Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies. Level of Evidence: Level IV, Case Series
Background: We studied whether musclin function in humans is related to glycemic control, body composition, and cardiorespiratory capacity. Methods: A cross-sectional study was performed in sedentary adults with or without metabolic syndrome (MS). Serum musclin was measured by enzyme-linked immunosorbent assay. Insulin resistance (IR) was evaluated by the homeostatic model assessment (HOMA-IR). Body composition was determined by dual-energy X-ray absorptiometry and muscle composition by measuring carnosine in the thigh, a surrogate of fiber types, through proton magnetic resonance spectroscopy. Cardiorespiratory capacity was assessed through direct ergospirometry. Results: The control (n=29) and MS (n=61) groups were comparable in age (51.5±6.5 years old vs. 50.7±6.1 years old), sex (72.4% vs. 70.5% women), total lean mass (58.5%±7.4% vs. 57.3%±6.8%), and peak oxygen consumption (VO2peak) (31.0±5.8 mL O2./kg.min vs. 29.2±6.3 mL O2/kg.min). Individuals with MS had higher body mass index (BMI) (30.6±4.0 kg/m 2 vs. 27.4± 3.6 kg/m 2 ), HOMA-IR (3.5 [95% confidence interval, CI, 2.9 to 4.6] vs. 1.7 [95% CI, 1.1 to 2.0]), and musclin (206.7 pg/mL [95% CI, 122.7 to 387.8] vs. 111.1 pg/mL [95% CI, 63.2 to 218.5]) values than controls (P˂0.05). Musclin showed a significant relationship with HOMA-IR (β=0.23; 95% CI, 0.12 to 0.33; P˂0.01), but not with VO2peak, in multiple linear regression models adjusted for age, sex, fat mass, lean mass, and physical activity. Musclin was significantly associated with insulin, glycemia, visceral fat, and regional muscle mass, but not with BMI, VCO2peak, maximum heart rate, maximum time of work, or carnosine. Conclusion:In humans, musclin positively correlates with insulinemia, IR, and a body composition profile with high visceral adiposity and lean mass, but low body fat percentage. Musclin is not related to BMI or cardiorespiratory capacity.
To decide the training for an athlete, it is essential to determine if he/she has a powerful or endurance profile, based on valid and simple measurements. This work describes how to classify athletes as powerful or endurance based on their performance on field physical tests, via clusters analysis, and measures the influence of skeletal muscle fibre type composition and cardiovascular function in such performance.Methods51 elite athletes (20.6 ± 2.9 years, 30 women) of team sports (25% handball, 22% basketball, 21% volleyball floor, 18% softball, 8% beach volleyball, 6% indoor soccer) were evaluated in Medellin, Colombia, with the following: 1. Performance on field tests: Three jumps -free vertical (FVJ), counter movement (CMJ), and squat (SQT)-; two velocity tests −20 metres dash and shuttle sprint- and ergospirometry (VO2); 2. Noninvasive quantification of intramuscular carnosine (mM/Kg.wt) in vastus lateralis muscle (VLM), a surrogate of area occupied by type II fibres in muscle, by proton magnetic resonance spectroscopy; 3. Cardiac structure and function by echocardiography; 4. Haemodynamic and autonomic response, both at rest and at 70°, by impedance cardiography.ResultsClusters determined that best field tests to distinguish between powerful (n = 26, 51%) and endurance (n = 25, 49%) were the three jumps and the 20 metres shuttle sprint. Both groups did not differ in age, sports age or training volume, but body mass index (BMI, Kg/m2) and percentage of body fat (bf%) were lower in powerful than in endurance athletes (p < 0,05). ANCOVA adjusted for BMI, bf% and age, showed larger muscular type II fibres area in VLM in powerful than in endurance athletes (38.2% vs. 29.5%; difference between means 8.7%, IC 95%, 4.02–13.3, p = 0.01). The only cardiovascular variable with significant difference was mitral valve E/A ratio, lower in powerful compared to endurance (1.9 vs 2.4; difference between means 0.5, IC 95%, −0.1 to −0.9, p < 0.05), suggesting better diastolic function and less cardiac rigidity in the latter. In multiple linear regression analysis, introducing