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Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced the initially high complication and revision rates associated with this implant. However, instability continues to be a leading cause of reoperation after RTSA, being related in previous studies with medialized designs. The aim of this study was to determine the dislocation rate with the employment of two medialized modular systems of RTSA in our institution. A retrospective review of two different modular systems of RTSA (SMR Modular Shoulder System and Delta XTEND Reverse Shoulder) was performed between 2009 and 2017 with a minimum 3-year follow-up. Baseline demographic, clinical (Constant, ASES and ROM), and radiographic data were collected. Characteristics of postoperative instability cases were also evaluated. 237 primary RTSA (41% SMR/59% Delta) and 34 revision RTSA (44% SMR/56% Delta) with a mean follow-up of 75.6 ± 5.2 months (79.2 SMR/86.3 Delta, p = .586) were included in the present study. Indications for primary RTSA were osteoarthritis, rotator cuff tear arthropathy and massive irreparable rotator cuff tear (64%), acute fracture (32%), and fracture sequelae (4%). Subscapularis tendon was always repaired in degenerative pathology and tuberosities reattached in traumatic cases. The mean age of the global series was 76.5 ± 5.3 years (75.8 SMR/78.6 Delta, p = .104) with a mean Constant/ASES score at final follow-up of 68.5 ± 4.3/72.9 ± 20.3 (71/68 SMR and 69/74 Delta, p = .653 and .642). Only 2 patients (one acute fracture and one fracture sequelae) suffered an early postoperative anterior dislocation (before 3 months) which represents a rate of .84% in primary cases and .73% including revision surgery. Closed reduction manoeuvres were not successful, and both patients required revision surgery. At the end follow-up, both were stable and had no further dislocations. The dislocation rate after RTSA with the employment of two contemporary modular systems with a medialized centre of rotation is extremely low, especially when compared with the previously published series with the original Grammont design. Acute fracture and fracture sequelae were the main diagnoses associated with this instability. The reasons for the low dislocation rate are multifactorial, but the improvement in the baseplate position according to the more recent standards of “ideal position” and technical aspects such as subscapularis repair or tuberosity reattachment in fractures probably play an important role in this aspect.

To compare the mid-term outcomes in intra-articular distal humerus fracture (AO/OTA type C) treated with either open reduction–internal fixation (ORIF) or total elbow arthroplasty (TEA) in patients older than 75 years and with more than five years of follow-up. Retrospective study including 24 patients (11 TEA vs. 13 ORIF) with a mean age of 82 years and being all females. Results assessed included (1) radiographic measures; (2) functional results: range of motion, Mayo Elbow Performance Score (MEPS), quick-DASH; and (3) complications. TEA group vs. ORIF group achieved a mean flexion of 117° ± 9.6° vs. 106° ± 14°, extension loss of 38° ± 17° vs. 30.8° ± 16°, pronation 75° ± 5° vs. 85° ± 7° and supination 75° ± 4° vs. 70° ± 5°. Mean MEPS score was 71.6 vs. 83.6 (p = .183) and mean quick-DASH was 44.8 vs. 42.6 (p = .789). All 13 patients in the ORIF group demonstrated radiographic signs of bone union and none underwent conversion to TEA. Sixty-three percent of the patients in the TEA group underwent re-operation at an average of 72 months (62.4–75.2 months), including three for periprosthetic fracture and four for implant loosening. Whereas in the ORIF group, 23% of the patients were re-operated upon excluding olecranon osteotomy hardware, two for stiffness, and one for an olecranon tension band wire failure. Although there were no differences in mid-term functional outcomes between either treatment, our results suggest that the recent trend towards the use of TEA instead of ORIF in the elderly should be re-examined due to the high rate of complications beyond five years of follow-up with TEA.

Arthroscopic balloon spacer arthroplasty (BSA) is a relatively recent procedure for patients with irreparable rotator cuff tears, conceived to prevent degenerative joint changes and relieve subacromial pain.This is a retrospective case series of 16 consecutive patients treated with BSA and followed up for a minimum 12 months. Besides BSA, partial tendon repair was done whenever possible. Radiographical parameters such as acromiohumeral distance and Hamada stage were measured preoperatively and postoperatively. Range of motion, functional results (Constant score; Simple Shoulder Test; American Shoulder and Elbow Surgeons score; and Disabilities of the Arm, Shoulder, and Hand score), health-related quality of life results with the EuroQol Five Dimensions tool, complications, and patient satisfaction were also analyzed.The mean age was 64 ± 10.3 years, and the male/female ratio was 6/10. Partial repair was achieved in five patients (31.2%) and did not influence functional or health-related quality of life results ( P = 0.11). The mean acromiohumeral distance and Hamada stage worsened from preoperative measures (3.7 ± 2.0 mm and 2.3 ± 1.1) to final follow-up measures (3.1 ± 2.4 mm and 3.1 ± 1.3). Shoulder abduction increased by 7.8° ± 26.8° and forward flexion decreased by 25.5° ± 32.4° after surgery. The functional results at the final follow-up were Constant 49.5 ± 18.0; American Shoulder and Elbow Surgeons 60.2 ± 27.2; Simple Shoulder Test 8.5 ± 4.6; and Disabilities of the Arm, Shoulder, and Hand 32.7 ± 12.1. The mean index value for the EuroQol Five Dimensions was 0.79, and perceived quality of life was 85.6 ± 15.4 of 100 points. 62.5% of the patients (10) were satisfied with surgery. The complication rate was 13% (2), accounting for one deep infection and one balloon migration.Theoretical benefits of BSA for delaying superior humeral head translation and arthropathic changes could not be demonstrated in our series. Its functional results and satisfaction rates are low, but self-reported quality of life after surgery does not seem impaired. Complications do not occur frequently but require reintervention and endanger joint viability.Level IV (case series).

