Luxación esternoclavicular posterior: a propósito de un caso y revisión de la literatura

La luxación esternoclavicular posterior es una patología poco frecuente. Se presenta sobre todo en varones jóvenes asociada a traumatismos de alta energía. Puede presentar complicaciones potencialmente letales por compresión de estructuras mediastínicas, por lo que es necesario su reducción urgente. El diagnóstico radiográfico puede ser difícil debido a la superposición de estructuras, siendo de gran utilidad la TC para determinar el tipo y grado de desplazamiento, así como la relación anatómica con las estructuras mediastínicas. Se presenta el caso de un paciente varón, de 23 años de edad, que presentó una luxación esternoclavicular posterior traumática aguda tras accidente de tráfico en el que se consiguió la reducción cerrada mediante manipulación bajo anestesia general y posterior inmovilización antiálgica durante 3 semanas, sin objetivarse inestabilidad esternoclavicular posterior que obligase a más procedimientos. Se realiza una revisión de la literatura médica al respecto de esta patología.Posterior sternoclavicular dislocation is a rare disease. It occurs mainly in young men associated with high-energy trauma. It can be life-threatening due to compression of mediastinal structures, so its reduction is urgently needed. The radiographic diagnosis can be difficult because of overlapping structures, CT is very helpful to determine the type and degree of displacement and the anatomic relationship with the mediastinal structures. We present the case of a male patient, aged 23, with an acute traumatic posterior sternoclavicular dislocation after accident, in which closed reduction was achieved by manipulation under general anesthesia, followed by analgesic immobilization for 3 weeks resulting in sternoclavicular healing without instability, so no more procedures were needed. A literature review is presented regarding to this case

Lesiones en el manguito rotador tras luxación anterior de hombro en pacientes mayores de 40 años.

Se ha realizado un estudio prospectivo de la evolución de 32 luxaciones anteriores de hombro en pacientes de más de 40 años con el objetivo de establecer la incidencia, localización y tipo de rotura del manguito rotador a causa de la luxación, conocer evolución clínica y establecer los criterios clínicos que nos permitan sospechar una rotura del manguito rotador, sin necesidad de recurrir a resonancia magnética (RM) de entrada. Los pacientes fueron sometidos a estudio mediante RM, clasificando las lesiones observadas en cinco grados en función de la extensión de la rotura, siendo el grupo 1 la integridad del manguito. El 90% de los casos presentó una rotura del manguito rotador asociada a la luxación. Tras un periodo de rehabilitación se demostró una diferencia significativa en la recuperación de la abducción en los pacientes con manguito íntegro, siendo un signo clínico de importancia para valorar el estado del manguito rotador.A prospective study of the evolution of 32 anterior dislocations of the shoulder in patients older than forty years has been done with the objective of establishing the incidence, location and kind of tear caused by the dislocation, to know the evolution and to establish the clinical parameters that allow us to suspect an injury of the rotator cuff without the help of magnetic resonance (MR) in the beginning. All the patients were studied with MR, doing a classification of the tears in five degrees, depending on the extension of the tears, being the group 1 the integrity of the rotator cuff. In 90% of the cases a rotator cuff tear has been found to be associated with the dislocation. After the rehabilitation, a significative difference in the recovery of the abduction has been demonstrated in the patients with integrity of the rotator cuff, being an important clinical sign to know the state of the rotator cuff

Effectiveness of dry needling for headache: A systematic review.

Introducción El uso de tratamientos no farmacológicos en pacientes con cefalea, como la punción seca (PS), está asociado a una baja morbimortalidad y a un bajo coste sanitario. Algunos han demostrado utilidad en la práctica clínica. El objetivo de esta revisión fue analizar el grado de evidencia de la efectividad de la PS en la cefalea. Métodos Revisión sistemática de ensayos clínicos aleatorizados sobre cefalea y PS en las bases de datos biomédicas PubMed, Web of Science, Scopus y PEDro. Se evaluó la calidad de los estudios incluidos mediante la escala PEDro por 2 evaluadores de forma independiente. Resultados De un total de 136 estudios, se seleccionaron 8 ensayos clínicos publicados entre 1994 y 2019, incluyendo en total 577 pacientes. Dos estudios evaluaron pacientes con cefalea cervicogénica, otros 2, pacientes con cefalea tensional, y otro, pacientes con migraña. Los otros 3 estudios evaluaron pacientes con cefalea de características mixtas (tensional/migraña). La calidad de los estudios incluidos osciló entre «baja» (3/10) y «alta» (8/10). La eficacia de la PS sobre los episodios de cefalea fue similar a la de los tratamientos con los que se comparó. No obstante, obtuvo mejoras significativas respecto a variables funcionales y de sensibilidad. Conclusiones La punción seca es una técnica a considerar para el tratamiento de las cefaleas en la consulta, pudiendo utilizarse de forma rutinaria, bien de forma aislada, bien en combinación con terapias farmacológicas. Introduction Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache. Methods We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers. Results Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes. Conclusions Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments

