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Objective The objective of the present work was to compare the measurement of acetabular component version on anteroposterior (AP) and on cross-table radiographs after total hip arthroplasty (THA). Methods Radiographs of 60 hips with a primary THA were selected. Version was calculated on the AP radiograph using the Lewinnek method and, on the cross-table, using the Woo and Morrey direct method. Results Mean and standard deviation (SD) were different on both radiographs, being 9.7° ± 5.5° on the AP, whereas in the cross-table the measurements were 20.6° ± 8.4° (p < 0.001). Minding our aim of 10°, the cross-table measurements were statistically different from it (p < 0.001), while the AP measurement did not differ (p = 0.716). Conclusion The present study showed that the best way to correctly evaluate the acetabular component positioning following a THA is by measuring anteversion and abduction on an AP radiograph after confirming, in a cross-table radiograph, that the component is not retroverted. Resumo Objetivo O objetivo do presente trabalho foi comparar a medição da versão do componente acetabular em radiografias em incidência anteroposterior (AP) e crosstable após artroplastia total do quadril (ATQ). Métodos Foram selecionadas radiografias de 60 quadris com ATQ primário. A versão foi calculada na radiografia AP usando o método de Lewinnek e, na cross-table, usando o método direto do Woo e Morrey. Resultados A média e o desvio padrão (DP) foram diferentes em ambas as radiografias, sendo 9,7° ± 5,5° no AP, enquanto na cross-table foram 20,6° ± 8,4° (p < 0,001). Considerando nosso objetivo de 10°, as medidas da cross-table foram estatisticamente diferentes dele (p < 0,001), enquanto a medição AP não diferiu (p = 0,716). Conclusão O presente estudo mostrou que a melhor maneira de avaliar corretamente o posicionamento do componente acetabular após uma ATQ é medindo a anteversão e a abdução em uma radiografia AP após confirmar, em uma radiografia cross-table, que o componente não é retrovertido.

Femoroacetabular impingement (FAI) is increasingly recognized as a risk factor for early hip degeneration in young active patients. The diagnosis depends on clinical examination and proper imaging that should be able to identify abnormal and sometimes subtle morphological changes. Labral tears and cartilage lesions rarely occur without underlying bone abnormalities. Surgical approaches to treat FAI are increasing significantly worldwide, even without a clearly defined consensus of what should be accepted as the standard imaging diagnosis for FAI morphology.Hip abnormalities encompass many variations related to the shape, size, and spatial orientation of both sides of the joint and can be difficult to characterize if adequate imaging is not available.This article presents a comprehensive review about the information orthopaedic surgeons need to know from radiologists to plan the most rational approach to a painful hip resulting from a mechanical abnormality.

Imaging assessment for the clinical management of femoroacetabular impingement (FAI) is controversial because of a paucity of evidence-based guidance and notable variability among practitioners. Hence, expert consensus is needed because standardised imaging assessment is critical for clinical practice and research. We aimed to establish expert-based statements on FAI imaging by using formal methods of consensus building. The Delphi method was used to formally derive consensus among 30 panel members from 13 countries. Forty-four questions were agreed upon, and relevant seminal literature was circulated and classified in major topics to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement (0–10). This is the second part of a three-part consensus series and focuses on ‘General issues’ and ‘Parameters and reporting’. Forty-seven statements were generated and group consensus was reached for 45. Twenty-five statements pertaining to ‘General issues’ (9 addressing diagnosis, differential diagnosis, and postoperative imaging) and ‘Parameters and reporting’ (16 addressing femoral/acetabular parameters) were produced. The available evidence was reviewed critically, recommended criteria for diagnostic imaging highlighted, and the roles/values of different imaging parameters assessed. Radiographic evaluation (AP pelvis and a Dunn 45° view) is the cornerstone of hip-imaging assessment and the minimum imaging study that should be performed when evaluating adult patients for FAI. In most cases, cross-sectional imaging is warranted because MRI is the ‘gold standard’ imaging modality for the comprehensive evaluation, differential diagnosis assessment, and FAI surgical planning. • Diagnostic imaging for FAI is not standardised due to scarce evidence-based guidance on which imaging modalities and diagnostic criteria/parameters should be used. • Radiographic evaluation is the cornerstone of hip assessment and the minimum study that should be performed when assessing suspected FAI. Cross-sectional imaging is justified in most cases because MRI is the ‘gold standard’ modality for comprehensive FAI evaluation. • For acetabular morphology, coverage (Wiberg’s angle and acetabular index) and version (crossover, posterior wall, and ischial spine signs) should be assessed routinely. On the femoral side, the head–neck junction morphology (α° and offset), neck morphology (NSA), and torsion should be assessed.

