BACKGROUND:Associations of youth sport participation patterns, health, and social-environmental factors with subsequent participation in the National Basketball Association (NBA) have not been investigated systematically. Prior studies suggest that high-performing athletes who achieve the world-class level of adult sport engaged in less organized training in their primary sport, participated in more multisport practice and competition, and incurred fewer injuries as youths compared with lower-performing adult national-class athletes. HYPOTHESIS:Players who sign an NBA player contract engaged in less organized basketball, demonstrated more multisport practice, and incurred fewer injuries as youth athletes compared with non-NBA peers. STUDY DESIGN:Cross-sectional study. LEVEL OF EVIDENCE:Level 4. METHODS:Top-ranked male high school basketball players (n = 627, 16.6 ± 1.3 years old) attending invitational events in the United States in 2018 and 2019 completed a questionnaire regarding participation in coach-led and nonorganized basketball and other sports, injuries, academic progress, residence relocation, and scholarship or funding. Of this sample, 40 (6%) signed an NBA player contract by age 22 years. These 40 players were matched by age, birth month, playing position, and national youth player ranking with 40 peers who did not reach the NBA. Matched-pairs analyses included χ2, unpaired t tests, U tests, and binary-logistic regression (BLR). RESULTS:Youth athletes who later became NBA players reported more organized participation in sports other than basketball until age 14 years (90.0% vs 52.5%), began playing on select teams and focusing exclusively on basketball at older ages (10.7 ± 2.4 vs 9.1 ± 2.5 and 12.9 ± 2.2 vs 9.6 ± 2.5 years), and spent less time in organized and nonorganized basketball than matched non-NBA peers. NBA players also reported fewer severe injuries at ≥14 years (25.0% vs 47.5%) and were less likely to stay back in school, relocate residence, and receive scholarships/funding, respectively. BLR correctly classified 85.0% of NBA and non-NBA players. CONCLUSION:Participation in approximately 2 other sports, later specialization, less coach-led and nonorganized basketball, fewer injuries, and less disruption to academic and home life were characteristic of top-ranked youth players who later played in the NBA. CLINICAL RELEVANCE:This is the first study to investigate youth basketball participation patterns associated with reaching the NBA among top-ranked U.S. high school basketball players.

Introduction: This explanatory pilot study presents a workflow to identify approved drugs, which could be repurposed for periodontitis therapy using salivary proteomics combined with drug-target database screening. Methods: Proteomic analyses of saliva using LC-MS/MS were conducted in two independent settings: a cohort (sub-study I, N = 187) and case-control (sub-study II, N = 72). Statistical analyses were performed using both stringent and lenient criteria. Under the stringent (lenient) criteria, proteins were considered potential targets if they showed a q-value < 0.05 (< 0.1) in the cohort study and a p-value < 0.05 together with an absolute fold change > 1.5 (1.3) in the case-control study. Four databases were searched to assess whether these proteins are known targets of approved drugs. Results: In the stringent (lenient) analysis one (26) proteins were associated with periodontitis in both studies, of which one (nine) were reported drug targets and one (seven) of those were potential drug targets in periodontitis. Target screening in databases identified 3/11 approved drugs, with eight of them having potential for repurposing for periodontal treatment. Several of these drugs (e.g., HDAC inhibitors, sivelestat, compstatin derivatives, auranofin, artenimol and bortezomib) have already shown efficacy in preclinical models of periodontal host modulation. Conclusion: This exploratory pilot study provided insights into potential therapeutic targets and potential drugs for periodontitis treatment. This workflow may help to identify approved drugs that could be repurposed for periodontal treatment.