Background Proximal humeral fractures (PHFs) are among the most common fractures in elderly patients, but there is insufficient evidence from randomized controlled trials (RCTs) to determine which interventions are the most appropriate for their management. To date, no RCT has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for 3- or 4-part PHFs in elderly patients. Methods This was a prospective RCT. The primary objective was to compare pain and function 12 months after fracture using the Constant score in patients aged 80 years or older with 3- and 4-part PHFs, treated by either RSA or nonoperative treatment. Secondary outcome measures included Disabilities of the Arm, Shoulder and Hand, visual analog scale (VAS), Short Form 12 (SF-12), EuroQol 5 Dimensions, and EQ-VAS scores. Results We analyzed 30 nonoperative and 29 RSA patients with mean ages of 85 years and 82 years, respectively. No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes at 12 months' follow-up except the VAS pain score. The Constant scores were 55.7 in the nonoperative group and 61.7 in the RSA group (P = .071); the Disabilities of the Arm, Shoulder and Hand scores were 29 and 21, respectively (P = .075); the VAS scores were 1.6 and 0.9, respectively (P = .011); the physical SF-12 scores were 36 and 37, respectively (P = .709); the mental SF-12 scores were 43 and 42, respectively (P = .625); the EuroQol 5 Dimensions scores were 0.89 and 0.92, respectively (P = .319); and the EQ-VAS scores were 65 and 67, respectively (P = .604). Conclusions This study yields important evidence for the treatment of complex PHFs in elderly patients suggesting minimal benefits of RSA over nonoperative treatment for displaced 3- and 4-part PHFs. At short-term follow-up, the main advantage of RSA appeared to be less pain perception.

Resumen La descompresion subacromial artroscopica aislada (DSA) es un procedimiento quirurgico ampliamente utilizado que presenta un elevado porcentaje de exito. Sin embargo, hasta un 25% de los pacientes puede presentar dolor residual tras la intervencion. No esta claro si el procesamiento aberrante del dolor, como ocurre en la fibromialgia (FM), podria ejercer un efecto deletereo en los resultados obtenidos. Para testar esta hipotesis hemos realizado un estudio casos-controles retrospectivo de los pacientes en los que se ha realizado una descompresion subacromial artroscopica como procedimiento quirurgico unico. Material y metodos Se seleccionaron 26 pacientes con diagnostico preoperatorio de fibromialgia de una serie de 293 pacientes intervenidos mediante DSA entre 2008-2015. Seis pacientes se perdieron durante el seguimiento. Cada paciente con diagnostico de fibromialgia fue emparejado con un control (n = 20). Los resultados fueron evaluados mediante la escala DASH, Constant, Constant relativo a la edad y sexo (rCS) y la escala visual analogica (EVA). La satisfaccion del paciente fue evaluada con una pregunta dicotomica. Se considero fracaso del procedimiento la presencia de una puntuacion superior a 3 en la EVA en el ultimo seguimiento. Resultados La media de edad de los grupos FM/control fue de 51/48 anos, con un seguimiento medio de 36/42 meses respectivamente. Ambos grupos experimentaron una mejoria postoperatoria significativa en las escalas de EVA, DASH y rCS (p Conclusiones La fibromialgia puede ser considerada como factor pronostico que condiciona un peor resultado postoperatorio tras DSA. Sin embargo, debido a la mejoria clinica que experimentan estos pacientes frente a su estado preoperatorio, recomendamos realizar este tratamiento quirurgico cuando exista indicacion.

Isolated arthroscopic subacromial decompression (IASD) is a widely used surgical procedure with high success rates. However, up to 25% of patients experience residual pain. It is unclear whether aberrant central nervous system processing of pain as described in fibromyalgia (FM) could have a detrimental effect on outcomes. To test this hypothesis, the authors conducted a retrospective case–control study of patients undergoing IASD. Material and methods Between 2008 and 2015, 26 patients with preoperative diagnosis of fibromyalgia and an IASD procedure were identified. Six patients were lost to follow-up. Each fibromyalgia patient was matched with one control patient (n = 20) recruited from the remainder with IASD. Outcomes were assessed by DASH score (Disability Arm Shoulder and Hand), Constant (CS), relative Constant score (rCS) and Visual Analogue Scale (VAS). Patient satisfaction was determined with a single 2-level question. Failure of the IASD was defined as persistent pain (VAS > 3) at last follow-up. Results The average age of the sample was FM/Control group 51/48, with a mean follow-up of 36/42 months respectively. Both groups exhibited significant clinical improvement in the pain VAS, DASH and rCS at final follow-up (p Mean postoperative scores FM/Control group were: Constant 63.5/74 (p = .07), rCS 82/88 (p = 18), DASH 38.9/20.7 (p = 009), VAS 3.8/2.8 (p = 2). Eighty-five percent of patients in the control group were satisfied with the surgery compared with 55% in the FM group (p = 03). Failure of the procedure was 60% in the FM group, and 30% in the control group (p = .056). Conclusions Fibromyalgia can be considered a prognostic factor of a poor postoperative outcome after an IASD. However the clinical improvement experienced by these patients over their preoperative situation leads us to recommend their surgical treatment when indicated.

Nanometer-thick epitaxial Co films intercalated between graphene (Gr) and a heavy metal (HM) substrate are promising systems for the development of spin–orbitronic devices due to their large perpendicular magnetic anisotropy (PMA). A combination of theoretical modeling and experiments reveals the origin of the PMA and explains its behavior as a function of the Co thickness. High quality epitaxial Gr/Con/HM(111) (HM = Pt,Ir) heterostructures are grown by intercalation below graphene, which acts as a surfactant that kinetically stabilizes the pseudomorphic growth of highly perfect Co face-centered tetragonal (fct) films, with a reduced number of stacking faults as the only structural defect observable by high-resolution scanning transmission electron microscopy (STEM). Magneto-optic Kerr effect (MOKE) measurements show that such heterostructures present PMA up to large Co critical thicknesses of about 4 nm (20 ML) and 2 nm (10 ML) for Pt and Ir substrates, respectively. X-ray magnetic circular dichroism (XMCD) measurements show an inverse power law of the anisotropy of the orbital moment with Co thickness, reflecting its interfacial nature, that changes sign at about the same critical values. First principles calculations show that, regardless of the presence of graphene, ideal Co fct films on HM buffers do not sustain PMAs beyond around 6 mLs due to the in-plane contribution of the inner bulk-like Co layers. The large experimental critical thicknesses sustaining PMA can only be retrieved by the inclusion of structural defects that promote a local hcp stacking such as twin boundaries or stacking faults. Remarkably, a layer resolved analysis of the orbital momentum anisotropy reproduces its interfacial nature, and reveals that the Gr/Co interface contribution is comparable to that of the Co/Pt(Ir)., Financial support from MINECO (Grant Nos. RTI2018-097895-B-C41, RTI2018-097895-B-C42 and RTI2018-097895-B-C43 (FUN-SOC), PID2019-103910GB-I00, FIS2016-78591-C3-1-R and FIS2016-78591-C3-2-R (SKYTRON), PGC2018-098613-B-C21 (SpOrQuMat), PCI2019-111908-2 and PCI2019-111867-2 (FLAGERA 3 grant SOgraphMEM)], from Regional Government of Madrid (grant number P2018/NMT-4321 (NANOMAGCOST-CM)) and from Gobierno Vasco-UPV/EHU (grant numbers GIU18/138 and IT-1246-19). We acknowledge experiments at ALBA BL29 via proposal no. 2019023333. IMDEA-Nanociencia acknowledges support from the “Severo Ochoa” Program for Centres of Excellence in R&D (MINECO, Grant SEV-2016-0686).

