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Purpose: Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes. Methods: Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up. Results: Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27). Conclusions: The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results., Depto. de Cirugía, Fac. de Medicina, TRUE, pub, APC financiada por la UCM

Background and aim: Rotator cuff tears emerge in approximately 30% of the population over 60 years of age. Arthroscopic surgical treatment of these lesions is the treatment of choice, however, despite the improved repair techniques, the rate of re-tears ranges between 11 and 94%. Therefore, researchers seek to improve the biological healing process through the use of different alternatives such as mesenchymal stem cells (MSCs). Our objective is to evaluate the efficacy of a Cellular Therapy Drug made from allogeneic stem cells derived from adipose tissue in a rat model of chronic rotator cuff injury. Material and methods: The supraspinatus lesion was created in 48 rats for subsequent suturing at 4 weeks. MSCs in suspension were added to 24 animals after suturing, and HypoThermosol-FRS® (HTS) to 24 animals as a control group. Histology (Åström and Rausing scale) and the maximum load, displacement and elastic constant of the supraspinatus tendon were analyzed in both groups 4 months after the repair. Results: No statistically significant differences were found in the histological score comparing the tendons treated with MSCs with respect to the tendons treated with HTS (P=.811) nor in the results of maximum load (P=.770), displacement (P=.852) or elastic constant (P=.669) of the tendon in both groups. Conclusions: The addition of adipose-derived cells in suspension to the repair of a chronic cuff injury does not improve the histology or biomechanics of the sutured tendon., Instituto Carlos III, Depto. de Cirugía, Fac. de Medicina, TRUE, pub

Introduction: The purposes of this study were to analyze and compare the functional outcomes and radiological changes around the press-fit humeral components in two contemporary medialized reverse total shoulder arthroplasty (RTSA) systems at a minimum of 5-year follow-up. Materials and methods: Between December 2003 and December 2015, 249 consecutive RTSAs were performed at our hospital. Of these, 68 primary uncemented RTSA met our inclusion criteria. The Constant-Murley score (CMS), the modified Constant score, a visual analog scale (VAS) and active shoulder range of motion (ROM) were measured pre- and postoperatively. Radiological assessment was performed by plain radiographs at a minimum of 5 years postoperatively. Results: At a mean follow-up of 80.2 months, there was no significant difference (p = .59) between the postoperative functional scores and range of motion of the two groups (Delta Xtend and Lima SMR). Radiological data of stress-shielding were observed in 38 patients (55.9%) being slightly more frequent in the Lima SMR group (21 patients) than in the Delta Xtend group (17 patients) (p = .62). Conclusions: Our study shows that the good functional results are similar between the two uncemented RTSA systems used and that they do not depend on the presence of radiological changes (stress-shielding) in the humeral stem at a minimum 5-year follow-up., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

Introduction: The aim of our study is to evaluate the functional and mobility outcomes in patients who have undergone arthroscopic circumferential arthrolysis of the shoulder and to find out if there are differences in the results in relation to the patient's age. Materials and methods: This is a retrospective case series of patients with idiopathic adhesive capsulitis treated by arthroscopic 360º circumferential capsulotomy in lateral position and followed for a minimum of 2 years. Range of motion (ROM), functional outcomes using the Constant Score (CS), health-related quality of life outcomes with the EuroQol Five Dimensions tool (EQ-5D), pain using the Visual Analogue Scale (VAS). Results: A total of 26 shoulders were included, 10 men (41.7%) and 14 women (58.3%), with 2 patients being bilateral. The mean age was 48.64 ± 7.5 years, and the mean follow-up was 50.2 months. Postoperative ROM improved significantly compared to preoperative ROM (p < 0.05). Shoulder forward flexion improved by 38.6° (95%CI 22.3-54.9, p < 0.01), abduction by 35.2° (95%CI 17.6-52.8, p < 0.01) and external rotation by 21.9° (95%CI 12.8-30.9, p < 0.01 p < 0.01). Median internal rotation improved from buttock to T12 (p < 0.01). The mean improvement in CS was 54.3 ± 24.4 points (p < 0.01). The EQ-5D and VAS scores at the end of follow-up were 0.73 ± 0.23 and 2.73 ± 2.55, respectively. There were no statistical differences between young patients and patients aged 50 years or older in ROM or functional results. Conclusions: Patient age did not affect outcomes significantly, with patients older than 50 years showing similar results to younger patients., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