Effects of ischemic compression on trigger points in the first dorsal interosseous muscle in patients with thumb carpometacarpal osteoarthritis

Background: Thumb carpometacarpal osteoarthritis (CMC OA) is a common disorder that interferes with the ability to perform the activities of daily life. The purpose of this study was to investigate the immediate effects of ischemic compression on myofascial trigger points (MTrPs) in the first dorsal interosseous (FDI) muscle in patients with the diagnosis of thumb CMC OA. Methods: In a quasi-experimental clinical trial, thirty-one patients, 87% female (age: 82 ± 9.4 years), with thumb CMC OA, were consecutively assigned to either an experimental treatment that included the ischemic compression of the FDI MTrP or a sham treatment of the FDI MTrP for one session. The main outcome considered in the study was the pressure pain threshold (PPT). Measurements were taken pre-and post-treatment and at a 1-week follow-up period. Results: The PPT over the right (affected) FDI muscle showed statistically significant differences between groups at 1-week follow up (F = 3.518; p = 0.04) in favor of the experimental group. Conclusions: The ischemic compression of FDI-MTrPs is an appropriate part of a multimodal treatment to decrease local pain sensitivity in patients with CMC OA

Bifocal design procedure for dual-reflectarray antennas in offset configurations

This letter presents a new bifocal design procedure for dual-reflectarray antennas (DRAAs) in offset configurations. The technique starts by considering an axially symmetric geometry with the reflectarrays placed in parallel planes, which allows the rotation of a two-dimensional bifocal design around the symmetry axis. To reach a more compact configuration and to obtain smoother phase distributions, the reflectarrays are tilted and their phases are adjusted by means of a ray-tracing routine. The technique has been validated by numerical simulations through the comparison with a previous center-fed dual-reflectarray prototype. Finally, the simulations of an offset DRAA with tilted reflectarrays are presented, providing 0.56° beam spacing at 20 GHz for multispot satellite applications in Ka-band.Agencia Estatal de Investigación | Ref. TEC2016-75103-C2-1-REuropean Space Agency | Ref. 4000117113/16/NL/A

The Area of Pressure-Induced Referred Pain Is Dependent on the Intensity of the Suprathreshold Stimulus: An Explorative Study

Objective: To investigate the pain referral area (number of pixels) and extent (vector length) as elicited from increasing intensities of pressure-induced pain at the shoulder. Design: Cross-sectional design. Setting: Clinical laboratory setting. Participants: Twenty-two healthy men and women participated in two experimental sessions. Methods: Delayed onset of muscle soreness (DOMS) was induced in the dominant shoulder and assessed 24 hours later. Participants rated the level of DOMS on a 6-point Likert scale. Four different intensities (pressure pain threshold [PPT]+20%, PPT+30%, PPT+40%, and PPT+50%) were applied to the infraspinatus in a randomized, balanced fashion for 60 seconds from low to high intensity or vice versa. The resulting location, area, and extent of referred pain as drawn by the participants on a digital body chart were extracted and expressed in pixels. The extent of pain was defined as the vector length extending from the ipsilateral earlobe to the most distal location of the pain. Results: The referred pain area from PPT+20% was smaller than PPT+30%, PPT+40%, and PPT+50%. The extent of referred pain did not differ between the pressure pain intensities. Conclusions: Pressure intensity at PPT+30%, but no more, produces the greatest referred pain area as compared with the traditional pressure intensity of PPT+20%. Thus, the intensity of PPT+30% may be ideal for exploring the mechanisms of referred pain. The extent of the pain represents an independent expression of the intensity of the provoking stimulus and may be more closely related to the location of the stimulus

Tailoring the magnetocaloric, magnetic and thermal properties of Dy6(Fe,Mn)X2 intermetallics (X==Sb, Te, Bi)