Alterations in the anatomical relationships of the musculocutaneous (MCN) and axillary nerves and the influence of arm positioning on these relationships after a Latarjet procedure have been demonstrated in the cadaver, but there are no studies in the literature that establish if there is any neurophysiological repercussion. We retrospectively identified 24 patients with a primary or revision open Latarjet procedure. A prospective clinical (Constant-Murley, Rowe and Walch-Duplay and active range of motion), radiographic (with CT), and electrodiagnostic evaluation was made at the most recent follow-up. Nonunion occurred in four patients (22%); there were, as well, one case of partial coracoid reabsorption (5%) and two (11%) with mild glenohumeral osteoarthritis. In the anatomical position, we found no alterations in the musculocutaneous nerve and two cases (11%) in the axillary nerve slight motor unit loss. In the risk position, 11 cases (61%) had neurophysiological involvement (36% had neurophysiological changes in the musculocutaneous nerve and 64% in the axillary nerve). No differences between patients with or without neurophysiologic changes were found: Constant 87/83; Rowe 89/90; Walch-Duplay 84/78; Forward elevation 175o/170o, abduction 165°/175°; external rotation 48°/45°. The rate of clinical electromyographic changes in the axillary and MCN in the abducted and externally rotated arm position (risk dislocation position) is higher than in neutral position. Nonunion of the coracoid process must play a role in these neurophysiological changes. Although in the medium-term they don’t have clinical impact, further randomized prospective studies with a larger sample size are necessary to determine their true repercussion. Level IV.

The catalytic oxidation of CO on transition metals, such as Pt, is commonly viewed as a sharp transition from the CO-inhibited surface to the active metal, covered with O. However, we find that minor amounts of O are present in the CO-poisoned layer that explain why, surprisingly, CO desorbs at stepped and flat Pt crystal planes at once, regardless of the reaction conditions. Using near-ambient pressure X-ray photoemission and a curved Pt(111) crystal we probe the chemical composition at surfaces with variable step density during the CO oxidation reaction. Analysis of C and O core levels across the curved crystal reveals that, right before light-off, subsurface O builds up within (111) terraces. This is key to trigger the simultaneous ignition of the catalytic reaction at different Pt surfaces: a CO-Pt-O complex is formed that equals the CO chemisorption energy at terraces and steps, leading to the abrupt desorption of poisoning CO from all crystal facets at the same temperature., We acknowledge financial support from the Spanish Ministry of Science and Innovation (Grants MAT-2017-88374-P, PID2019-107338RB-C63, PID2019-107338RB-C66), the Basque Government (Grants IT-1255-19, IT-1246-19), the Knut and Alice Wallenberg foundation (DNR KAW 2015.0058 „Atomistic Design of new Catalysts“) and the Swedish Research Council (DNR 349-2011-6491 „Catalysis on the atomic scale“).

Background Some local events after reverse shoulder arthroplasty (RSA) occur without the patient experiencing symptoms and yet may be detected on diagnostic imaging, thereby serving as indicators of future complications that may require revision. Most of these events involve the glenoid component, but radiographic studies evaluating this component are scarce, especially medium- and long-term studies. This study aimed to analyze the radiographic changes around the glenoid component and determine the risk factors associated with the presence of these radiographic changes. Materials and methods A retrospective review of 105 primary Grammont-style RSAs implanted between 2003 and 2014 was conducted. Radiographic outcomes were evaluated in patients with ≥5 years of radiographic follow-up. Standardized digital radiographs obtained immediately postoperatively and at a minimum follow-up time of 5 years were analyzed to determine (1) glenoid component position (inclination and height) and (2) minor radiographic changes (Sirveaux grade 1 or 2 scapular notching; nondisplaced acromial fracture; radiolucent lines around 1 or 2 screws; Brooker grade 1a, 1b, or 2 heterotopic calcifications; or single screw rupture), as well as major radiographic changes (Sirveaux grade 3 or 4 scapular notching; radiolucent lines around ≥3 screws or central peg; Brooker grade 1c or 3 heterotopic calcifications; prosthetic dislocation; loosening or migration; or disassembly). Results Major radiologic changes were identified in 14.3% of the cases. Bivariate analysis showed that more changes were associated with the arthroplasties implanted in the first years of the study (odds ratio [OR] = 0.81, P = .012). This time-related variable was also associated with inclination (OR = 0.88, P = .045) and height (OR = 0.75, P = .001), improving in arthroplasties implanted in the last years of the study. Multivariate analysis revealed an increased risk of severe scapular notching mainly associated with superior tilt (OR = 2.52, P = .036) and a high (OR = 2.68, P = .019) or excessively high (OR = 7.55, P = .013) position and an increased risk of loosening signs associated with superior tilt (OR = 8.92, P = 9.1 × 10–6). Conclusions The percentage of radiologic changes of the glenoid component in RSA is considerable, despite the detection of a decrease in their presence among the arthroplasties implanted outside the initial period. Superior tilt and an excessively high position appear to be associated with a severe degree of scapular notching development and increased risk of radiographic loosening signs. Knowledge of the factors associated with major radiologic changes in the medium-term follow-up will help to optimize the primary surgical technique for each patient and indication, improving implant survival in primary RSA surgery.

Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients. A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12 months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS. Mean age was 82.1 (range 80–90) and mean follow-up was 45.6 months (range 16–53 months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck–shaft angle (NSA) at final follow-up was 132o ± 17.9o. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115o ± 35o, 100o ± 35o, and 20o ± 15o, respectively. Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population.