This article investigates the evolution of a kind of astronomic observatory -the radio telescope- that has been varying since its origin due to the advances in science and technology associated with the field of radio astronomy. The article raises the hypothesis that the origin of this branch of science produced a paradigm shift that leads to a transgression of the typology of the spaces for knowledge and observation of the cosmos. At the same time, it offers a new type of infrastructure that, due to its scale, establishes a new relationship with the landscape. It creates spaces of convergence between nature, technology and culture. A study of six of the most representative large-scale radio telescopes of their class is carried out. The research compares both the technical data and the formal aspects with the aim of reaching a series of conclussions that contribute to a better understanding of the types of space that radio telescopes produce in relation to the landscape and the human beings., Este artículo investiga acerca de la evolución de un tipo de observatorio astronómico –el radiotelescopio- que desde sus orígenes hasta la actualidad ha ido variando en base a los avances en la ciencia y la tecnología asociadas al campo de la radioastronomía. Se plantea la hipótesis de que el origen de esta rama de la ciencia supuso un cambio de paradigma que conlleva una transgresión de la tipología de los espacios dedicados al conocimiento y la observación del cosmos. Esta nueva clase de observatorio, al mismo tiempo ofrece un nuevo tipo de infraestructuras que, por su gran escala, establece una nueva relación con el paisaje, generando espacios de convergencia entre la naturaleza, la tecnología y la cultura.Se realiza un estudio de seis de los radiotelescopios de gran escala más representativos de su clase, comparando tanto los datos técnicos como los aspectos formales con el objetivo de obtener una serie de conclusiones que contribuyan a un mejor entendimiento de los tipos de espacio que estos producen en relación al paisaje y a los seres humanos.

La prótesis total invertida de hombro (PTIH) se diseñó inicialmente para el tratamiento de la artropatía del manguito rotador y debido al éxito obtenido, se ha extendido su indicación a múltiples procesos degenerativos y traumáticos del hombro. El trabajo que presentamos agrupa cuatro artículos publicados sobre diversos aspectos que giran en torno a la evolución en el uso de la PTIH. Los tres primeros estudios son trabajos retrospectivos que analizan diferentes indicaciones actuales de las prótesis invertidas de hombro: artrosis de hombro con defecto óseo glenoideo, rescate de osteosíntesis fallidas tras fractura proximal de húmero y fracturas desplazadas de la extremidad proximal del húmero. El primer estudio analiza las complicaciones, la tasa de consolidación y los resultados funcionales del uso de injerto óseo glenoideo (aloinjerto y autoinjerto)para la reconstrucción glenoidea en cirugía primaria o de revisión de PTIH. Se identificaron 20 pacientes intervenidos entre 2011 y 2014. La puntuación media de la escala de Constant mejoró de 30.7 ± 9,4 puntos a 51.3 ± 13.4 puntos. La tomografía axial computerizada (TAC) confirmó la consolidación del injerto en la glena en el 95% de los casos. No se encontraron diferencias estadísticamente significativas en el análisis de los resultados clínicos y radiográficos relacionados con la fuente del injerto. Hubo una tasa de complicaciones postoperatorias del 20%..., The reverse total shoulder arthroplasty (RTSA) was initially designed for the treatment of rotator cuff arthropathy and due to its success, its indication has been extended to multiple degenerative and traumatic processes of the shoulder The work that we present brings together four articles published on various aspects concerning the evolution of the use of the RTSA. The first three studies are retrospective works that analyze different current indications for RTSA: shoulder osteoarthritis with glenoid bone defect, salvage of failed osteosynthesis after proximal humerus fracture, and displaced fractures of the proximal humerus. The first study analyzes the complications, rate of healing, and functional results of the use of glenoid bone grafting (allograft and autograft) for glenoid reconstructionin primary or revision surgery of RTSA. Twenty patients who underwent surgery between 2011 and 2014 were identified. The mean Constant scale score improved from 30.7 ± 9.4 points to 51.3 ± 13.4 points. Computerized axial tomography confirmed graft consolidation in the glenoid in 95% of the cases. No statistically significant differences were found in the analysis of clinical and radiographic results related to the graft used. There was a 20% of postoperative complication rate...

Organic diradicals are envisioned as elementary building blocks for designing a new generation of spintronic devices and have been used in constructing prototypical field effect transistors and nonlinear optical devices. Open-shell systems, however, are also reactive, thus requiring design strategies to "protect" their radical character from the environment, especially when they are embedded in solid-state devices. Here, we report the persistence on a metallic surface of the diradical character of a diindeno[b,i]anthracene (DIAn) core protected by bulky end-groups. Our scanning tunneling spectroscopy measurements on single-molecules detected singlet-triplet excitations that were absent for DIAn species packed in assembled structures. Density functional theory simulations unravel that the molecular geometry on the metal substrate can crucially modify the value of the singlet-triplet gap via the delocalization of the radical sites. The persistence of the diradical character over metallic substrates is a promising finding for integrating radical-based materials into functional devices.

The synthesis of novel organic prototypes combining different functionalities is key to achieve operational elements for applications in organic electronics. Here we set the stage towards individually addressable magneto-optical transducers by the on-surface synthesis of optically active manganese-phthalocyanine derivatives (MnPc) obtained directly on a metallic substrate. We created these 2D nanostructures under ultra-high vacuum conditions with atomic precision starting from a simple phthalonitrile precursor with reversible photo-induced reactivity in solution. These precursors maintain their integrity after powder sublimation and coordinate with the Mn ions into tetrameric complexes and then transform into MnPcs on Ag(111) after a cyclotetramerization reaction. Using scanning tunnelling microscopy and spectroscopy together with DFT calculations, we identify the isomeric configuration of two bi-stable structures and show that it is possible to switch them reversibly by mechanical manipulation. Moreover, the robust magnetic moment brought by the central Mn ion provides a feasible pathway towards magneto-optical transducer fabrication. This work should trigger further research confirming such magneto-optical effects in MnPcs both on surfaces and in liquid environments.

