Muscles in “Concert”: Study of Primary Motor Cortex Upper Limb Functional Topography

BACKGROUND: Previous studies with Transcranial Magnetic Stimulation (TMS) have focused on the cortical representation of limited group of muscles. No attempts have been carried out so far to get simultaneous recordings from hand, forearm and arm with TMS in order to disentangle a 'functional' map providing information on the rules orchestrating muscle coupling and overlap. The aim of the present study is to disentangle functional associations between 12 upper limb muscles using two measures: cortical overlapping and cortical covariation of each pair of muscles. Interhemispheric differences and the influence of posture were evaluated as well. METHODOLOGY/PRINCIPAL FINDINGS: TMS mapping studies of 12 muscles belonging to hand, forearm and arm were performed. Findings demonstrate significant differences between the 66 pairs of muscles in terms of cortical overlapping: extremely high for hand-forearm muscles and very low for arm vs hand/forearm muscles. When right and left hemispheres were compared, overlapping between all possible pairs of muscles in the left hemisphere (62.5%) was significantly higher than in the right one (53.5% ). The arm/hand posture influenced both measures of cortical association, the effect of Position being significant [p = .021] on overlapping, resulting in 59.5% with prone vs 53.2% with supine hand, but only for pairs of muscles belonging to hand and forearm, while no changes occurred in the overlapping of proximal muscles with those of more distal districts. CONCLUSIONS/SIGNIFICANCE: Larger overlapping in the left hemisphere could be related to its lifetime higher training of all twelve muscles studied with respect to the right hemisphere, resulting in larger intra-cortical connectivity within primary motor cortex. Altogether, findings with prone hand might be ascribed to mechanisms facilitating coupling of muscles for object grasping and lifting -with more proximal involvement for joint stabilization- compared to supine hand facilitating actions like catching. TMS multiple-muscle mapping studies permit a better understanding of motor control and 'plastic' reorganization of motor system

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Compressive strength of glass ionomer cements using different specimen dimensions Resistência à compressão de cimentos de ionômero de vidro utilizando-se diferentes tamanhos de corpos-de-prova

The purpose of this study was to evaluate the compressive strength of two glass ionomer cements, a conventional one (Vitro Fil® - DFL) and a resin-modified material (Vitro Fil LC® - DFL), using two test specimen dimensions: One with 6 mm in height and 4 mm in diameter and the other with 12 mm in height and 6 mm in diameter, according to the ISO 7489:1986 specification and the ANSI/ADA Specification No. 66 for Dental Glass Ionomer Cement, respectively. Ten specimens were fabricated with each material and for each size, in a total of 40 specimens. They were stored in distilled water for 24 hours and then subjected to a compressive strength test in a universal testing machine (EMIC), at a crosshead speed of 0.5 mm/min. The data were statistically analyzed using the Kruskal-Wallis test (5%). Mean compressive strength values (MPa) were: 54.00 ± 6.6 and 105.10 ± 17.3 for the 12 mm x 6 mm sample using Vitro Fil and Vitro Fil LC, respectively, and 46.00 ± 3.8 and 91.10 ± 8.2 for the 6 mm x 4 mm sample using Vitro Fil and Vitro Fil LC, respectively. The resin-modified glass ionomer cement obtained the best results, irrespective of specimen dimensions. For both glass ionomer materials, the 12 mm x 6 mm matrix led to higher compressive strength results than the 6 mm x 4 mm matrix. A higher variability in results was observed when the glass ionomer cements were used in the larger matrices.<br>Este estudo teve como objetivo avaliar a resistência à compressão de dois cimentos de ionômero de vidro, um convencional (Vitro Fil® - DFL) e outro modificado por resina (Vitro Fil LC® - DFL), utilizando-se dois tamanhos de amostras: uma com 6 mm de altura e 4 mm de diâmetro e outra com 12 mm de altura e 6 mm de diâmetro, seguindo-se a especificação 7489:1986 da ISO e a especificação n. 66 da ANSI/ADA para Cimento Dental de Ionômero de Vidro, respectivamente. Foram confeccionados 10 corpos-de-prova (CP) de cada material para cada tamanho de amostra, totalizando 40 CP. Estes CP foram armazenados em água destilada e ensaiados 24 horas após a manipulação do material, sob uma carga de compressão em uma Máquina de Ensaio Universal (EMIC) a uma velocidade de 0,5 mm/min. Foi realizada a análise estatística para comparação dos resultados utilizando-se o teste Kruskal-Wallis (5%). As médias dos testes de resistência à compressão (MPa) foram: 54,00 ± 6,6 e 105,10 ± 17,3 para a amostra de 12 mm x 6 mm utilizando-se Vitro Fil e Vitro Fil LC, respectivamente, e 46,00 ± 3,8 e 91,10 ± 8,2 para a amostra de 6 mm x 4 mm utilizando-se Vitro Fil e Vitro Fil LC, respectivamente. O cimento de ionômero de vidro modificado por resina obteve melhores resultados independentemente do tamanho do corpo-de-prova. Para ambos os cimentos de ionômero de vidro, a matriz de 12 mm x 6 mm apresentou maiores valores de resistência que a matriz de 6 mm x 4 mm. Uma maior variabilidade nos resultados pôde ser observada quando os cimentos ionoméricos foram utilizados nas matrizes maiores