Making use of the inherent surface anisotropy of different high index surface planes vicinal to the low index Au(111) orientation, one-dimensional polymers have been synthesized following established procedures from two different precursor molecules. The successful polymerization of both 4,4″-dibromo-p-terphenyl and 5,5′-dibromo-salophenato-Co(II) precursors into poly(p-phenylene) and poly[salophenato-Co(II)], respectively, has been confirmed by scanning tunneling microscopy and low energy electron diffraction. Angle-resolved photoemission spectroscopy data reveal a highly dispersive band in the case of poly(p-phenylene) while no significant dispersion is resolved for poly[salophenato-Co(II)]. On the basis of density functional theory calculations, we explain this observation as a result of a high conjugation along the aromatic phenyl groups in poly(p-phenylene) that is absent in the case of poly[salophenato-Co(II)], where intramolecular conjugation is interrupted in the salophenato-Co(II) unit. Furthermore, we make use of multicenter and delocalization indexes to characterize the electron mobility (corresponding to a high band dispersion) along different paths associated with individual molecular orbitals., The authors thank for technical and human support provided by IZO-SGI SGIker of UPV/EHU and European funding (ERDF and ESF). Financial support comes from Eusko Jaurlaritza (Basque Government) through the projects IT-588-13, IT-756-13, and IT621-13 as well as from the Spanish MINECO/FEDER through Grants MAT2013-46593-C6-4-P and MAT2016-78293-C6-6-R, as well as projects CTQ2014-52525-P and FIS2016-75862-P. E.S., M.B., and R.W. gratefully acknowledge financial support from the Office of Naval Research via Grant N00014-16-1-2900 and the Deutsche Forschungsgemeinschaft via SFB668-B4.

Background Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose of this study was to determine the complications, rate of healing, and functional results of glenoid bone grafting in primary or revision surgery with reverse shoulder arthroplasty. Methods We retrospectively reviewed 23 patients with glenoid bone loss who underwent primary or revision surgery using a glenoid bone graft with a minimum follow-up of 2 years. Range of motion and the Constant, American Shoulder and Elbow Surgeons, and visual analog scale scores were obtained from preoperative assessment and the latest follow-up visit. Radiographic evaluation included analysis of plain radiographs as well as preoperative and follow-up computed tomography. Results Three patients were excluded from the study. Allografts were used in 13 cases and autografts in 7 cases. The mean Constant score improved from 30.7 ± 9.4 to 51.3 ± 13.4 (P

Resumen Introduccion y objetivos La artroplastia total de hombro inversa en el contexto de la artropatia de manguito rotador mejora la anteversion y abduccion existentes, no asi las rotaciones. Nuestro objetivo es determinar la repercusion de este hecho en la realizacion de actividades mas cotidianas. Material y metodos Entre 2009 y 2011 se implantaron 210 artroplastias de hombro en nuestro centro. De ellas, 126 artroplastias totales de hombro inversas por artropatia de manguito rotador. El 88% eran mujeres, con una edad media en el momento de la cirugia de 81 anos, encontrandose el 95% laboralmente retirados. El seguimiento medio fue de 53 meses. En cada paciente fue valorada la escala Constant, la escala visual analogica e indice de comorbilidad de Charlson, el balance articular asi como la capacidad de realizacion de 40 actividades cotidianas, divididas segun grado de demanda funcional para el hombro en un cuestionario nuevo adaptado a nuestro grupo poblacional. Resultados y discusion El Constant medio normalizado por edad y sexo fue del 81,2%. EL valor medio de la escala visual analogica e indice de comorbilidad de Charlson medios de 3,56 y 1,69 respectivamente. Mejoria del balance articular en anteversion y abduccion, no en rotaciones. Limitacion para realizar actividades de baja y alta demanda funcional del 20 y 51% respectivamente, apreciandose mayor limitacion en aquellas que implican rotacion interna. Conclusion La artropatia de manguito rotador en el paciente anciano tratada mediante artroplastia total de hombro inversa consigue un adecuado control analgesico y buenos resultados funcionales. Sin embargo, hay que asumir un importante riesgo de limitacion en actividades cotidianas de alta demanda y que impliquen rotaciones, sobre todo interna.

Resumen Objetivo La reparacion del manguito rotador se acompana de una elevada tasa de rerrotura. Nuestro objetivo es determinar si el empleo de rhBMP-2 vehiculizada en un transportador hibrido mejora el proceso de reparacion en lesiones cronicas del manguito. Material y metodos Estudio experimental en 62 ratas. A las 4 semanas de la lesion se llevo a cabo una sutura transosea y la asignacion aleatoria a uno de los 5 grupos de estudio: 1) grupo control: solo sutura; 2) grupo doble-control: se aplico ademas un transportador de alginato-quitina; 3) grupo control-alginato: se anadio rhBMP-2 al alginato; 4) grupo control-quitina: se anadio rhBMP-2 a la quitina, y 5) grupo doble-muestra: se anadio rhBMP-2 a ambos componentes. A los 4 meses se evaluaron los resultados mediante estudios biomecanicos e histologicos. Resultados En todos los casos se observo una brecha osteotendinosa macroscopicamente a las 4 semanas. La tasa de rerrotura fue del 7,5%, ocurriendo el 20% de ellas en el grupo control-alginato. En la evaluacion histologica los mejores resultados se obtuvieron en el grupo doble muestra: 4,5 (3,3-5). La carga maxima soportada fue mayor en el grupo doble muestra 62,9 N (59,8-69,4) presentando ademas una menor rigidez 12,7 (9,7-15,9). Conclusiones El empleo de la rhBMP-2 vehiculizada en un transportador hibrido de alginato-quitina parece mejorar las caracteristicas histologicas de la reparacion e incrementar las propiedades biomecanicas del tendon en el contexto de una lesion cronica del manguito rotador.

Aim Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of rhBMP-2 in a carrier could improve the biomechanical and histological properties of the repair. Material and methods Controlled experimental study conducted on 40 rats with section and repair of the supraspinatus tendon and randomisation to one of five groups: Group 1 (control) only suture; Group 2 (double control), suture and alginate-chitin carrier; Group 3 (alginate-control), the rhBMP-2 was added to the alginate; Group 4 (chitin-control), application of the rhBMP-2 to the chitin; and Group 5 (double sample): the two components of the carrier (alginate and chitin) have rhBMP-2. A biomechanical and histological analysis was performed at 4 weeks. Results A gap was observed in all cases 4 weeks after supraspinatus detachment. The re-rupture rate was 7.5%, with 20% of them in the control-alginate group. Histologically the best results were obtained in the double sample group: 4.5 (3.3–5.0). Double sample were also able to support higher loads to failure: 62.9 N (59.8–69.4) with lower rigidity 12.7 (9.7–15.9). Conclusions The use of alginate-chitin carrier with rhBMP-2 improves the biomechanical and histological properties of the repair site in a chronic rotator cuff tear.

