Babak Shadgan

The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis

The aim of this systematic review was to determine if eccentric exercise is superior to concentric exercise in stimulating gains in muscle strength and mass. Meta-analyses were performed for comparisons between eccentric and concentric training as means to improve muscle strength and mass. In order to determine the importance of different parameters of training, subgroup analyses of intensity of exercise, velocity of movement and mode of contraction were also performed. Twenty randomised controlled trials studies met the inclusion criteria. Meta-analyses showed that when eccentric exercise was performed at higher intensities compared with concentric training, total strength and eccentric strength increased more significantly. However, compared with concentric training, strength gains after eccentric training appeared more specific in terms of velocity and mode of contraction. Eccentric training performed at high intensities was shown to be more effective in promoting increases in muscle mass measured as muscle girth. In addition, eccentric training also showed a trend towards increased muscle cross-sectional area measured with magnetic resonance imaging or computerised tomography. Subgroup analyses suggest that the superiority of eccentric training to increase muscle strength and mass appears to be related to the higher loads developed during eccentric contractions. The specialised neural pattern of eccentric actions possibly explains the high specificity of strength gains after eccentric training. Further research is required to investigate the underlying mechanisms of this specificity and its functional significance in terms of transferability of strength gains to more complex human movements.

100 most cited articles in orthopaedic surgery.

BackgroundCitation analysis reflects the recognition a work has received in the scientific community by its peers, and is a common method to determine ‘classic’ works in medical specialties.Questions/purposesWe determined which published articles in orthopaedic journals have been most cited by other authors by ranking the 100 top-cited works. By analyzing characteristics of these articles, we intended to determine what qualities make an orthopaedic article important to the specialty. Finally, we determined if there was a change in level of evidence of studies on this list with time.MethodsScience Citation Index Expanded was searched for citations to articles published in any of the 49 journals in the subject category “ORTHOPEDICS.” Each of the 49 journals was searched separately using the “cited reference search” to determine the 100 most often cited articles. Each article was reviewed for basic information including year of publication, country of origin, source journal of the article, article type, and level of evidence. We categorized the journal article by field of research where possible.ResultsThe number of citations ranged from 1748 to 353. The 100 most often cited articles in orthopaedic surgery were published in 11 of the 49 journals, spanning from general to more specific subspecialty journals. The majority of the papers (76) were clinical, with the remaining representing some type of basic science research. The most common level of evidence was IV (42 of the 76 studies). Of the 76 clinical articles, 27 introduced or tested classification systems or outcome measurement tools.ConclusionsAuthors aiming to write a highly cited article in an orthopaedic surgery journal will be favored by language of publication, source journal, country of origin, and introduction of a classification scheme or outcome tool.

Diagnostic techniques in acute compartment syndrome of the leg.

Objectives: To review the efficacy of the current diagnostic methods of acute compartment syndrome (ACS) after leg fractures. Data Sources: A Medline (PubMed) search of the English literature extending from 1950 to May 2007 was performed using “compartment syndromes” as the main key word. Also a manual search of orthopaedic texts was performed. Study Selection and Extraction: The results were limited to articles involving human subjects. Of 2605 primary titles, 489 abstracts limited to compartment syndromes in the leg and 577 articles related to the diagnosis of compartment syndromes were identified and their abstracts reviewed. Further articles were identified by reviewing the references. Sixty-six articles were found to be relevant to diagnostic techniques for compartment syndrome in the leg and formed the basis of this review. Conclusions: Early diagnosis of an ACS is important. Despite its drawbacks, clinical assessment is still the diagnostic cornerstone of ACS. Intracompartmental pressure measurement can confirm the diagnosis in suspected patients and may have a role in the diagnosis of this condition in unconscious patients or those unable to cooperate. Whitesides suggests that the perfusion of the compartment depends on the difference between the diastolic blood pressure and the intracompartmental pressure. They recommend fasciotomy when this pressure difference, known as the Δp, is less than 30 mm Hg. Access to a precise, reliable, and noninvasive method for early diagnosis of ACS would be a landmark achievement in orthopaedic and emergency medicine.