[EN] The structural, magnetic, magnetocaloric (MCE) and thermal properties of seven Fe2P-type Dy6(Fe,Mn)X2 (X=Sb, Bi, Te) intermetallics (space group P 6 over line 2 m, N 189, hP9) have been experimentally studied. They present a paramagnetic to ferromagnetic transition (in the range 129-370 K), followed, as temperature decreases, by a spin-reorientation one (from 52 to 170 K) and a ground magnetic state at 2 K with anti-ferromagnetic components. This state turns into a ferromagnetic state when a magnetic field is applied. The critical exponents beta,gamma,delta related to the PM-FM transition point to long range order interactions but in most compounds their values severely deviate from the Mean Field class, presenting an unconventional critical behavior, probably due to magnetocrystalline anisotropies. This magnetic complexity has the consequence that in every intermetallic three MCE effects arise: Two direct magnetocaloric effects (DMCE) with a table-like effect in between (from 40 K to more than 400 K), with moderate values of the magnetic entropy maxima (up to 6.9 J/kgK for 140 Delta H = 5 T, with the tableau in-between being around 4 J/kgK, for Dy6FeSb2 and Dy6FeSbTe). The calculation of the Thermal Average Entropy Change allows to place the properties of two compounds (Dy6FeSb2 and Dy6FeSbTe) close to other rare earth based high entropy alloys described in literature. The seven compounds present a relevant third MCE, inverse, below 25 K, with a value as high as 17.8 J/kgK (140 Delta H = 5 T) for Dy6FeSbTe. The maximum of the magnetic entropy change at the Curie tem-perature has been shown to scale with the critical exponents found and universal curves have been built. Finally, the thermal diffusivities in the range of the DMCE have been measured, with the result that they present good values (between 1 and 3 mm2/s) to be used in real magnetocaloric refrigeration systems.This work has been supported by Universidad del Pais Vasco UPV/EHU (project GIU19/058) and the Russian Fund for Basic Research (project No 20-03-00209-a). A. Herrero thanks the Department of Education of the Basque Government as grantee of the programme "Programa Predoctoral de Formacion de Personal Investigador No Doctor". The authors thank for technical and human support provided by SGIker of UPV/EHU, specially the fruitful discussions with Dr. I. Orue

Selecting optimal R6TX2 intermetallics (R = Gd, Tb, Dy; T = Mn, Fe, Co, Ni; X = Sb, Te) for magnetic refrigeration

A complete experimental study of the physical properties playing a relevant role on magnetic refrigeration application (structural, magnetic, magnetocaloric and thermal) has been performed over nine selected Fe2P-type R6TX2 (R= Gd, Tb, Dy; T= Mn, Fe, Co, Ni; X=Sb, Te) intermetallic compounds, to work close to room temperature. Two magnetic phase transitions are present on these materials: a paramagnetic to ferromagnetic transition in the range 182-282 K and a spin reorientation transition in the range 26-76 K. As a consequence, two peaks related to a direct magnetocaloric effect (DMCE) appear in the magnetic entropy change, generating a wide table-like plateau region in between both peaks, which is required to improve the efficiency of refrigerators following an Ericsson cycle. The highest magnetic entropy peak value for μ0ΔH = 5 T is found for Tb2Dy4FeSb2, with 7.72 J/kg K around 182 K. For the same applied field the other compounds show moderate values around room temperature (2.88-4.53 J/Kg K). However, the superposition of the two peaks results in huge refrigerant capacity values, up to RCFWHM(5 T)=1103.04 J/kg in the case of Tb2Dy4FeSb2. The thermal diffusivity, effusivity conductivity and specific heat have been measured at room temperature, and the temperature dependence of the former has been obtained around the relevant magnetic phase transition region, with values in the range 1.3-2.3 mm2/s, which are good for magnetic refrigerators under high working frequencies. The study is completed with a rigorous critical behavior analisis of the second order PM-FM transition. The critical exponent γ points to long range order interactions, in general, while β values are in the range (0.59-0.90), indicating a deviation from theoretical models as a reflection of the magnetic complexity in these compounds. The critical exponents have been used to confirm the scaling relations of magnetocaloric properties, and the scaling of refrigerant capacity (RC) values in materials presenting two magnetic phase transitions is addressed, concluding that for a correct scaling of RC the magnetic entropy change peak must be considered symmetric. The role of each atom on the properties of the compounds is discussed.This work was supported by Departamento de Educación del Gobierno Vasco (project IT1430-22) and the Russian Fund for Basic Research through the project no. 20-03-00209-a, as well as by an ICDD (International Centre for Diffraction Data) (USA) grant n 05-07

High optimization process for increasing the attenuation properties of acoustic metamaterials by means of the creation of defects