Background This study evaluates the clinical outcomes in patients with proximal humerus fractures (PHF) treated with reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed fixation that have more than 5 years of follow-up. Materials and Methods This is a retrospective study of 270 RTSA. The inclusion criteria for this study consisted of patients initially treated with either open reduction and plate fixation (ORIF) or fixation using an intramedullary nail (IMN), who were managed with a single-stage revision to a RTSA, and had a minimum of 24 months clinical and radiological follow-up. Six patients with failed fixation of displaced PHF were revised with RTSA. One patient was excluded from the study because she died. Five shoulders were reviewed for the purpose of this study. The patients were evaluated using Constant score, relative Constant score and visual analogue scale for pain. Results The mean follow-up was 89 months (65–108). The mean absolute Constant score improved from 31, 81 to 44, 2 and the relative Constant score improved from 31,81% to 67,2%. Mean VAS improved from 6, 8 to 2. One patient rated their outcome excellent, 1 good, 1 satisfied and 2 poor. Conclusion RTSA is an appropriate treatment as a revision surgery for failed fixation of PHF. Patients should be adequately warned that they will improve their function but may have complications following this salvage procedure.

There is no consensus on the optimal surgical procedure for treating Neer type-2 distal clavicle fractures. Hook plates provide better stability than other fixation methods for small fragments but have been related to multiple complications. Retrospective study on patients operated for Neer type-2 fractures using a hook plate. At the time of the study, we performed functional (UCLA and Constant scales) and radiographic (coracoclavicular distance CCD) evaluation and ultrasound assessments of the condition of the rotator cuff. Twenty-four patients were included in the study, with a mean age of 43 years (18–81) and a mean follow-up of 40.4 months (22–67). All the fractures healed, except one. The plate was removed at a mean of five months (3–13). The Constant score was 85.7 and the UCLA score was 32. The mean increase in CCD at final follow-up was 9.6% ± 7.2% (range 1.9–54.3%) compared with the uninjured side. Nine patients showed acromioclavicular arthrosis (only one case was symptomatic), and 12% showed subacromial osteolysis. No acromion fractures were recorded. The implant failed in three cases due to medial movement of the material, and we found one peri-plate fracture. The use of hook plates in this particular type of fracture provides high consolidation rates and good functional outcomes, irrespective of the fracture subtype. However, it is essential to select the correct length and depth of the hook to prevent complications such as medial movement of the implant. Ultrasound assessment showed that rotator cuff injury is not a common complication if the implant is removed as soon as the fracture has consolidated.

We thank Javier Zaldivar and Joeri de Bruijckere for developing the deconvolution process and Sebastian Bergeret for discussions. D.-J. C. and J. I. P. thank the European Union for support under the H2020-MSCA-IF-2014 Marie-Curie Individual Fellowship program (Proposal No. 654469), Spanish MINECO (MAT2016-78293-C6-1-R), Diputacion Foral de Gipuzkoa for Grant No. 64/15, and the European Regional Development Fund (ERDF). N. L. thanks Spanish MINECO (Grant No. MAT2015-66888-C3-2-R). M. M. U. acknowledges Spanish MINECO (MAT2014-60996-R). E. H., I. G., and H. S. acknowledge FIS2014-54498-R and MDM-2014-0377, COST MP16218 nanocohybri, ERC PNICTEYES Grant Agreement No. 679080, and Departamento Administrativo de Ciencia, Tecnologia e Innovacion, COLCIENCIAS (Colombia), Programa doctorados en el exterior and convocatoria 568-2012, as well as Comunidad de Madrid through program Nanofrontmag-CM (Grant No. S2013/MIT-2850)

Introduction-objectives To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy. Material and method A retrospective study was conducted on 126 RSA between 2009 and 2011, in which four fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D). Results The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P > .05); postoperative Constant score: 81.2 and 66.5%, respectively (P > .001). Forward elevation and abduction in fracture patients decreased by 39° (P = .02), and 34° (P = .057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P = .002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months. Conclusions Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication.

Resumen Introduccion-objetivos Describir la incidencia, factores etiologicos, repercusion funcional y actitud terapeutica de las fracturas de acromion y espina de la escapula tras artroplastia invertida por artropatia de manguito rotador. Material y metodo Analisis retrospectivo de 126 artroplastias inversas entre los anos 2009-2011. Se identificaron 4 fracturas que se compararon con un grupo control de 40 pacientes. Se analizan variables relacionadas con el proceso quirurgico, funcionales y de calidad de vida (escala Constant, EQ-5D). Resultados La incidencia de la fractura fue 3,28% (4 pacientes), edad media 74,7 anos y tiempo medio hasta el diagnostico 11,9 meses. El Constant preoperatorio del grupo control fue de 37,3% y de los pacientes con fractura 34,7% (p > 0,05); el postoperatorio 81,2% y 66,5%, respectivamente (p En ninguno de los casos de fractura se observo inestabilidad, no precisando cirugias de revision. La tasa de consolidacion fue de un 50% tras un seguimiento medio de 39,6 meses. Conclusiones La fractura de escapula tras artroplastia invertida es una complicacion poco frecuente. A pesar de su aparicion los resultados funcionales y de calidad de vida de estos pacientes son superiores a los presentes preoperatoriamente, sin embargo, resultan inferiores a los de los pacientes intervenidos en los que no se encuentra dicha complicacion. Son necesarios mas estudios prospectivos que nos ayuden a definir las pautas de actuacion terapeutica ante esta complicacion.

The purpose of this study was to record the incidence and management of periprosthetic humeral fractures (PHF) using reverse total shoulder arthroplasty (RTSA) in our institution. We performed a retrospective study of 203 RTSA implanted in 200 patients between 2003 and 2014. The mean follow-up was 78.82 months (range, 12–141). Mean age of the study cohort was 75.87 years (range, 44–88). There were only 25 male patients (12.5 %). We assessed the presence of periprosthetic humeral fractures studying the medical files and X-rays of all patients. We identified seven periprosthetic humeral fractures in 203 RTSA (3.4 %): three intra-operative (1.47 %) and four post-operative (1.97 %). The average age at the time of the fracture was 75.14 years (59–83). All patients were women (100 %). Three patients with post-operative fractures type B were treated by osteosynthesis, and one patient with post-operative fracture type A was treated conservatively. All intra-operative fractures needed cerclage wire and in one case long cemented stem. All our periprosthetic fractures healed. Surgical treatment with osteosynthesis in type B post-operative fractures with a stable stem is recommended. Conservative treatment is sufficient in non-displaced type A post-operative fracture. Special attention should be paid to bone quality patients using non-cemented stems in primary surgery but especially in revision shoulder surgery.