The original version of this article, published on 14 May 2020, unfortunately contained a mistake.

Background: The ATP7A gene encodes a copper transporter whose mutations cause Menkes disease, occipital horn syndrome (OHS), and, less frequently, ATP7A-related distal hereditary motor neuropathy (dHMN). Here we describe a family with OHS caused by a novel mutation in the ATP7A gene, including a patient with a comorbid dHMN that worsened markedly after being treated with copper histidinate. Methods: We studied in detail the clinical features of the patients and performed a genomic analysis by using TruSight One Expanded Sequencing Panel. Subsequently, we determined the ATP7A and ATP7B expression levels, mitochondrial membrane potential, and redox balance in cultured fibroblasts of Patient 1. Results: We found a novel ATP7A late truncated mutation p.Lys1412AsnfsX15 in the two affected members of this family. The co-occurrence of OHS and dHMN in Patient 1 reveals the variable phenotypic expressivity of the variant. A severe clinical and neurophysiologic worsening was observed in the dHMN of Patient 1 when he was treated with copper replacement therapy, with a subsequent fast recovery after the copper histidinate was withdrawn. Functional studies revealed that the patient had low levels of both ATP7A and ATP7B, the other copper transporter, and high levels of superoxide ion in the mitochondria. Conclusions: Our findings broaden the clinical spectrum of ATP7A-related disorders and demonstrate that two clinical phenotypes can occur in the same patient. The copper-induced toxicity and low levels of both ATP7A and ATP7B in our patient suggest that copper accumulation in motor neurons is the path-ogenic mechanism in ATP7A-related dHMN. (c) 2021 Elsevier Inc. All rights reserved.

Purpose of review: Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adults and poses clinical challenges which have placed it at the forefront of imaging and orthopedics. Diagnostic hip imaging has dramatically changed in the past years, with the arrival of new imaging techniques and the development of magnetic resonance imaging (MRI). This article reviews the current state-of-the-art clinical routine of individuals with suspected FAI, limitations, and future directions that show promise in the field of musculoskeletal research and are likely to reshape hip imaging in the coming years. Recent findings: The largely unknown natural disease course, especially in hips with FAI syndrome and those with asymptomatic abnormal morphologies, continues to be a problem as far as diagnosis, treatment, and prognosis are concerned. There has been a paradigm shift in recent years from bone and soft tissue morphological analysis towards the tentative development of quantitative approaches, biochemical cartilage evaluation, dynamic assessment techniques and, finally, integration of artificial intelligence (AI)/deep learning systems. Imaging, AI, and hip preserving care will continue to evolve with new problems and greater challenges. The increasing number of analytic parameters describing the hip joint, as well as new sophisticated MRI and imaging analysis, have carried practitioners beyond simplistic classifications. Reliable evidence-based guidelines, beyond differentiation into pure instability or impingement, are paramount to refine the diagnostic algorithm and define treatment indications and prognosis. Nevertheless, the boundaries of morphological, functional, and AI-aided hip assessment are gradually being pushed to new frontiers as the role of musculoskeletal imaging is rapidly evolving. info:eu-repo/semantics/publishedVersion

