regression analysis was used to evaluate the effect of block type on isokinetic strength outcome variables, controlling for age, sex, body mass index, graft type, and surgeon. RESULTS: There were 230 patients receiving FNB and 30 patients receiving ACB included in the study. The multivariate regression analysis identified a greater side-to-side deficit in extension total work for the ACB group compared with the FNB group (P = .040), after controlling for age, sex, body mass index, graft type, and surgeon. CONCLUSION: Compared with FNB, ACB for ACL reconstruction is associated with a persistent fast-activation isokinetic strength deficit at 6 months after surgery. This is the first study to compare FNB to ACB, and results are concerning for patients planning an early return to sport.

Albuterol Improves Alveolar-Capillary Membrane Conductance in Healthy Humans.

BACKGROUND: Beta-2 adrenergic receptors (ß2ARs) are located throughout the body including airway and alveolar cells. The ß2ARs regulate lung fluid clearance through a variety of mechanisms including ion transport on alveolar cells and relaxation of the pulmonary lymphatics. We examined the effect of an inhaled ß2-agonist (albuterol) on alveolar-capillary membrane conductance (DM) and pulmonary capillary blood volume (VC) in healthy humans. METHODS: We assessed the diffusing capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO) at baseline, 30 minutes, and 60 minutes following nebulized albuterol (2.5 mg, diluted in 3 mL normal saline) in 45 healthy subjects. Seventeen subjects repeated these measures following nebulized normal saline (age = 27 ± 9 years, height = 165 ± 21 cm, weight = 68 ± 12 kg, BMI = 26 ± 9 kg/m2). Cardiac output (Q), heart rate, systemic vascular resistance (SVR), blood pressure, oxygen saturation, forced expiratory volume at one-second (FEV1), and forced expiratory flow at 50% of forced vital capacity (FEF50) were assessed at baseline, 30 minutes, and 60 minutes following the administration of albuterol or saline. RESULTS: Albuterol resulted in a decrease in SVR, and an increase in Q, FEV1, and FEF50 compared to saline controls. Albuterol also resulted in a decrease in VC at 60 minutes post albuterol. Both albuterol and normal saline resulted in no change in DLCO or DM when assessed alone, but a significant increase was observed in DM when accounting for changes in VC. CONCLUSION: These data suggest that nebulized albuterol improves pulmonary function in healthy humans, while nebulization of both albuterol and saline results in an increase in DM/VC.

Isokinetic muscle strength differences in patients with mucopolysaccharidosis I, II, and VI.

PURPOSE: To determine muscular strength differences in patients with MPS-I, II, and VI versus age- and sex-matched healthy controls. METHODS: Dominant leg isokinetic knee extension strength was measured at 90 and 120 degrees per second (d/s) using a dynamometer in 30 subjects with MPS and 42 controls (5-16 yrs). MPS-I was further divided into MPS-IA (attenuated) and MPS-IH (severe). Strength measures analyzed were peak torque (PkT), peak torque per unit body weight (PkT/BW) and per unit lean body mass (PkT/LBM), and average power (AP). RESULTS: Following adjusting strength measures for age, MPS-IH and MPS-II had significantly lower strength measures for all variables at both angular velocities. MPS-VI had significantly lower PkT, PkT/LBM, and AP compared to controls at 90 and 120d/s. In contrast, MPS-IA was not significantly different from controls for any strength variable at either angular velocity. CONCLUSION: The results of this study suggest that decrements in skeletal muscle strength depend on MPS diagnosis and severity of disease. Children with MPS-IH demonstrate the greatest difference in muscular strength compared to healthy controls.