Achieving the Ag(001)-supported synthesis of heptacene from two related reactants reveals the effect of the presence of Br atoms on the reaction process. The properties of reactants, intermediates and end-products are further characterized by scanning tunneling microscopy and spectroscopy., We acknowledge funding from the European Research Council under the European Union’s Horizon 2020 programme (Grant Agreement No. 635919), and from the Spanish Ministry of Economy, Industry and Competitiveness (MINECO, Grant No. MAT2016-78293-C6, MAT2015-66888-C3-2-R), Agencia Estatal de Investigación (AEI)/FEDER, UE (CTQ2016-75960-P), the AGAUR (2017 SGR 1257), and the CERCA Program/Generalitat de Catalunya.

The description of tunneling currents from non-equilibrium electronic structure using localized basis sets is very demanding. The problem stems from the lack of accuracy to describe evanescent waves in the tunneling barrier when the basis set is limited. The same problem exists for extended basis sets such as planewaves, except because increasing the number of planewaves simply improves the description. With local basis sets several strategies exist for improving the tunneling scattering structure. Here, we explore them and compare with previous work. Our conclusion is that using ghost atoms in self-consistent codes such as Transiestais a valid and accurate way of performing tunneling calculations. However, attention must be paid not to break the symmetry of the transmission channels by incorrect inclusion of the ghost atom and to perform a fully self-consistent calculation to avoid ghost transmissions., We gratefully acknowledge support from MINECO (grant no. MAT2015-66888-C3-2-R) and FEDER funds.

En un contexto sociopolítico donde nada escapaba a los ojos del censor, se desarrolló un tipo de cine que hoy en día sorprende por su crudeza sanguinolenta, así como por sus excesos sexuales. El desdén de la censura por el cine de terror español producido en las décadas de los sesenta y setenta permitió que se convirtiera en el espacio idóneo donde los espectadores de la época encontraron la válvula de escape a la represión a la que estaban sometidos. La muerte del general Francisco Franco y el aperturismo provocaron que las ansiedades eróticas de un buen número de espectadores se centraran en otro tipo de cine. Sin embargo, ese corto pero intenso periodo de tiempo, caracterizado por una altísima producción de género terrorífico, ha legado imágenes con una gran carga erótica, sexual y violenta, muy desconocidas, que merecen ser rescatadas. Para ello, haremos un repaso histórico por el género en España para, finalmente, centrarnos en el análisis de cuatro filmes representativos de los setenta. Abstract: A rawness and crudity cinema was developed in Spain, in a socio-political context where everything was always subject to censorship, through the sixties and seventies. Still today, this bloody and erotic cinema may cause surprise to the audience. Censorship showed a scornful attitude to this cinema, and spectators considered it as a release-valve, due to the repression they were suffered. This fact permitted an intense production of this kind of movies in a really short time. The death of Francisco Franco and the brand new openness caused that all this audience focused their attention in another kind of cinema. Nevertheless, that brief but extremely intense period allowed us to enjoy those erotical and violent images, that today remains almost unknown, and, withouth a doubt, it deserves to be rescued. For that, we will make a skim though this genre in Spain and, eventually, we will analyze four emblematic films of the seventies.

We show that the magnetic ordering of coupled atomic dimers on a superconductor is revealed by their intragap spectral features. Chromium atoms on the superconductor β-Bi_{2}Pd surface display Yu-Shiba-Rusinov bound states, detected as pairs of intragap excitations in tunneling spectra. By means of atomic manipulation with a scanning tunneling microscope's tip, we form Cr dimers with different arrangements and find that their intragap features appear either shifted or split with respect to single atoms. These spectral variations are associated with the magnetic coupling, ferromagnetic or antiferromagnetic, of the dimer, as confirmed by density functional theory simulations. The striking qualitative differences between the observed tunneling spectra prove that intragap Shiba states are extremely sensitive to the magnetic ordering on the atomic scale.

Background Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. Methods Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. Results Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injuries remain unchanged, and the rest improved or normalized. The mean postsurgery rCS of the entire cohort at 6-month follow-up was 78 ± 6.5. Mean postoperative rCS for acute postoperative nerve injury was 71 ± 3 for the axillary nerve and 64 ± 5 for SSN. Conclusions Axillary and SSN injuries in RCTA have a much higher incidence than expected. Most of these axillary lesions are transient, with an almost complete recovery seen on electromyography at 6 months and with scarce functional impact. However, SSN lesions appear to behave differently, with poor functional results and having a lower potential for a complete recovery.

INTRODUCTION AND OBJECTIVE Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. MATERIAL AND METHODS Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. RESULTS Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. DISCUSSION Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life.

Introduction and objective Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Material and methods Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005 and 2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65–89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Results Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3 quarters (79.1%) of the patients showed 0–1 grade degenerative changes on the X -ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Discussion Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life.

Introduction and objectives Persistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem. Our aim is to establish the incidence of recurrence and its revision surgery, and to analyze the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. Materials and methods A retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analog scale. Results Of the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. Conclusions Surgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognizing the problem, and the technical demand (greater variety and the increasingly complex techniques).

Introduccion y objetivos Aunque las tasa de recidiva tras la cirugia primaria de la inestabilidad no son despreciables, son pocos los estudios que encontramos sobre su cirugia de revision. Los objetivos de esta serie son establecer la frecuencia de recidiva de la inestabilidad en la misma y de su cirugia de revision; analizar los resultados funcionales obtenidos, y determinar un protocolo quirurgico de actuacion ante la necesidad de realizar una cirugia de revision. Material y metodos Analisis retrospectivo: 16 pacientes con recidiva de inestabilidad tras cirugia previa en 164 pacientes intervenidos entre 1999-2011. Seguimiento medio de 57 meses y edad promedio 29 anos. Evaluacion de resultados mediante las escalas Constant, Rowe y UCLA. Resultados De los 12 casos de cirugia artroscopica que recidivaron, en 6 se reparo el labrum mediante artroscopia, en 4 mediante reparacion abierta y plicatura capsular, y en 2 mediante trasferencia de coracoides. En los 2 casos de cirugia abierta se realizo una cirugia de trasferencia de coracoides. Las puntuaciones obtenidas en la escala de Constant en el hombro intervenido fueron excelente/buena en el 64% de los pacientes. Conclusiones Aunque las tecnicas de estabilizacion primaria abierta y/o artroscopica se han perfeccionado mucho, el porcentaje de recurrencia no resulta nada despreciable. De ahi la importancia de establecer un protocolo quirurgico de actuacion como existe para la indicacion quirurgica de una estabilizacion primaria. Podemos afirmar que los resultados funcionales obtenidos tras la cirugia de revision resultan satisfactorios para las elevadas demandas funcionales que presentan este tipo de pacientes.