In this study, the association between obstructive sleep apnea severity and the parapharyngeal fat pad volume is examined in a population-based sample. We included 680 participants who underwent standardised overnight polysomnography between 2008 and 2012 as part of the Study of Health in Pomerania in a sleep laboratory in Greifswald, Germany. The apnea-hypopnea index was used as a marker of obstructive sleep apnea severity and the parapharyngeal fat pad volume, as our variable of interest, was analysed based on Magnetic Resonance Imaging data by automated image segmentation. We performed an ordinal logistic regression analysis to test the effect of parapharyngeal fat pad volume on apnea-hypopnea index, controlling for body-mass index as a confounder. The results indicated that greater parapharyngeal fat volume was associated with a higher apnea-hypopnea index in an unadjusted analysis. After adjustment for body-mass index, this association was no longer significant. An exploratory body-mass index-stratified analysis suggested that the association between parapharyngeal fat volume and apnea-hypopnea index may be present primarily in non-obese individuals. These findings highlight the importance of considering body-mass index as a measure for overall obesity when evaluating the specific role of parapharyngeal fat in obstructive sleep apnea.

BACKGROUND:High-level basketball athletes at the collegiate level and in the National Basketball Association (NBA) have a greater proportion of knee cartilage pathology than the nonathlete population. However, little is known as to whether identified pathology on knee magnetic resonance imaging (MRI) correlates with clinical symptoms or orthopaedic history in these players. PURPOSES:(1) To evaluate knee MRI scans in a cross-sectional population of NBA Draft Combine players to establish prevalence of knee pathology, including that of articular cartilage and meniscus in professional basketball players. (2) To identify independent variables including demographic characteristics, playing history, previous knee injury, and symptoms that correlate to these MRI findings. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:Players from the NBA Draft Combine over a 2-year period voluntarily participated by undergoing bilateral knee MRI scanning and completing clinical questionnaires. MRI scans were independently and blindly evaluated by 2 radiologists for cartilage assessment (using modified Noyes score) and meniscal pathology. Associations between imaging findings and pain/function scores and orthopaedic history were evaluated. RESULTS:A total of 43 players (80 knees) were included. Intraclass correlation coefficients were a mean of 0.827 for agreement and 0.831 for consistency for the modified Noyes score. Cartilage pathology was identified in 48.3% of knees, with the most common locations being the patella and trochlea. Previous knee surgery was associated with lateral tibial plateau chondral pathology (odds ratio [OR], 6.58; P = .04). Reduced function scores were predictive of cartilage pathology on the lateral femoral condyle (OR, 0.55; P = .03). Increased pain scores were associated with a nonzero modified Noyes score (OR, 6.11; P < .01). CONCLUSION:The incidence of pathology identified on knee MRI scans in players at the NBA Draft Combine without clinical symptoms was high, in line with the hypothesis. Little correlation was found between the objective imaging findings and subjective pain, function, and orthopaedic injury history. Clinicians treating high-level athletes should focus on treating clinically significant findings and be cautious about treating pathology found on imaging that may not explain or correlate with symptoms. It remains critical to study the natural history of imaging findings in these athletes to better ascertain the ultimate effect of sport and physiologic load on disease progression.

BACKGROUND:Theobromine, a methylxanthine mainly found in chocolate, has been suggested to possess various health-promoting properties. This study aimed to investigate the long-term effect of salivary theobromine levels on periodontitis severity using 7- and 10-year follow-up data from the prospective Studies of Health in Pomerania (SHIP-TREND and SHIP-START). MATERIALS AND METHODS:We conducted a non-targeted metabolomics analysis of salivary methylxanthines in 679 participants from SHIP-TREND and 953 participants from SHIP-START. Inverse-probability-of-treatment-weighted generalised linear models were used to assess the relationship between salivary theobromine and periodontal variables, including bleeding on probing, probing depth and clinical attachment loss. RESULTS:Higher salivary theobromine levels were significantly associated with improved periodontal health, as evidenced by lower mean probing depth and a reduced percentage of sites with probing depth ≥ 3 mm. The results were successfully replicated in the SHIP-START data and extended to a lower clinical attachment loss. DISCUSSION:Our cohort studies suggest that elevated salivary theobromine levels are associated with improved periodontal parameters over 7 and 10 years. These results indicate the potential for theobromine-containing products to support periodontal health, warranting further investigation through randomised controlled trials.