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Using an extended retinacular flap containing the blood supply for the femoral head, proximal femur osteotomies can be performed at the neck level increasing the potential of correction of complex morphologies. The aim of this study was to analyze the safety, clinical, and radiographic results of this intra-articular surgical technique performed in skeletally mature patients with a minimum follow-up of three years. Fourteen symptomatic adult patients (16 hips) with a mean age of 26 years underwent FNO using surgical hip dislocation and an extended soft tissue flap. Radiographs and radial magnetic resonance imaging (MRI) were obtained before and after surgery to evaluate articular congruency, cartilage damage, and morphologic parameters. Clinical functional evaluation was done using the Nonarthritic Hip Score (NAHS), the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS). After surgery, no avascular necrosis was observed, and all the osteotomies healed without complication. The initial neck/shaft angle (range 120 to 150°) improved in all cases to a mean value of 130° ± 4.6 (p < 0.001). In eight of nine valgus hips, the high-positioned fovea capitis changed to a normal position after surgery. The NAHS score improved from a mean of 36.5 ± 14.9 to 82.9 ± 13.9 points after surgery (p < 0.001). After surgery, the mean HOS was 87.1 ± 17.6 points, and the mean mHHS was 78.6 ± 17 points. In this series, femoral neck osteotomy in the adult, although technically more demanding compared with other classic osteotomies, can be considered a safe procedure with considerable potential to correct hip deformities.

Objectives The purpose of this study was to report (1) a different but specific pattern of impingement in hips involved with valgus slipped capital femoral epiphysis (valgus SCFE) and (2) the results of surgical treatment using intracapsular realignment techniques. Design Case series. Setting Multiple academic centers. Patients Six patients with 8 involved hips referred for valgus alignment of proximal femoral epiphysis (valgus SCFE). Intervention Intracapsular realignment osteotomy combined with periacetabular osteotomy if needed. Main outcome measurement The clinical and radiographical results and pathophysiology of motion. Results Eight hips in 6 patients were treated with subcapital (5 hips) or femoral neck (3 hips) osteotomy for realignment. The medially prominent metaphysis created an inclusive impingement at the anterior acetabular wall, whereas the high coxa valga favored impacting impingement at the posterior head-neck junction. The mean preoperative epiphyseal-shaft angle of 110.5 (range 90-125 degrees) was reduced to 62 degrees (range 55-70 degrees) postoperatively. At the last follow-up, all but 1 hip were pain-free and impingement-free, with normal range of motion. One hip was replaced after repeated attempts of correction. The overall hip functional result using modified Merle d'Aubigne scoring system was excellent in 5 hips (18-16 points), good in 2 hips (16-15 points), and poor in 1 hip (6 points). Conclusions Impingement in valgus SCFE deformity is specific and complex. Anatomical realignment can lead to favorable results by the restoration of normal morphology and impingement-free range of motion. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The purpose of this study was to determine if there were significant differences between patients submitted to hip arthroscopy (HA) and surgical hip dislocation (SHD) to treat femoro-acetabular impingement (FAI), which variables were significantly associated with hip function before surgery and those predictive of the applied functional outcome scale and its variation rate after surgery. We selected 198 patients treated with HA or SHD with a mean follow-up of 59 months. Inclusion criteria were ages 18–50 years, isolated FAI cam morphology and complete clinical and radiologic documentation. The subjective outcome measure used was the nonarthritic hip score (NAHS). We compared pre-operative and post-operative NAHS, alpha angles and complication rates. Multiple linear regression analyses were performed to find which variables could influence NAHS values. The mean alpha-angle value improved from 71.5° to 40.8°, and mean NAHS improved from 50 to 83 points, with no difference between groups (HA/SHD). We found only a 16.9% influence rate on the pre-operative score, explained by variables of gender/pre-operative alpha angle and presence of degenerative changes/age. The influence rate on the NAHS variation ratio after surgery was 62.8%, explained by the variables of pre-operative score, type of surgery and type of surgery/alpha angle. The complication rate was 7%. FAI surgery can be considered effective in improving patient symptoms. There were no differences in clinical or radiographic results between techniques. We could more accurately predict the variation ratio of NAHS after surgery than its pre-operative value.