The electronic transport properties of a point-contact system formed by a single Co atom adsorbed on Cu (100) and contacted by a copper tip is evaluated in the presence of intra-atomic Coulomb interactions and spin-orbit coupling. The calculations are performed using equilibrium Green's functions evaluated within density functional theory completed with a Hubbard U term and spin-orbit interaction, as implemented in the Gollum package. We show that the contribution to the transmission between electrodes of spin-flip components is negative and scaling as λ/Δ where λ is the SOC and Δ the Co atom-electrode coupling. Hence, due to this unfavorable ratio, SOC effects in transport in this system are small. However, we show that the spin-flip transmission component can increase by 2 orders of magnitude depending on the value of the Hubbard U term. These effects are particularly important in the contact regime because of the prevalence of d-electron transport, while in the tunneling regime, transport is controlled by the sp-electron transmission, and results are less dependent on the values of U and SOC. Using our electronic structure and the elastic transmission calculations, we discuss the effect of U and SOC on the well-known Kondo effect of this system., We gratefully acknowledge support from MINECO (Grant No. MAT2015-66888-C3-2-R), FEDER funds, the CCT-Rosario Computational Center, and CONICET.

Introduction and objective Reverse total shoulder arthroplasty in rotator cuff arthropathy patients, improves anteversion and abduction, but not rotational, outcomes. The main aim of this study is to determine its repercussions on daily life activities in our patients. Material and methods Between 2009 and 2011 we implanted 210 shoulder arthroplasties, 126 of them were reverse total shoulder arthroplasty in a rotator cuff arthropathy context. About 88% were women, with a mean age at time of surgery of 81 years, 95% were retired. The mean follow up was 53 months. The Constant scale, Visual Analogue Scale, Charlson Comorbidity Index, and range of motion were measured for each patient and whether they could manage 40 daily life activities by means of a new questionnaire, classifying them according to shoulder functional demand. Results and discussion Mean normalised by sex and age Constant value was 81.2%. Mean Visual Analogue Scale and Charlson Index were 3.56 and 1.69 respectively. Improvement in anteversion and abduction, not in rotational range of motion. Limitation was found in low and high functional demand activities in 20% and 51% respectively, especially those which involved internal rotation. Conclusion Reverse total shoulder arthroplasty treatment for RCA in the elderly, achieves adequate pain management and good functional outcomes. Nevertheless, an important risk of DLA limitation must be accepted in those which involve internal rotation or shoulder high functional demand.

Este artículo presenta las conclusiones de una investigación realizada durante la temporada audiovisual del año 2014 sobre la percepción del cine español por el público. Para obtener los datos cuantitativos del experimento se ha realizado la mayor encuesta sobre este tema desde el 2009 con un muestreo de n=1.244 entrevistados en todo el estado. Además, se ha completado esta investigación cuantitativa con datos de producción, ventas de entradas y entrevistas en profundidad a miembros de la industria cinematográfica. Por último, se ha realizado un análisis cualitativo en el cual se ha indagado en los gustos de los espectadores y en las estrategias que han realizado los productores, directores y otros sectores de la industria fílmica. El objetivo central de este trabajo era valorar cuál era la percepción que el público español tenía sobre el cine de su país. Nuestra investigación pone de manifiesto que existe un cambio de tendencia en la relación con las películas producidas en España. Una mayoría de los encuestados se muestran más cercanos a los largometrajes de la última temporada, dato que se reafirma con otras cifras de control (ventas de entradas en taquilla e impacto en la audiencia). This paper presents the conclusions of a study carried out during the audiovisual season of 2014 that was aimed at seeing the public’s perception of Spanish cinema. To obtain the quantitative data for the experiment, a field survey has been carried out, the mayor on this issue since 2009, with a total sampling of n=1244 people surveyed all over the country. Besides, this quantitative study has been backed up with further data from production, ticket sales and in-depth interviews to members of the film industry. Finally, a qualitative analysis has been carried out to delve into two further aspects: the audience’s tastes and the strategies used by film producers, film directors and other sectors within the film industry. The central aim of this study was to assess what was the perception of the Spanish public on their cinema. Our study reveals that regarding the films produced in Spain a change of trend has occurred. A majority of the people surveyed seem to feel closer and keen on the films of the last season, this being a conclusion reaffirmed with other control data, such as box office sales and impact on the audience.

Using the contribution of web pages related to flm industry in Spain in the image they project, with the purpose of eventually assessing whether there is an adequate usage of these online resources in order to improve the Spanish Cinema perception in Spain, across a qualitative analysis of the most relevant web sites, which was making the results more complete obtained on having be applied to the totality of selected web sites. We have come to the conclusion that there is hardly any interest, or virtually none, in watching over a image that may increase the public’s interest in the Spanish flm industry.; A partir de la contribución que realizan las páginas web relacionadas con el sector cinematográfco en España a la imagen que proyectan, se trata de valorar si existe una buena utilización de estos recursos online para mejorar la percepción del cine que se produce en el estado español, a través del análisis cualitativo de los sitios web más relevantes, que hiciera más completos los resultados obtenidos al aplicarse a la totalidad de sitios web seleccionados. Concluimos que existe poco o casi nulo interés por cuidar una imagen que pudiera hacer crecer el interés del público por la industria cinematográfica española.; Espainiako zinemagintzaren sektoreko webguneek espainiar zinemaren inguruko iritziari egiten dioten ekarpena oinarri hartu da ikusteko ea behar bezala erabili diren sareko baliabide horiek herritarrek Espainiako estatuan ekoizten den zinemari buruz duten iritzia hobetzeko. Horretarako, webgunerik garrantzitsuenen azterketa kualitatiboa egin da, hautatutako webgune guztien azterketarekin batera emaitza osoagoak lortu ahal izateko. Bada, ondorioztatu dugu ez dagoela interesik edo oso interes gutxi dagoela ikusleen artean Espainiako zinemagintzaren aldeko iritzia hobetu lezakeen irudia zaintzeko.

