Summary Objective Determining the relation between acetabular coverage, especially overcoverage which may lead to pincer impingement, and development of osteoarthritis (OA) of the hip. Design From a ...prospective cohort study of 1,002 individuals with symptoms of early OA (Cohort Hip and Cohort Knee, CHECK), 720 participants were included. Standardized anteroposterior pelvic radiographs and false profile lateral radiographs were obtained at baseline and 5 years follow-up. Acetabular undercoverage (mild dysplasia) and overcoverage (pincer deformity) were measured by a centre edge angle of <25° and >40° respectively in both radiographic views. The strength of association between those parameters at baseline and development of incident OA (Kellgren and Lawrence (K&L) grade >2 or total hip replacement), or joint space narrowing within 5 years was expressed in odds ratio (OR) adjusted for K&L grade, age, body mass index (BMI), and sex using generalized estimating equations. Results At baseline, 76% of the included hips had no signs of radiographic OA (K&L = 0) whereas 24% had doubtful OA (K&L = 1). Within 5 years, 7.0% developed incident OA. Acetabular dysplasia was significantly associated with development of incident OA with ORs between 2.62 (95% confidence interval (CI) 1.44–4.77) and 5.45 (95% CI 2.40–12.34), dependent on the radiographic view. A pincer deformity was not associated with any outcome measure, except for a significantly protective effect on incident OA when a pincer deformity was present in both radiographic views OR 0.34 (95% CI 0.13–0.87). Conclusion Acetabular dysplasia was significantly associated with development of OA. However, a pincer deformity was not associated with OA, and might even have a protective effect on its development, which questions the supposed detrimental effect of pincer impingement.
The flux of very high-energy neutrinos produced in our Galaxy by the interaction of accelerated cosmic rays with the interstellar medium is not yet determined. The characterization of this flux will ...shed light on Galactic accelerator features, gas distribution morphology and Galactic cosmic ray transport. The central Galactic plane can be the site of an enhanced neutrino production, thus leading to anisotropies in the extraterrestrial neutrino signal as measured by the IceCube Collaboration. The ANTARES neutrino telescope, located in the Mediterranean Sea, offers a favorable view of this part of the sky, thereby allowing for a contribution to the determination of this flux. The expected diffuse Galactic neutrino emission can be obtained, linking a model of generation and propagation of cosmic rays with the morphology of the gas distribution in the Milky Way. In this paper, the so-called “gamma model” introduced recently to explain the high-energy gamma-ray diffuse Galactic emission is assumed as reference. The neutrino flux predicted by the “gamma model” depends on the assumed primary cosmic ray spectrum cutoff. Considering a radially dependent diffusion coefficient, this proposed scenario is able to account for the local cosmic ray measurements, as well as for the Galactic gamma-ray observations. Nine years of ANTARES data are used in this work to search for a possible Galactic contribution according to this scenario. All flavor neutrino interactions are considered. No excess of events is observed, and an upper limit is set on the neutrino flux of 1.1 (1.2) times the prediction of the “gamma model,” assuming the primary cosmic ray spectrum cutoff at 5 (50) PeV. This limit excludes the diffuse Galactic neutrino emission as the major cause of the “spectral anomaly” between the two hemispheres measured by IceCube.
In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a ...beneficial effect on functional outcome is lacking.
We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified prognostic factors. The adjusted common odds ratio measured the likelihood that intraarterial treatment would lead to lower modified Rankin scores, as compared with usual care alone (shift analysis).
We enrolled 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The mean age was 65 years (range, 23 to 96), and 445 patients (89.0%) were treated with intravenous alteplase before randomization. Retrievable stents were used in 190 of the 233 patients (81.5%) assigned to intraarterial treatment. The adjusted common odds ratio was 1.67 (95% confidence interval CI, 1.21 to 2.30). There was an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2) in the rate of functional independence (modified Rankin score, 0 to 2) in favor of the intervention (32.6% vs. 19.1%). There were no significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage.
In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe. (Funded by the Dutch Heart Foundation and others; MR CLEAN Netherlands Trial Registry number, NTR1804, and Current Controlled Trials number, ISRCTN10888758.).
To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively.
We reviewed high level athletes with an anterior cruciate ...ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury.
In total 50 patients were pair-matched.
We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.
We conclude that the instability repair using a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.
Abstract
We report the discovery of four Fast Radio Bursts (FRBs) in the ongoing SUrvey for Pulsars and Extragalactic Radio Bursts at the Parkes Radio Telescope: FRBs 150610, 151206, 151230 and ...160102. Our real-time discoveries have enabled us to conduct extensive, rapid multimessenger follow-up at 12 major facilities sensitive to radio, optical, X-ray, gamma-ray photons and neutrinos on time-scales ranging from an hour to a few months post-burst. No counterparts to the FRBs were found and we provide upper limits on afterglow luminosities. None of the FRBs were seen to repeat. Formal fits to all FRBs show hints of scattering while their intrinsic widths are unresolved in time. FRB 151206 is at low Galactic latitude, FRB 151230 shows a sharp spectral cut-off, and FRB 160102 has the highest dispersion measure (DM = 2596.1 ± 0.3 pc cm−3) detected to date. Three of the FRBs have high dispersion measures (DM > 1500 pc cm−3), favouring a scenario where the DM is dominated by contributions from the intergalactic medium. The slope of the Parkes FRB source counts distribution with fluences >2 Jy ms is $\alpha =-2.2^{+0.6}_{-1.2}$ and still consistent with a Euclidean distribution (α = −3/2). We also find that the all-sky rate is $1.7^{+1.5}_{-0.9}\times 10^3$FRBs/(4π sr)/day above ${\sim }2{\rm \, }\rm {Jy}{\rm \, }\rm {ms}$ and there is currently no strong evidence for a latitude-dependent FRB sky rate.