Background: Accurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of fluoroscopy as a surgical assistance method. Methods: Prospective comparative study of 33 patients undergoing primary reverse shoulder arthroplasty during a 12-month period. Fifteen patients had a baseplate placed using the conventional "free hand" technique (control group), and 18 patients using intraoperative fluoroscopy assistance group, in a case-control design. Postoperative glenoid position was evaluated on postoperative Computed Tomography (CT) scan. Results: The mean deviation of version and inclination for fluoroscopy assistance vs. control group was 1.75° (0.675-3.125) vs. 4.2° (1.975-10.45) (p = .015), and 3.85° (0-7.225) vs. 10.35° (4.35-18.75) (p = .009). The distance from the central peg midpoint to the inferior glenoid rim (fluoroscopy assistance 14.61 mm/control 4.75 mm, p = .581) and the surgical time (fluoroscopy assistance 1.93 ± 0.57/control 2.18 ± 0.44 h, p = .400) showed no differences, with an average radiation dose of 0.45 mGy and fluoroscopy time of 14 s. Conclusions: Accurate axial and coronal scapular plane positioning of glenoid component is improved with intraoperative fluoroscopy at the cost of a greater radiation dose and without differences in surgical time. Comparative studies are needed to determine whether their use in relation to more expensive surgical assistance systems result in similar effectiveness.L evel of evidence : Level III, therapeutic study., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

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/Co-n/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).

Como sucedió con la sostenibilidad, las arquitecturas de la posproducción y del «hacer (casi) nada» no han logrado proponer un modelo arquitectónico alejado del paradigma imperante, el del crecimiento y la acumulación. Se propone, como alternativa, una familia de estrategias de proyecto agrupadas bajo el término «edición», menos centradas en la reutilización intelectual y más en la transformación pragmática de las preexistencias materiales. El desaparecido Building 20 del MIT, conocido por el excepcional ambiente de creatividad y experimentación que proliferó en él, se utiliza como sujeto de ensayo para aplicar estrategias de proyecto asociadas a tres modos de edición: la acción directa, el gizmo y el protocolo. A modo de manifiesto retroactivo, se proyectan nueve ficciones restitutivas relacionadas con nueve casos de estudio diferentes. Estas, en primer lugar, permiten hacer una reconstrucción especulativa del Building 20, del cual apenas existe documentación arquitectónica como para llevar a cabo una reconstrucción fidedigna. En segundo lugar, se demuestra la capacidad del edificio para asimilar exitosamente las transformaciones a las que se vio sometido durante su existencia. Y, finalmente, se prueba la universalidad de aplicación de una serie de estrategias de edición: estas pueden ser una alternativa crítica válida a la producción acumulativa como motor de la arquitectura. As with sustainability, the architectures of post-production and ‘doing (almost) nothing’ have failed to propose an architectural model that diverges from the prevailing paradigm of growth and accumulation. As an alternative, a set of project strategies grouped under the term ‘edition’ is proposed, less focused on intellectual reuse and more on the pragmatic transformation of material pre-existences. MIT’s now-disappeared Building 20, known for the exceptional atmosphere of creativity and experimentation that proliferated within its walls, is used as a trial subject to implement project strat

Durante muchos siglos, las viviendas tradicionales en Japón han sido un remarcable signo de identidad dentro de la cultura japonesa, tanto en su forma tangible como en la inteligible. Hoy en día estas siguen siendo un elemento fundamental para comprender la forma de vida japonesa pero sin embargo, la tecnología ha evolucionado y con ella, la sociedad. Debido a esto, la mentalidad y necesidades de las personas ha cambiado y es necesario que la arquitectura doméstica cambie junto con ellas. Existen muchas estrategias de diseño a la hora de proyectar un edificio o una vivienda. Los valores en los que se basan estas estrategias varían desde los puntos de vista japonés y occidental por lo que los fundamentos en los que se basan sus arquitecturas son bastante distintos. La herencia cultural es un factor fundamental para poder entender el presente y mirar hacia el futuro. Por ello, aunque el objeto de este estudio está enfocado de cara al futuro, se habla multitud de veces de obras y acciones acontecidas en el pasado. Lo que nos depara el mañana es incierto pero sí que podemos adelantarnos para que sea posible seguir un proceso de adaptación adecuado y eficiente. El metabolismo japonés se basa en estos principios por lo que juega un papel fundamental en este análisis. Este trabajo de investigación se centra en el desarrollo de estrategias fundamentales a partir del estudio de viviendas japonesas dotadas de un carácter experimental e innovador para poder generar herramientas útiles de cara al futuro, capaces de evolucionar a la vez que lo hace la tecnología y la sociedad. Estas casas, por tanto, pasan a ser laboratorios domésticos en los que se experimenta con los hábitats y las distintas formas de vivir.

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).

Depto. de Cirugía, Fac. de Medicina, TRUE, pub

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 superio, Depto. de Cirugía, Fac. de Medicina, TRUE, pub