Objectives This study sought to determine if sport specialization increases the risk of anterior knee pain in adolescent female athletes. Design Retrospective cohort epidemiology study. Methods Female basketball, soccer and volleyball players (N=546) were recruited from a single county public school district in Kentucky consisting of five middle schools and four high schools. A total of 357 multi-sport, and 189 single sport (66 basketball, 57 soccer and 66 volleyball) athlete subjects were included due to their diagnosis of patellofemoral pain on physical exam. Testing consisted of completion of a standardized history and physician-administered physical examination to determine the presence of patellofemoral pain (PFP). This study compared self-reported multi-sport athletes with sport specialized athletes participating in only one sport. The sports participation data was normalized by sport season with each sport accounting for one season of exposure. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated and used to determine significant differences between athletes who specialized in sport in early youth and multi-sport athletes. Results Specialization in a single sport increased the relative risk of PFP incidence by 1.5 fold (95% CI 1.0 to 2.2; p=0.038) for cumulative PFP diagnoses. Specific diagnoses such as Sinding Larsen Johansson/patellar tendinopathy (95% CI 1.5 to 10.1; p=0.005) and Osgood Schlatter Disease (95% CI 1.5 to 10.1; p=0.005) demonstrated a four-fold greater relative risk in single sport compared to multiple sport athletes. Other specific PFP diagnoses such as Fat Pad, Plica, Trauma, Pes Anserine Bursitis and IT Band Tendonitis incidence were not different between single sport and multiple sport participants (p>0.05). Conclusion Early sport specialization in female adolescents is associated with increased risk of anterior knee pain disorders including PFP, Osgood Schlatter, Sinding Larsen-Johansson compared to multi-sport athletes.

Subsequent to our intervention, there was a significant reduction of the peripheral blood culture contamination rate as well as considerable cost savings to the institution. When performed in a standardized fashion by using sterile technique, blood culture collection with low contamination rates can be performed via the insertion of an intravenous catheter.

Background-A dysregulated growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis is well-recognized in children and adolescents with type 1 diabetes mellitus (T1DM). Decreased IGF-1 levels can also be found in chronic inflammatory diseases, while hyperglycemia promotes inflammatory cytokine production. Therefore, inflammatory cytokines may link poor metabolic control with GH/IGF-1 axis changes. This study examined the relationship between serum inflammatory cytokines and IGF-1 in adolescents (age 13-18) with TIDM in chronic poor (n=17) or favorable (n=19) glucose control. Poor control (PC) was defined as ≥ 3, consistent HbA1C > 9% during the previous 2 years, while favorable control (FC) was consistent levels of HbA1C < 9%.Results-HbA1C (FC: 7.5±0.6%; PC: 10.5±0.9%, p<0.001) and interleukin (IL)-8 (FC: 3.7±4.0 pg/ml; PC: 7.4±4.3 pg/ml, p=0.01) were increased and IGF-1 (FC: 536.5±164.3 ng/ml; PC: 408.9 ±157.1 ng/ml, p=0.03) was decreased in patients with poor control compared to patients with favorable control. Moreover, IL-8 was inversely correlated with IGF-1 (r=−0.40, p=0.03) and positively correlated with HbA1C (r=0.36, p=0.03).Conclusions-In adolescents with T1DM and chronic, poor glucose control, increased serum IL-8 is associated with reduced IGF-1 suggesting a pro-inflammatory milieu that may contribute to alterations in the GH/IGF-1 axis.

BackgroundAdults with type 1 diabetes (T1D) have decreased bone mineral density (BMD) and increased fracture risk, yet the etiologies remain elusive. Early detection of derangements in bone biomarkers during adolescence could lead to timely recognition. In adolescents with T1D, we evaluated the relationships between metabolic control, BMD, and bone anabolic and turnover markers.MethodsCross-sectional study of 57 adolescent subjects with T1D who had HbA1c consistently ≥ 9% (Poor Control, PC n = 27) or < 9% (Favorable Control, FC n = 30) for two years prior to enrollment. Subjects had T1DM for at least three years and were without diabetes complications, known celiac disease, or other chronic diseases.ResultsThere were no differences between HbA1c groups in BMD, components of the IGF system, or 25-hydroxyvitamin D status. The prevalence of 25-hydroxyvitamin D abnormalities was similar to that seen in the general adolescent population. Few patients met the recommended dietary allowance (RDA) for vitamin D or calcium.ConclusionsThese data provide no evidence of association between degree of metabolic control and BMD in adolescents with T1D. Adolescents with T1D have a high prevalence of serum 25-hydroxyvitamin D abnormalities. Longitudinal studies are needed to evaluate the predictive value of vitamin D abnormalities on fracture risk.

We investigated whether inadequate dietary protein would result in increased serum parathyroid hormone (PTH) concentration, consistent with secondary hyperparathyroidism. Data from 2 controlled feeding studies were utilized. In study 1, 26 healthy women (15 young, 21-46 y, and 11 elderly, 70-81 y) consumed for 12 d each in separate trials 3 levels of protein, 1.00, 0.75, and 0.50 g protein/(kg. d). Blood was drawn from fasting subjects on d 12 of each trial. In study 2, 24 persons (54-80 y) were fed diets with either 1.20 g protein/(kg. d) for 2 wk (HPro, n = 11, 6 men, 5 women) or 1.2 g protein/(kg. d) for 1 wk and then 0.50 g protein/(kg. d) for a 2nd week (IPro, n = 13, 6 men, 7 women). Blood was obtained from fasting subjects after wk 1 and 2. Consistent with altered protein metabolism, urinary total nitrogen excretion and blood urea nitrogen fell progressively with decreasing protein intake in study 1; in study 2, the values decreased from wk 1 to 2 in the IPro group only. Serum intact PTH concentrations did not differ among the 3 protein intakes in study 1, or between the HPro and IPro groups in study 2. These findings do not support the hypothesis that the short-term ingestion of inadequate dietary protein increases serum PTH concentration.