Top-Cited Articles in Rehabilitation

OBJECTIVE To identify the 100 top-cited articles ever published in rehabilitation journals and to analyze their characteristics as a quantitative approach to investigating the quality and evolution of rehabilitation research. DATA SOURCES The Institute for Scientific Information Web of Knowledge Database and the 2007 and 2008 Journal Citation Report Science Editions were used to retrieve the 100 top-cited articles from 30 rehabilitation dedicated journals. STUDY SELECTION The 100 top-cited articles included randomized controlled trials, case-control studies, case series studies, case reports, methodologic studies, systematic reviews, narrative reviews, and expert opinions. DATA EXTRACTION Two independent reviewers performed data extraction from the retrieved articles and compared their results. The Sacketts initial rules of evidence were used to categorize the type of study design as well as to evaluate the level of evidence provided by the results of the 100 top-cited articles. DATA SYNTHESIS Among the 45,700 articles published in these journals, the 100 top-cited articles were published between 1959 and 2002 with an average of 200 citations an article (range, 131-1109). Top-cited articles were all English-language, primarily from North America (United States=67%; Canada=11%) and published in 11 journals led by the Archives of Physical Medicine and Rehabilitation. Eighty-four percent of the articles were original publications and were most commonly prospective (76%) case series studies (67%) that used human subjects (96%) providing level 4 evidence. Neurorehabilitation (41%), disability (19%), and biomechanics (18%) were the most common fields of study. CONCLUSIONS We demonstrated that methodologic observational studies performed in North America and published in English have had the highest citations in rehabilitation journals.

Eccentric Exercise in Patients with Chronic Health Conditions: A Systematic Review

PURPOSE The capacity of eccentric actions to produce muscle hypertrophy, strength gains, and neural adaptations without stressing the cardiopulmonary system has led to the prescription of eccentric training programmes in patients with low tolerance to exercise, such as elders or those with chronic health conditions. The purpose of this systematic review was to analyze the evidence regarding the effectiveness and suitability of eccentric training to restore musculoskeletal function in patients with chronic diseases. SUMMARY OF KEY POINTS Relevant articles were identified from nine databases and from the reference lists of key articles. Articles were assessed to determine level of evidence and scientific rigour. Nine studies met the inclusion criteria. According to Sacketts levels of evidence, 7 studies were graded at level IIb, 1 study at level IV, and the remaining study at level V. Articles were also graded for scientific rigour according to the PEDro scale. One study was rated as high quality, 4 studies were rated as moderate, and 2 studies were graded as poor quality. CONCLUSIONS Eccentric training may be safely used to restore musculoskeletal function in patients with some specific chronic conditions. However, the heterogeneity of diseases makes it very difficult to extrapolate results and to standardize clinical recommendations for adequate implementation of this type of exercise. More studies are needed to establish the potential advantages of eccentric training in chronic conditions.

Leading 20 at 20: top cited articles and authors in the Journal of Orthopaedic Trauma, 1987-2007.

Objective: To determine the 20 most cited articles and authors in the Journal of Orthopaedic Trauma during the first 20 years of publication, 1987 to 2007. Design: Review. Methods: We used Web of Science “cited reference search” to determine the most cited articles originating in the Journal of Orthopaedic Trauma from 1987 to 2007, the first 20 years of publication. The characteristics of each article were recorded. Next, we manually searched each authors citations for works in the same time period to determine the most cited authors. The number of first authorships for each author was then determined using Medline, and a relative citation impact ratio was calculated. Finally, citation reports for the journal overall were created to evaluate the citation impact of the journal over the last 10 years. Results: The top cited articles ranged from 64 to 566 citations with two articles over 100. Fifteen were clinical articles with the most common topic being tibia fractures (shaft, plateau, and pilon). The top cited authors ranged for 111 to 566 citations, whereas the citations per lead authorship ratio for the authors on that list ranged from 9.5 to 566 citations per lead authorship. The number of citations to the Journal of Orthopaedic Trauma overall over the last 20 years has increased from 181 in 1997 to 3050 in 2007. Conclusions: The influence of the Journal of Orthopaedic Trauma, its articles, and its authors is readily apparent in this review of the most cited articles and authors in the journal over its first 20 years of publication. This journal is a source of highly cited original articles and the work of many highly cited leaders in the field of orthopaedic trauma.

Wireless near-infrared spectroscopy of skeletal muscle oxygenation and hemodynamics during exercise and ischemia

The majority of in vivo applications of near-infrared spectroscopic (NIRS) monitoring use continuous wave instruments that require a fiberoptic cable connection between the subject and the instrument during monitoring. In studies of muscle physiology where subjects are exercising, and particularly in those who are engaged in sports activity, a wireless instrument with telemetric capacity provides obvious advantages. Having access to reliable telemetric NIRS technology will also increase the practicality and scope of this biomedical monitoring technique in clinical settings.