Copyright (2008) American Institute of Physics. This article may be downloaded for personal use only. Any other use requires prior permission of the author and the American Institute of Physics along with the following message: The following article appeared in “Romero García, V.; Sánchez Pérez, JV.; García-Raffi, LM.; Herrero Durá, JM.; S. Garcia-Nieto; Blasco Ferragud, FX. (2008). High optimization process for increasing the attenuation properties of acoustic metamaterials by means of the creation of defects. Applied Physics Letters. 93:2235021-2235023” and may be found at http://dx.doi.org/10.1063/1.3040317. Authors own version of final article on e-print serversAn improvement in the attenuation capabilities of acoustic metamaterials by means of the creation of defects is considered here as a multiobjective optimization problem. From this point of view, it is possible to define the optimum strategy in the creation of defects to achieve an important increase in acoustic attenuation in a predetermined range of frequencies. A powerful multiobjective optimization algorithm called evMOGA has been used to solve this problem. The study has been restricted to the case of a two-dimensional sonic crystal formed by rigid cylinders in air, the defects being vacancies in the initial structure.This work was partially supported by MEC (Spanish Government) and FEDER funds: Project Nos. 419DPI2005-07835 and MAT2006-03097 and Generalitat Valenciana Project Nos. GV06/026 and GV/2007/191.Romero García, V.; Sánchez Pérez, JV.; García-Raffi, LM.; Herrero Durá, JM.; García Nieto, S.; Blasco Ferragud, FX. (2008). High optimization process for increasing the attenuation properties of acoustic metamaterials by means of the creation of defects. Applied Physics Letters. 93(22):2235021-2235023. https://doi.org/10.1063/1.3040317S223502122350239322Fang, N., Xi, D., Xu, J., Ambati, M., Srituravanich, W., Sun, C., & Zhang, X. (2006). Ultrasonic metamaterials with negative modulus. Nature Materials, 5(6), 452-456. doi:10.1038/nmat1644Torrent, D., & Sánchez-Dehesa, J. (2008). Anisotropic mass density by two-dimensional acoustic metamaterials. New Journal of Physics, 10(2), 023004. doi:10.1088/1367-2630/10/2/023004Sánchez-Pérez, J. V., Caballero, D., Mártinez-Sala, R., Rubio, C., Sánchez-Dehesa, J., Meseguer, F., … Gálvez, F. (1998). Sound Attenuation by a Two-Dimensional Array of Rigid Cylinders. Physical Review Letters, 80(24), 5325-5328. doi:10.1103/physrevlett.80.5325Fokin, V., Ambati, M., Sun, C., & Zhang, X. (2007). Method for retrieving effective properties of locally resonant acoustic metamaterials. Physical Review B, 76(14). doi:10.1103/physrevb.76.144302Sanchez-Perez, J. V., Rubio, C., Martinez-Sala, R., Sanchez-Grandia, R., & Gomez, V. (2002). Acoustic barriers based on periodic arrays of scatterers. Applied Physics Letters, 81(27), 5240-5242. doi:10.1063/1.1533112Torrent, D., & Sánchez-Dehesa, J. (2007). Acoustic metamaterials for new two-dimensional sonic devices. New Journal of Physics, 9(9), 323-323. doi:10.1088/1367-2630/9/9/323Romero-García, V., Fuster, E., García-Raffi, L. M., Sánchez-Pérez, E. A., Sopena, M., Llinares, J., & Sánchez-Pérez, J. V. (2006). Band gap creation using quasiordered structures based on sonic crystals. Applied Physics Letters, 88(17), 174104. doi:10.1063/1.2198012Herrero, J. M., Blasco, X., Martínez, M., Ramos, C., & Sanchis, J. (2007). Non-linear robust identification of a greenhouse model using multi-objective evolutionary algorithms. Biosystems Engineering, 98(3), 335-346. doi:10.1016/j.biosystemseng.2007.06.004Kafesaki, M., & Economou, E. N. (1999). Multiple-scattering theory for three-dimensional periodic acoustic composites. Physical Review B, 60(17), 11993-12001. doi:10.1103/physrevb.60.11993Ehrgott, M., & Tenfelde-Podehl, D. (2003). Computation of ideal and Nadir values and implications for their use in MCDM methods. European Journal of Operational Research, 151(1), 119-139. doi:10.1016/s0377-2217(02)00595-7Coello Coello, C. A., Van Veldhuizen, D. A., & Lamont, G. B. (2002). Evolutionary Algorithms for Solving Multi-Objective Problems. Genetic Algorithms and Evolutionary Computation. doi:10.1007/978-1-4757-5184-