demography, anthropometry, cardiac structure and function, and intramuscular mM/Kg.wt of carnosine, the variability of 20 metres sprints was explained (R2 = 0.82, p < 0.05 for all cases) by bf% (ß coefficient −0.6, meaning that for each 1% rise in body fat, velocity reduces 0.6 m/s), left ventricle diastolic diameter index (ß 0.47, for each cm/m2 rise in diameter, velocity raises 0.47 m/sec), cardiac index at 70° (ß 0.9) and contractility index at 70° (ß −0.04). The variability of jumps was explained (R2 = 0.78) by bf% (ß −0.84 for CMJ) and carnosine (ß 1.9 for CMJ, which means that each 1 mM/Kg.wt rise in carnosine raises 1.9 cm the CMJ).ConclusionsThe 20 metres velocity is explained essentially by body composition and cardiovascular variables and the jump is explained fundamentally by body composition and muscle composition, which can be accessed by noninvasive spectroscopy. This new methodology associates biochemical intramuscular variables such carnos...
The relationship between force and the velocity at which a load can be moved is known as force-velocity (F-V) curve. Methods that control strength training intensity based on F-V curves have been proposed. However, F-V curves available were built for a specific European population. Moreover, those curves need to be revisited since they ignored one factor that strongly affect their kinetics, namely muscle fibre type composition. We propose that F-V curves must consider the functional and metabolic profile of the athletes, and hypothesise that at least two F-V curves with different kinetics can be built. Then, we evaluated whether there are differences in speed during the concentric phase of the deep squat at submaximal loads and also built F-V curves according to the different functional and metabolic profile of the athletes.An analytical, cross-sectional observational study involving 147 elite team sports athletes (basketball, handball, softball, indoor soccer, field soccer, volleyball floor and beach volleyball) was carried out in Medellín, Colombia. All athletes (19.3 ± 3.2 years old, 51.7% men) underwent a medical and anthropometric evaluation, as well as six physical tests: free vertical, counter movement, and squat jumps, 20 metres and fly 20 metres sprint tests and ergospirometry. A cluster analysis that included the results of physical tests allowed us to classify athletes as “powerful” or “endurance”. The speed at submaximal loads (30%, 40%, 50%, 60%, 70% and 80% of maximal load lifted), measured with an isoinertial force transducer during the concentric phase of the deep squat, allowed us to build F-V curves. Moreover, a subsample of 49 athletes (38.8% men) was evaluated by proton resonance magnetic spectroscopy for noninvasive quantification of intramuscular carnosine in their vastus lateralis muscle (VLM), in order to estimate the area occupied by type II fibres.66 athletes were classified as powerful and were different in body composition and physical tests results compared to endurance athletes (p < 0.01). A multivariate model adjusted for age, sex, body mass index (BMI) and body fat percentage, showed significantly higher values in powerful vs. endurance athletes in maximal load (15.6%), velocities at all submaximal loads (5.6%), load values (15.9%), and maximal power (20.5%), giving F-V curves with different kinetics between both groups of athletes. After adjusting for age, BMI and body fat percentage, the carnosine concentration in VLM was higher in powerful athletes (4.5 ± 0.2 mM/Kg.wt, n = 26) than in endurance ones (3.6 ± 0.2 mM/Kg.wt, n = 23; P < 0.01). This corresponded to a higher (P < 0.01) area occupied by fibres type II in powerful (38.2 ± 1.6%) than endurance (29.5 ± 1.4%) athletes.In conclusion, there are differences in speed during the concentric phase of the deep squat at submaximal loads according to the functional profile of the athletes. This establishes two F-V curves with different kinetics, which consider the fact that powerful athletes have more area of type II fibres in their V...
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