ABSTRACTAimTo elucidate whether ranked probing depth (PD) data translate into ranked PD outcomes after 10 years of follow‐up and the associated tooth loss.Materials and MethodsFrom the Study of Health in Pomerania (SHIP‐START), all participants were retrospectively included with complete PD measurements in both baseline and 10‐year follow‐up, comprising 1887 participants. The trajectory of percentile‐based quintiles of mean PD measurements was followed.ResultsQuintiles of mean PD at baseline were, in a dose dependent manner, associated with the number of teeth at baseline, number of teeth after 10 years and involved risk of tooth loss. The trajectory of membership to individual PD quintiles indicated that the majority of participants remained in or near their baseline quintile after reaching the 10‐year end analysis. Periodontal risk factors assessed at baseline continued to affect PD outcomes at follow‐up. Two categories of tooth loss were identified: 1–2 teeth lost versus ≥ 3 teeth and differentiated by baseline PD.ConclusionPD severity ranked within this population translates, in a dose‐dependent manner, to follow‐up tooth loss even after many years. This underlines the prospective importance of pocket probing in the dental practice. Ranked PD offers a simple measure to identify patients at high risk of tooth loss.

In population-based longitudinal studies, bias caused by nonresponse among eligible participants and attrition during follow-up thwarts conclusions. As this issue is not commonly addressed in dental studies, it is the aim of this study to examine the consequences of attrition with respect to tooth loss and mortality in a 10-y follow-up study. From the Study of Health in Pomerania (SHIP-0), a biological age (BA) score was constructed from 10 systemic biomarkers and related to one's actual chronological age (CA). The 3,417 dentate participants were stratified according to their BA-CA scores into tertiles: individuals with younger BA than their CA, those with concurrent BA and CA, and those with older BA than their CA. Baseline characteristics and propensity of leaving or remaining in the study were compared across these tertiles. We compared the characteristics within BA strata in the remainers of SHIP-2 (10-y follow-up) and their impact on tooth loss. Besides dropout by those who died, the attrition propensity of baseline study participants was dose dependent as related to BA-CA scores and socioeconomic factors. BA younger participants were underrepresented in dropouts but overrepresented in remaining follow-up participants. BA younger participants had a more favorable risk profile, better oral health, and a lower mortality rate than BA older participants. For the BA older participants, the opposite was observed. Remainers attaining the follow-up SHIP-2 were healthier and more health conscious. After 10 y, their tooth retention was still directed by BA constructed at baseline. The results support the assumption that individual risk profiles aggregated in BA constitute characteristic susceptibility patterns affecting perseverance or attrition in long-term follow-up studies. Attrition, which is common to follow-up studies, changes the study composition of participants depending on their BA and hence the transferability of results to the baseline population. The baseline BA gradient persists even after a long time.

In high-income countries, the oral health of the population is influenced by public health interventions, widespread use of oral care products, dental practice measures, and the cost of dental treatment. We compiled information on changes of the prevalence of proximal and upstream determinants of periodontitis, caries, and tooth loss over the last three decades to outline their potential effects on changes of oral health during this period. Information was retrieved from repeated cross-sectional studies and from published literature. While both the prevalence of edentulism and the number of missing teeth (from the DMF-T index) decreased, the number of sound teeth as well as the total number of teeth increased. The prevalence of severe periodontitis was unchanged, whereas the prevalence of periodontal health and moderate periodontitis may have increased to a minor extent. Concerning oral health risk factors, the proportion of individuals with tertiary education increased, while smoking prevalence declined. More and more people used oral care products. Whether one reimbursement system worked better than another one in terms of tooth retention could not be elucidated. In tooth retention, population-wide use of fluoridated toothpastes had the greatest impact. To some extent, the higher number of teeth present may be related to the more frequent use of interdental cleaning aids and powered toothbrushes. Since there was no decrease in severe periodontitis in most cohorts, periodontal interventions probably contributed little to improved tooth retention.