To assess whether three-dimensional imaging of the Achilles tendon by ultrasonographic tissue characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons.
Case-control ...study.
Sports Medical Department of the Hague Medical Centre.
Twenty-six tendons from patients with chronic midportion Achilles tendinopathy were included. The "matched" control group consisted of 26 asymptomatic tendons.
Symptomatic and asymptomatic tendons were scanned using the UTC procedure. One researcher performed the ultrasonographic data collection. These blinded data were randomised, and outcome measures were determined by two independent observers.
The raw ultrasonographic images were analysed with a custom-designed algorithm that quantifies the three-dimensional stability of echo patterns, qua intensity and distribution over contiguous transverse images. This three-dimensional stability was related to tendon structure in previous studies. UTC categorises four different echotypes that represent (I) highly stable; (II) medium stable; (III) highly variable and (IV) constantly low intensity and variable distribution. The percentages of echo-types were calculated, and the maximum tendon thickness was measured. Finally, the inter-observer reliability of UTC was determined.
Symptomatic tendons showed less pixels in echo-types I and II than asymptomatic tendons (51.5% vs 76.6%, p<0.001), thus less three-dimensional stability of the echo pattern. The mean maximum tendon thickness was 9.2 mm in the symptomatic group and 6.8 mm in the asymptomatic group (p<0.001). The Intraclass Correlation Coefficient (ICC) for the interobserver reliability of determining the echo-types I+II was 0.95. The ICC for tendon thickness was 0.84.
UTC can quantitatively evaluate tendon structure and thereby discriminate symptomatic and asymptomatic tendons. As such, UTC might be useful to monitor treatment protocols.
A search for cosmic neutrino sources using the data collected with the ANTARES neutrino telescope between early 2007 and the end of 2015 is performed. For the first time, all neutrino ...interactions-charged- and neutral-current interactions of all flavors-are considered in a search for point-like sources with the ANTARES detector. In previous analyses, only muon neutrino charged-current interactions were used. This is achieved by using a novel reconstruction algorithm for shower-like events in addition to the standard muon track reconstruction. The shower channel contributes about 23% of all signal events for an E−2 energy spectrum. No significant excess over background is found. The most signal-like cluster of events is located at (α,δ)=(343.8°,23.5°) with a significance of 1.9σ. The neutrino flux sensitivity of the search is about E2dΦ/dE=6×10−9 GeV cm−2 s−1 for declinations from −90° up to −42°, and below 10−8 GeV cm−2 s−1 for declinations up to 5°. The directions of 106 source candidates and 13 muon track events from the IceCube high-energy sample events are investigated for a possible neutrino signal and upper limits on the signal flux are determined.
A search for muon neutrinos originating from dark matter annihilations in the Sun is performed using the data recorded by the ANTARES neutrino telescope from 2007 to 2012. In order to obtain the best ...possible sensitivities to dark matter signals, an optimisation of the event selection criteria is performed taking into account the background of atmospheric muons, atmospheric neutrinos and the energy spectra of the expected neutrino signals. No significant excess over the background is observed and 90% C.L. upper limits on the neutrino flux, the spin-dependent and spin-independent WIMP-nucleon cross-sections are derived for WIMP masses ranging from 50 GeV to 5 TeV for the annihilation channels WIMP+WIMP→bb¯,W+W− and τ+τ−.
Using data recorded with the ANTARES telescope from 2007 to 2015, a new search for dark matter annihilation in the Milky Way has been performed. Three halo models and five annihilation channels, ...WIMP+WIMP→bb¯,W+W−,τ+τ−,μ+μ− and νν¯, with WIMP masses ranging from 50 GeVc2 to 100 TeVc2, were considered. No excess over the expected background was found, and limits on the thermally averaged annihilation cross-section were set.
Purpose
The aim of this study was to (1) investigate whether radiographic and clinical parameters, which influence how stresses during sporting activities act on the proximal femur, are associated ...with cam morphology or (2) precede cam morphology development.
Methods
Young male football players participated at baseline (
n
= 89, 12–19 years of age), 2.5-year (
n
= 63) and 5-year follow-up (
n
= 49). Standardized anteroposterior pelvic and frog-leg lateral radiographs were obtained at each time-point. Cam morphology was quantified by an alpha angle ≥ 60°, and large cam morphology ≥ 78°. The neck–shaft angle (NSA), epiphyseal extension (EE), lateral center–edge angle (LCEA) and hip internal rotation (IR) were also measured. Cross-sectional associations between NSA, EE, LCEA and IR and (large) cam morphology were studied at all time-points. To study whether these variables preceded cam morphology development, hips without cam morphology at baseline were studied prospectively.
Results
A lower NSA, a higher EE and limited IR were consistently associated with cam morphology at all three time-points. These differences were more pronounced in hips with large cam morphology. No association between cam morphology and the LCEA was found. None of the parameters studied preceded cam morphology development.
Conclusion
Cam morphology developed simultaneously with a varus orientation, growth plate extension towards the femoral neck and limited hip internal rotation. These parameters did not precede cam morphology development. The hip parameters studied cannot be used to identify individuals at risk of developing cam morphology.
Level of Evidence:
Level II.
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