Sternocleidomastoid muscle deoxygenation in response to incremental inspiratory threshold loading measured by near infrared spectroscopy

This study investigated the pattern of changes in muscle oxygenation, deoxygenation and blood volume in the sternocleidomastoid (SCM) in comparison with the parasternal (PS) and intercostal (IC) muscles during a bout of incremental inspiratory threshold loading (ITL) in healthy subjects using near-infrared spectroscopy. During progressive loading, the PS and IC showed a significant increase in oxygenated hemoglobin (5.9 ± 2.3 and 6.8 ± 2.4 μM, P<0.05) and the SCM showed an increase in deoxygenated hemoglobin (17.3 ± 3.8 μM, P<0.05). Total hemoglobin also steadily increased in the SCM whereas it decreased in the quiescent vastus lateralis muscle (20.7 ± 6.1μM vs. -6.6 ± 2.4 μM, P<0.05), which was used as the control muscle during the ITL. Our data suggests that the SCM is recruited progressively during progressive ITL and is accompanied by an increased blood volume and maintenance of O(2)Hb. Blood redistribution away from the nonactive limb muscles during the ITL may provide one source of maintaining inspiratory muscle blood volume and oxygenation during high respiratory motor output.

100 top-cited scientific papers in limb prosthetics

Research has tremendously contributed to the developments in both practical and fundamental aspects of limb prosthetics. These advancements are reflected in scientific articles, particularly in the most cited papers. This article aimed to identify the 100 top-cited articles in the field of limb prosthetics and to investigate their main characteristics. Articles related to the field of limb prosthetics and published in the Web of Knowledge database of the Institute for Scientific Information (ISI) from the period of 1980 to 2012. The 100 most cited articles in limb prosthetics were selected based on the citation index report. All types of articles except for proceedings and letters were included in the study. The study design and level of evidence were determined using Sackett’s initial rules of evidence. The level of evidence was categorized either as a systematic review or meta-analysis, randomized controlled trial, cohort study, case–control study, case series, expert opinion, or design and development. The top cited articles in prosthetics were published from 1980 to 2012 with a citation range of 11 to 90 times since publication. The mean citation rate was 24.43 (SD 16.7) times. Eighty-four percent of the articles were original publications and were most commonly prospective (76%) and case series studies (67%) that used human subjects (96%) providing level 4 evidence. Among the various fields, rehabilitation (47%), orthopedics (29%), and sport sciences (28%) were the most common fields of study. The study established that studies conducted in North America and were written in English had the highest citations. Top cited articles primarily dealt with lower limb prosthetics, specifically, on transtibial and transradial prosthetic limbs. Majority of the articles were experimental studies.

Near-infrared spectroscopy of the bladder: a new technique for studying lower urinary tract function in health and disease

Background: Continuous wave near-infrared spectroscopy (NIRS) can monitor chromophore change in the bladder detrusor muscle during voiding; oxygenation and hemodynamic data derived differ in health and disease. Application of wireless NIRS for evaluation of voiding dysfunction would benefit children. Methods: Subjects: 20 children (4-17 yrs) [5 normal, 15 with urinary tract pathology]. Instrumentation: self-contained device weight 84 gm; 3 paired light emitting diodes (760/850 nm) in a spatially resolved configuration; source-detector separation distances (30, 35 and 40 mm); silicon photodiode detector; and Bluetooth®. Procedure: Transcutaneous monitoring (midline abdominal skin 2 cm above pubis) during spontaneous voiding (bladder contraction) of oxygenated (O2Hb), deoxygenated (HHb) and total hemoglobin (tHb) and tissue oxygen saturation index (TSI %) at 10 Hz. Results: All 20 trials produced clear graphic data with no movement effect evident. Comparison of patterns of chromophore change between normal and symptomatic subjects revealed trend differences in O2Hb and tHb. (Normal positive; Symptomatic negative, and TSI% fell in symptomatic group). Conclusions: Wireless NIRS is technically feasible in ambulant children. Negative trends in chromophore concentration and falls in TSI% suggest a hemodynamic impairment may underlie some forms of voiding dysfunction, with abnormal physiology involving the microcirculation possibly resulting in muscle fatigue during voiding.