Background The aim of this study was to describe the fracture patterns of capitellum coronal fractures and to evaluate the complications and functional and radiographic outcomes of open reduction and internal fixation in patients older than 65 years. Methods A retrospective study of 23 patients with a mean follow-up of 48 months (36-105) was performed. Fractures were classified according to the Dubberley classification. All patients were evaluated by the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results Three patients were lost to follow-up. There were 16 type 1 and 4 type 2 fractures. The mean age was 71 years (66-79), and 65% were women. The mean MEPI score was 92 (60-100), and the mean DASH score was 9 (0-75). Either a concomitant fracture or an elbow dislocation was present in 50% of the patients. Mean sagittal plane range of motion at last follow-up was 122° ± 8°, with lower extension in type 2 and worse scores on MEPI (91 vs. 97) and DASH (3 vs. 0) scales. Placement of the screws in the posteroanterior direction was associated with better range of motion in flexion (130° vs. 122°) and better outcomes in functional scores (MEPI, 97 vs. 89; QuickDASH, 0 vs. 4). Complications were post-traumatic osteoarthritis in 3 patients, avascular necrosis in 1 patient, and heterotopic ossification in 5 patients. One patient required reoperation. Conclusions Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. Open reduction and internal fixation with cannulated screws allow stable fixation and provide satisfactory functional results with a lower complication rate.

Reverse shoulder arthroplasty (RSA) in fractures is especially indicated in patients of advanced age, although the influence of age on functional outcomes, health-related quality of life (HRQoL) and complication rate is unknown. We hypothesized that complication rate would decrease in the geriatric population because of their reduced activity, improving the perceived HRQoL.Retrospective study of 42 patients with proximal humeral fractures treated with RSA, divided into two groups:80 years (80y)(n = 16) and ≥80 years (≥80y)(n = 26). The assessment tools used were radiological images (functional outcome) with the Constant-Murley score(CMS); disabilities of the arm, shoulder and hand (DASH) score; and HRQoL with the EQ-5D index. Mean follow-up time was 32.6 months.Mean CMS adjusted for age and sex (R-CMS) was 68 % ± 29 %. Patients in the ≥80y group had a lower total CMS, 33 vs 64 (p = 0.027). Mean active range of motion at 24 months80y/≥80y was: forward flexion: 126°/110°; abduction: 117°/105°; external rotation: 22°/20°; and internal rotation: L3/sacrum. Mean EQ-VAS was 74 ± 16 in the80y group, and 63 ± 12.6 in the ≥80y group. Mean DASH was 29.5 ± 9.2. The EQ-5D "self-care" item in the80y group was the most affected. The "pain/discomfort" item was lower for the two age groups than for the reference population. There were 9.5 % complications: one prosthesis dislocation, one periprosthetic fracture and two surgical wound haematoma.Our results indicate that age is a critical factor for RSA success. Lower functional outcomes have been obtained in patients older than 80y, although the EQ-5D results in our sample were similar or even better than the referred population.Level III.

La figura de la mujer ha sido, desde siempre, el referente principal de la comunicación publicitaria por dos razones principales: primero como destinataria de los mensajes comerciales, al concebir que es la máxima compradora de bienes y servicios, y segundo como figu­ rante, porque su presencia visual permite comunicar una serie de situaciones que ayudan a entender de manera sencilla lo que se quiere comunicar. The woman's figure has been the relating one main of the advertising communication for two main reasons: first as addressee of the commercial messages, when understanding that it is the maximum buyer of goods and services, and second as figurant, because their visual presence allows to communicate a series of situations that help to understand in a simple way what wants to say.

Objectives: To determine the percentage of physicians who use clinical practice guidelines in our center, their motives, the type of guidelines they use, their opinion of these guidelines, and how they are evaluated. Material and methods: A survey of 161 physicians from 32 clinical specialties was performed. The questionnaire contained 17 closed questions and 1 open question referring to the use of clinical practice guidelines. Results: Seventy-eight physicians (48.4%) from 30 specialties responded. Of these, 38 (48.7%) reported that they never or infrequently follow clinical practice guidelines, 61 (78.2%) believe that guidelines reduce variability, 64 (82%) believe that they improve healthcare quality, 31 (39.7%) believe that guidelines are influenced by the pharmaceutical industry, and 60 (76.9%) consider that creating their own guidelines is useful. Of the 40 physicians (51.3%) who use guidelines, 35 (87.5%) do so to improve clinical care, 21 (52.5%) use the guidelines of the medical specialty societies, 5 (12.5%) use their own guidelines and 14 (35%) use both. In most departments, guidelines are seldom evaluated or they are evaluated on the basis of individual opinion. Conclusions: A significant percentage of our physicians does not usually employ clinical practice guidelines, although most physicians consider them to be useful. The physicians who habitually use them do so to improve healthcare quality and usually follow those of the medical specialty societies. Forty percent believe that guidelines are influenced by the pharmaceutical industry. Most physicians believe that creating their own guidelines is useful. Guidelines are not used homogeneously nor are they properly evaluated.

Este artículo es un resumen de una investigación sobre la situación de la promoción, distribución y exhibición cinematográfica en España. Abordamos las nuevas formas de promoción y exhibición y el nuevo modelo de espectador/audiencia en el mundo digital que nos rodea.

First-principles calculations are performed to characterize the NO adsorption on large carbonaceous clusters modeling the surface of soot. Adsorption on the face and on the edges of perfect and defective clusters is considered in the calculations. It is shown that the first situation corresponds to physisorption and requires taking into account long-range dispersion interactions in the calculations. In contrast, interaction of NO with the unsaturated edge of a defective cluster leads preferentially to a C-N rather than to a C-O chemical binding. This indicates that soot may be an efficient sink for NO in the troposphere only if it contains a high number of unsaturated carbon atoms. From a more fundamental point of view, this study also clearly evidences that quantum calculations have to be carefully conducted when considering the interaction between radical species and carbonaceous surfaces. Problems encountered with the choice of the functional used in density functional theory approaches as well as with the size of the basis set, spin multiplicity, and spin contamination have to be systematically addressed before any relevant conclusion can be drawn.