Patients with newly diagnosed multifocal glioblastoma on presentation experience significantly worse survival than patients with solitary glioblastoma. Patients with multifocal tumors continue to pose a therapeutic challenge in the temozolomide era and magnify the challenges faced while treating patients with malignant gliomas.
Background:Up to 1 billion people have insufficient or deficient vitamin D levels. Despite the well-documented, widespread prevalence of low vitamin D levels and the importance of vitamin D for athletes, there is a paucity of research investigating the prevalence of vitamin D deficiency in athletes.Hypothesis:We investigated the prevalence of abnormal vitamin D levels in National Collegiate Athletic Association (NCAA) Division I college athletes at a single institution. We hypothesized that vitamin D insufficiency is prevalent among our cohort.Study Design:Cohort study.Level of Evidence:Level 1.Methods:We measured serum 25-hydroxyvitamin D (25(OH)D) levels of 223 NCAA Division I athletes between June 2012 and August 2012. The prevalence of normal (≥32 ng/mL), insufficient (20 to <32 ng/mL), and deficient (<20 ng/mL) vitamin D levels was determined. Logistic regression was utilized to analyze risk factors for abnormal vitamin D levels.Results:The mean serum 25(OH)D level for the 223 members of this study was 40.1 ± 14.9 ng/mL. Overall, 148 (66.4%) participants had sufficient 25(OH)D levels, and 75 (33.6%) had abnormal levels. Univariate analysis revealed the following significant predictors of abnormal vitamin D levels: male sex (odds ratio [OR] = 2.83; P = 0.0006), Hispanic race (OR = 6.07; P = 0.0063), black race (OR = 19.1; P < 0.0001), and dark skin tone (OR = 15.2; P < 0.0001). Only dark skin tone remained a significant predictor of abnormal vitamin D levels after multivariate analysis (adjusted OR = 15.2; P < 0.0001).Conclusion:In a large cohort of NCAA athletes, more than one third had abnormal vitamin D levels. Races with dark skin tones are at much higher risk than white athletes. Male athletes are more likely than female athletes to be vitamin D deficient. Our study demonstrates a high prevalence of vitamin D deficiency among healthy NCAA athletes.Clinical Relevance:Many studies indicate a significant prevalence of vitamin-D insufficiency across various populations. Recent studies have demonstrated a direct relationship between serum 25(OH)D levels and muscle power, force, velocity, and optimal bone mass. In fact, studies examining muscle biopsies from patients with low vitamin D levels have demonstrated atrophic changes in type II muscle fibers, which are crucial to most athletes. Furthermore, insufficient 25(OH)D levels can result in secondary hyperparathyroidism, increased bone turnover, bone loss, and increased risk of low trauma fractures and muscle injuries. Despite this well-documented relationship between vitamin D and athletic performance, the prevalence of vitamin D deficiency in NCAA athletes has not been well studied.
Objectives: Although dislocation of the knee is rare, the high-energy nature of most injuries often results in high morbidity and sometimes limb-threatening injury. Literature regarding knee dislocations tends to focus upon management. There is a lack of research investigating quality of life for patients having undergone multi-ligament knee reconstruction. The purpose of our study was to review quality of life and functional outcomes as well as examine preoperative variables that may affect these outcomes for patients having undergone multi-ligament knee reconstruction. Methods: Retrospectively, we identified a total of 31 patients who underwent a standardized method of surgical reconstruction for multi-ligament knee injuries since 2006 at a single institution. A single surgeon performed all operations. A total of 28 knees (26 patients) were included in the final analysis. We contacted patients at a minimum of 12 months postoperatively (mean: 40.5 months; range: 12-111 months) and administered the Multi-ligament Quality of Life Questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two-sample t-tests to examine the difference in quality of life and functional measures for the following factors: age (≤ 40 vs. > 40), sex, mechanism of injury, time to surgery ( 3 weeks), vascular injury, nerve injury, concomitant fracture, other injuries, Schenk classification for knee dislocation, manipulation, surgical release, previous knee ligament surgery, and subsequent revision. We then performed ageadjusted multivariable linear regression analysis, including factors that we found to be statistically significant in univariate analysis. A p-value of 0.05 was used for statistical significance and all analysis was performed using STATA (College Station, TX). Results: For ML-QOL, we found that patients who had undergone previous knee ligament surgery had significantly worse mean scores relative to patients who had not undergo previous knee ligament surgery (122.9 vs. 80.2; p = 0.001) (higher score indicates worse quality of life). All other differences in ML-QOL scores were not statistically significant. IKDC and Lysholm scores did not differ significantly with regards to the studied variables. After stratifying patients by history of previous knee ligament surgery (7 vs. 21), we found that patients with Schenk classifications of III or IV had significantly worse mean ML-QOL scores relative to patients with Schenk classifications of I or II (91.3 vs. 62.1; p = 0.0152). Conclusion: To our knowledge, our study is the first to investigate both quality of life and functional outcome measures for patients undergoing multi-ligament reconstruction after knee dislocation. We found that patients with a previous history of knee ligament surgery had a significantly worse quality of life relative to those with no history of knee ligament surgery. Among patients with no history of knee ligament surgery, higher Schenk classification was ass...
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