BACKGROUND:Understanding the epidemiology of injuries to athletes is essential to informing injury prevention efforts. HYPOTHESIS:The incidence and impact of basketball-related injuries among National Basketball Association (NBA) players from 2013-2014 through 2018-2019 is relatively stable over time. STUDY DESIGN:Descriptive epidemiology study. LEVEL OF EVIDENCE:Level 3. METHODS:Injuries from 2013-2014 through 2018-2019 were analyzed using the NBA Injury and Illness Database from an electronic medical record system. Descriptive statistics were calculated for injuries by season, game-loss, and onset. Incidence rates were estimated using Poisson models and linear trend tests. RESULTS:Between 552 and 606 players participated in ≥1 game per season during the study. Annual injury incidence ranged from 1550 to 1892, with 33.6% to 38.5% resulting in a missed NBA game. Game-loss injury rates ranged from 5.6 to 7.0 injuries per 10,000 player-minutes from 2014-2015 through 2018-2019 (P = 0.19); the rate was lower in 2013-2014 (5.0 injuries per 10,000 player-minutes), partly due to increased preseason injury rates and transition of reporting processes. The 6-year game-loss injury rate in preseason and regular season games was 6.9 (95% CI 6.0, 8.0) and 6.2 (95% CI 6.0, 6.5) injuries per 10,000 player-minutes; the rate in playoff games was lower (P < 0.01) at 2.8 (95% CI 2.2, 3.6). Most (73%) game-loss injuries had acute onset; 44.4% to 52.5% of these involved contact with another player. CONCLUSION:From 2013-2014 through 2018-2019, over one-third of injuries resulted in missed NBA games, with highest rates of game-loss injuries in preseason games and lowest rates in playoff games. Most game-loss injuries had acute onset, and half of those involved contact with another player. CLINICAL RELEVANCE:These findings - through reliable data reporting by team medical staff in an audited system - can guide evidence-based injury reduction strategies and inform player health priorities.

In this descriptive analysis of the 21-year follow-up data from the SHIP-START cohort and the 7-year follow-up data from the SHIP-TREND cohort, we report the progression of clinical attachment levels (CAL), age effects on CAL change, and a detailed description of CAL progression and remission. At baseline, 4307 and 4420 persons participated in SHIP-START and SHIP-TREND, respectively. At the final follow-up, 1181 and 2507 subjects were available for evaluation, respectively. In SHIP-START and SHIP-TREND participants, the mean CAL progressed by 0.04 and 0.02 mm/year, respectively. The older the participants were, the lower the average annual change in mean CAL (from 0.043 to 0.031 mm/year); annual tooth loss was 0.11-0.14 teeth/year. When participants were ranked according to their annual change in mean CAL, remission was more frequently observed in older subjects. To correctly understand the data, it is important to realize that selection bias due to dropouts during follow-up favored younger and more health-conscious persons. In addition, extraction of severely periodontally compromised teeth during follow-up biased the progression towards zero. Another explanation for these low CAL progression rates is that most sites had little or no change in CAL; this means that CAL progression was partly offset by CAL remission. Therefore, changes in mean CAL do not adequately describe the temporal course of periodontitis. Older age was not a risk factor for CAL progression in either cohort.

There is still considerable controversy surrounding the impact of mastication on obesity. The aim of this study was to identify the interplay between the masticatory muscles, teeth, and general muscular fitness and how they contribute to body adiposity in a general German population. This cross-sectional study included 616 participants (300 male, 316 female, age 31-93 years) from the population-based Study of Health in Pomerania. The cross-sectional areas of the masseter, medial and lateral pterygoid muscles were measured using magnetic resonance imaging (MRI), muscular fitness assessed by hand grip strength (HGS) and body fat distribution was measured by bioelectrical impedance analysis (BIA) and MRI. The overall prevalence of obesity was high in our cohort. The cross-sectional area of the masseter muscles was positively associated with the number of teeth, body mass index (BMI) and HGS, and negatively associated with the BIA-assessed body fat when adjusted for age, sex, teeth, and BMI. Especially the correlation was strong (p < 0.001). Analogous relationships were observed between the masseter, HGS and MRI-assessed subcutaneous fat. These associations were most pronounced with masseter, but also significant with both pterygoid muscles. Though the masticatory muscles were affected by the number of teeth, teeth had no impact on the relations between masseter muscle and adiposity. Physical fitness and masticatory performance are associated with body shape, controlled and directed by the relevant muscles.