© 2017 University of Phoenix In a world increasingly critical of leadership, we propose a grid representing five primary leadership styles derived from Machiavellian and Authentic Leadership archetypes. We argue that Authenticity and Machiavellianism are independent constructs and not two sides of the same coin as implied in the literature. We conclude suggesting some implications of our grid for leadership accountability and decision-making.

Background Pantothenate kinase-associated neurodegeneration is a progressive neurological disorder occurring in both childhood and adulthood. The objective of this study was to design and pilot-test a disease-specific clinical rating scale for the assessment of patients with pantothenate kinase-associated neurodegeneration. Methods In this international cross-sectional study, patients were examined at the referral centers following a standardized protocol. The motor examination was filmed, allowing 3 independent specialists in movement disorders to analyze 28 patients for interrater reliability assessment. The scale included 34 items (maximal score, 135) encompassing 6 subscales for cognition, behavior, disability, parkinsonism, dystonia, and other neurological signs. Results Forty-seven genetically confirmed patients (30 ± 17 years; range, 6-77 years) were examined with the scale (mean score, 62 ± 21; range, 20-106). Dystonia with prominent cranial involvement and atypical parkinsonian features were present in all patients. Other common signs were cognitive impairment, psychiatric features, and slow and hypometric saccades. Dystonia, parkinsonism, and other neurological features had a moderate to strong correlation with disability. The scale showed good internal consistency for the total scale (Cronbach's α = 0.87). On interrater analysis, weighted kappa values (0.30-0.93) showed substantial or excellent agreement in 85% of the items. The scale also discriminated a subgroup of homozygous c.1583C>T patients with lower scores, supporting construct validity for the scale. Conclusions The proposed scale seems to be a reliable and valid instrument for the assessment of pediatric and adult patients with pantothenate kinase-associated neurodegeneration. Additional validation studies with a larger sample size will be required to confirm the present results and to complete the scale validation testing. © 2017 International Parkinson and Movement Disorder Society

Knowledge of the vascular supply of the femoral head is crucial for hip-preserving surgical procedures. The critical area for reshaping cam deformity is at the retinacular vessel penetration, an area with ill-defined topographic anatomy. We performed a cadaver study of the extension of the lateral retinaculum near the head-neck junction, distribution of the arterial vascular foramina, and initial intracapital course of these vessels.In 16 fresh proximal parts of the femur without head-neck deformities, the deep branch of the medial femoral circumflex artery was injected with gadolinium for magnetic resonance imaging (MRI) sequences to identify arterial structures.We found a mean number of 4.5 arterial foramina, showing a predominance from 10 to 12 o'clock. The retinaculum extended 20 mm from 1 to 10 o'clock. The surface distance from the cartilage border to the vascular foramina under the synovial fold was 6.5 mm, and the depth from the same cartilage border to the initial intraosseous vessel pathways was 5.3 mm.The data add further precision to the arterial topography at the retinacular foramina, an area that is crucial for the perfusion of the femoral head. It may overlap with the area of anterolateral cam deformity and plays a role in choosing the cuts for subcapital and intracapital osteotomies.The information is taken from normal hips and may not be directly applicable to the deformed hip. Nevertheless, it is a prerequisite for a surgeon to understand the normal anatomy and use those boundaries to prevent mistakes during intra-articular joint-preserving hip surgical procedures.

ResumenObjetivoLa anatomía de la cadera presenta una serie de peculiaridades que condicionan el tratamiento artroscópico de su patología. El objetivo de la presente publicación es describir los hallazgos anatómicos y biomecánicos más destacados para la aplicación clínica y terapéutica.MétodoDividiremos el capítulo en biomecánica de la cadera con aplicación clínica y las estructuras anatómicas según estén en el compartimento central o en periférico.ResultadosLa necesidad de tracción para poder acceder a la articulación y la dificultad de movilidad dentro de la misma, nos obliga a conocer la anatomía normal y sus variantes. En el compartimento central describiremos estructuras como el labrum, cartílago acetabular, ligamento redondo, fosita semilunar y cartílago de carga de la cabeza femoral. En el compartimento periférico se observará el cartílago de la cabeza, cara no articular del labrum, cápsula y diferentes plicas sinoviales.ConclusionesConocer la anatomía artroscópica y sus variantes, junto con nociones básicas de biomecánica de la cadera, nos permiten mejorar nuestra orientación en una articulación de difícil acceso.Relevancia clínicaEl conocimiento de la anatomía artroscópica y la biomecánica aplicada de la cadera nos permite acortar nuestra curva de aprendizaje quirúrgico en artroscopia de cadera.Nivel de evidenciaOpinión de expertos Nivel IV.AbstractObjectiveHip joint anatomy has a number of peculiarities that determine the arthroscopic treatment. The aim of this article is to describe the most significant anatomical and biomechanical findings for clinical and therapeutic applications.MethodWe divide the chapter into hip biomechanics with clinical application and anatomical structures of the central or peripheral compartment.ResultsAccess and mobility into the hip joint is difficult, and requires understanding the normal anatomy and its variants. In the central compartment, we describe important structures such as the labrum, acetabular cartilage, round ligament, acetabular cartilage, and cartilage of the femoral head. In the peripheral compartment, femoral head cartilage, non-articular labrum, capsule and synovial folds are described.ConclusionsUnderstanding hip arthroscopic anatomy and its variants, along with the basics of hip biomechanics, allow us to improve our orientation in a joint with a difficult access.Clinical relevanceThe knowledge of applied anatomy and arthroscopic hip biomechanics allows us to reduce our surgical learning curve in hip arthroscopy technique.Level of evidenceLevel IV Expert opinion.

Background:Given the high prevalence of patients with hip deformities and no ongoing hip dysfunction, understanding the anatomic factors predicting the symptomatic state is critical. One such variable is how the spinopelvic parameters (SPPs) may interplay with hip anatomic factors.Hypothesis/Purpose:SPPs and femoral- and acetabular-specific parameters may predict which patients will become symptomatic. The purpose was to determine which anatomic characteristics with specific cutoffs were associated with hip symptom development and how these parameters relate to each other.Study Design:Cohort study (Diagnosis); Level of evidence, 2.Methods:548 participants were designated either symptomatic patients (n = 176, scheduled for surgery with hip pain and/or functional limitation) or asymptomatic volunteers (n = 372, no pain) and underwent 3-dimensional magnetic resonance imaging. Multiple femoral (α angle, Ω angle, neck angle, torsion), acetabular (version, coverage), and spinopelvic (pelvic tilt, sacral slope [SS], pelvic incidence) parameters were measured semiautomatically. Normative values, optimal differentiating thresholds, and a logistic regression analysis were computed.Results:Symptomatic patients had larger cam deformities (defined by increased Ω angle and α angle), smaller acetabular coverage, and larger pelvic incidence and SS angles compared with the asymptomatic volunteers. Discriminant receiver operating characteristic analysis confirmed that radial 2-o’clock α angle (threshold 58°-60°, sensitivity 75%-60%, specificity 80%-84%; area under the curve [AUC] = 0.831), Ω angle (threshold 43°, sensitivity 72%, specificity 70%; AUC = 0.830), acetabular inclination (threshold 6°, sensitivity 65%, specificity 70%; AUC = 0.709), and SS (threshold 44°, sensitivity 72%, specificity 75%; AUC = 0.801) ( P < .005) were the best parameters to classify participants. When parameters were entered into a logistic regression, significant positive predictors for the symptomatic patients were achieved for SS, acetabular inclination, Ω angle, and α angle at 2-o’clock, correctly classifying 85% of cases (model sensitivity 72%, specificity 91%; AUC = 0.919).Conclusion:Complex dynamic interplay exists between the hip and SPPs. A cam deformity, acetabular undercoverage, and increased SPP angles are predictive of a hip symptomatic state. SPPs were significant to discriminate between participants and were important in combination with other hip deformities. Symptomatic patients can be effectively differentiated from asymptomatic volunteers based on predictive anatomic factors.