BACKGROUND:The National Basketball Association (NBA) suspended operations in response to the COVID-19 pandemic in March 2020. To safely complete the 2019-20 season, the NBA created a closed campus in Orlando, Florida, known as the NBA "Bubble." More than 5000 individuals lived, worked, and played basketball at a time of high local prevalence of SARS-CoV-2.METHODS:Stringent protocols governed campus life to protect NBA and support personnel from contracting COVID-19. Participants quarantined before departure and upon arrival. Medical and social protocols required that participants remain on campus, test regularly, physically distance, mask, use hand hygiene, and more. Cleaning, disinfection, and air filtration was enhanced. Campus residents were screened daily and confirmed cases of COVID-19 were investigated.RESULTS:In the Bubble population, 148 043 COVID-19 reverse transcriptase PCR (RT-PCR) tests were performed across approximately 5000 individuals; Orlando had a 4% to 15% test positivity rate in this timeframe. There were 44 COVID-19 cases diagnosed either among persons during arrival quarantine or in non-team personnel while working on campus after testing but before receipt of a positive result. No cases of COVID-19 were identified among NBA players or NBA team staff living in the Bubble once cleared from quarantine.CONCLUSIONS:Drivers of success included the requirement for players and team staff to reside and remain on campus, well-trained compliance monitors, unified communication, layers of protection between teams and the outside, activation of high-quality laboratory diagnostics, and available mental health services. An emphasis on data management, evidence-based decision-making, and the willingness to evolve protocols were instrumental to successful operations. These lessons hold broad applicability for future pandemic preparedness efforts.

Background: Concerns for youth sports in the United States often focus on early sport specialization, overemphasis on competition, injuries, and burnout. Little research has addressed relationships among the preceding and other concerns, including time away from organized sport, sleep, and perceptions of physical and psychological well-being. Hypothesis: There is an association between reported competitive gameplay volume and specialization, injury, and fatigue among elite youth basketball players. Study Design: Cross-sectional study; convenience sample. Level of Evidence: Level 4. Methods: An anonymous questionnaire was administered to a convenience sample of youth basketball players between 13 and 18 years of age from across the United States. Participants were queried about multiple factors, including the extent of their participation in organized basketball and other sports, time away from organized basketball, injury, sleep, and feelings of exhaustion related to basketball participation. Results: A total of 772 participants (145 girls, 627 boys) completed a survey. All participants played for a select or elite club basketball team and/or a high school basketball team. Overall, 49% played more than 50 games within the past year. A total of 73% were specialized in basketball, 58% prior to age 14 years, and 35% prior to age 11 years. In all, 70% reported less than 1 month away from organized basketball within the past year, and 28% reported no time away. A total of 54% reported sleeping less than the recommended 8 hours each night during the school year. Within the prior year, 55% reported feeling physically exhausted and 45% reported feeling mentally exhausted from basketball. Regression analysis did not find any significant relationships between early specialization prior to age 14 years and basketball-related injury or feelings of mental or physical exhaustion. Conclusion: In this select group of youth basketball players, the majority specialized in basketball prior to age 14 years and reported a large number of competitive events with little time away from organized basketball. Clinical Relevance: The results from a sample of highly competitive youth basketball players indicate issues that warrant further attention and research regarding the potential impact of specialization, frequent competitions, lack of time away from organized sport, and perceptions of well-being in young athletes.

Chocolate and coronary artery disease Peter Meisel, Peter Meisel Department of Periodontology, University Medicine Greifswald, Clinics of Dentistry, Fleischmannstrasse 42, D-17475 Greifswald, Germany Corresponding author. Tel: +49 3834 867324, Fax: +49 3834 867171, Email: meiselp@uni-greifswald.de https://orcid.org/0000-0002-0243-2435 Search for other works by this author on: Oxford Academic Google Scholar Thomas Kocher Thomas Kocher Department of Periodontology, University Medicine Greifswald, Clinics of Dentistry, Fleischmannstrasse 42, D-17475 Greifswald, Germany Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwaa076, https://doi.org/10.1093/eurjpc/zwaa076 Published: 17 November 2020 Article history Received: 24 August 2020 Editorial decision: 05 September 2020 Accepted: 08 September 2020 Published: 17 November 2020

The online version of the original article can be found at https://doi.org/10.1007/s00784-020–03594-w

OBJECTIVES:We aimed at investigating whether the interaction between the local inflammation, periodontitis, and obesity is independently associated with systemic inflammation.METHODS:From the population-based Study of Health in Pomerania, 3366 participants, without (2366) and with (1000) obesity, were studied for the association of periodontitis, measured as probing depth (PD) and plaque together with body mass index (BMI) on C-reactive protein (CRP). Quantile regression was used to evaluate the association between periodontal, anthropometric, and inflammatory variables (outcomes).RESULTS:The overall prevalence of obesity in this adult population was 31.4% in men and 28.1% in women. Both PD and plaque were positively associated with CRP, revealing an increasing impact across the CRP concentration distribution. Adjusting the regression of CRP or fibrinogen on PD for waist circumference attenuated but did not abolish the PD coefficients. Dental plaque was similarly associated with these interrelations. Association between PD and a dental plaque was different among participants with low-, medium-, or high-risk CRP concentrations.CONCLUSION:Local and systemic sources of inflammation contribute to blood levels of inflammatory markers. The respective contributions depend on the relative rate in each of the inflammation-inducing risks and are dominated by adiposity.CLINICAL RELEVANCE:Keeping systemic inflammation low in order to prevent age-related disease sequelae.

Purpose: Periodontitis is an inflammatory disease of the oral cavity with an alarmingly high prevalence within the adult population. The signaling lipid sphingosine-1-phosphate (S1P) plays a crucial role in inflammatory and immunomodulatory responses. In addition to cardiovascular disease, sepsis and tumor entities, S1P has been recently identified as both mediator and biomarker in osteoporosis. We hypothesized that S1P may play a role in periodontitis as an inflammation-prone bone destructive disorder. The goal of our study was to evaluate associations between periodontitis and S1P serum concentrations in the Study of Health in Pomerania (SHIP)-Trend cohort. In addition, we investigated the expression of S1P metabolizing enzymes in inflamed gingival tissue. Patients and Methods: We analyzed data from 3371 participants (51.6% women) of the SHIP-Trend cohort. Periodontal parameters and baseline characteristics were assessed. Serum S1P was measured by liquid chromatography tandem mass spectrometry. The expression of S1P metabolizing enzymes was determined by immunofluorescence staining of human gingival tissue. Results: S1P serum concentrations were significantly increased in subjects with both moderate and severe periodontitis, assessed as probing depth and clinical attachment loss. In contrast, no significant association of S1P was seen with caries variables (number and percentage of decayed or filled surfaces). S1P concentrations significantly increased with increasing high-sensitivity C-reactive protein (hs-CRP) levels. Interestingly, inflamed compared to normal human gingival tissue exhibited elevated expression levels of the S1Pgenerating enzyme sphingosine kinase 1 (SphK1). Conclusion: We report an intriguingly significant association of various periodontal parameters with serum levels of the inflammatory lipid mediator S1P. Our data point towards a key role of S1P during periodontitis pathology. Modulation of local S1P levels or its signaling properties may represent a potential future therapeutic strategy to prevent or to retard periodontitis progression and possibly reduce periodontitis-related tooth loss.

Evidence-based research has resulted in incredible advances in sports medicine and is an important component of minimizing injury risk. Such research is similarly important when applied to care delivery to athletes after injury. For research into injury reduction and treatment outcomes to be most impactful, however, the methods must be of sufficient rigor to generate high-quality evidence. Two recent trends in sports injury research have led to specific concerns about evidence quality: 1) use of athletic performance metrics as an injury or treatment outcome and 2) use of publicly available data for injury or treatment research.