In this study, three-dimensional finite element models based on the specific anatomy of a patient presenting a femoroacetabular impingement of the "cam" type were developed. The finite element meshes were obtained from arthrographic magnetic resonance images captured before and after hip arthroscopy. All soft tissues were considered linear elastic and isotropic and the bones were assumed as rigid. Physiological loads and rotational motions were applied. Stresses and contact pressures were evaluated in these patient specific models in order to better interpret the mechanism of aggression of the cartilages and of the labrum and to evaluate the effectiveness of the surgery. The results of the analyses are presented and discussed. The values obtained for the stresses and contact pressures in the pathological hip were similar to those reported by other models based on idealised geometries or similar reconstruction methodologies and were larger than the ones obtained in the same hip after the surgical treatment. The surgical treatment effectively reduces the intra-articular pressures and stresses approaching the values of a normal hip. Thus, early surgical treatment may help to prevent, or delay, the joint degeneration.

The alpha angle is used to quantify in a single plane the head-neck junction deformity of cam femoro-acetabular impingement (FAI). When the deformity overlaps the superior retinaculum, femoral head osteoplasty in this area can jeopardise intra-articular vascular structures. This study proposes a new angular measure of the linear radial extension of cam deformity as a planning tool for bone resection and compares the accuracy of femoral head osteoplasty using open and arthroscopic surgery.Twenty-five symptomatic patients operated on for FAI were included in this study. Radial magnetic resonance imaging (MRI) was done before and after surgery. Bi-dimensional coordinates of the vascular foramina and radial extension of the deformity (omega angle) were measured. This extension was correlated with the vascular foramina location and alpha-angle value. Accuracy of resection and hip function were evaluated before and after surgery.The cam lesion frequently extended posteriorly. No relation between values of alpha and omega angles was found. Cam resection was complete in 88 % of cases; there was a significant improvement in outcome score after surgery.This study showed that alpha angle, measured in one plane, was not a predictor of the radial extension of cam deformity. To achieve a full resection, it was frequently necessary to extend the femoral head osteoplasty over the retinacular area. Pre-operative determination of the omega angle and location of the vascular foramina helped improve cam resection safety and accuracy.

The Bernese periacetabular osteotomy (PAO) is a widely used procedure to reorient a dysplastic acetabulum resulting from developmental dysplasia of the hip, retroversion, protrusio, or some deformities with a traumatic etiology. Throughout the execution, the lateral femoral cutaneous nerve (LFCN) as well as the obturator, femoral, and sciatic nerves can be injured. Injury to 1 of the 3 major nerves is a devastating event for the patient followed by an ill-defined period of hope for nerve recovery and fear of lifelong disability. Surgical experience is an essential factor in reducing the prevalence of nerve injury, whereas proof of the value of intraoperative fluoroscopy and nerve monitoring still must be established. Although it is known that, for example, the ischial cuts of the complex osteotomy place the sciatic nerve at risk, the action causing the nerve injury is rarely clear in the individual situation. The literature has been mostly limited to reports of incidence and offers little analytic information. Through the use of cadaveric dissections, we visualized the possible impacts of the different steps of the procedure on the nerves in their anatomic vicinity, and the present report demonstrates how nerves can be protected with retractor positioning and how lower-limb positioning can lead to nerve relaxation, an important means to avoid mechanical injury. While the frequent injuries of the LFCN are exclusively related to the approach, sciatic nerve injuries are mainly the result of the ischial osteotomy steps and femoral nerve injuries are seen nearly exclusively with the correction of the acetabular fragment. The authors implemented the demonstrated measures for 9 years, during which approximately 800 periacetabular osteotomies resulted in a total of 2 femoral and 2 sciatic nerve lesions-or a nerve injury rate of 0.5%. The nerves injuries resolved within 6 to 9 months in 3 hips, and 1 patient had a definitive foot drop requiring a splint at the time of writing.

To determine the reference intervals (RefInt) of the quantitative morphometric parameters of femoroacetabular impingement (FAI) in asymptomatic hips with computed tomography (CT) and determine their dependence on age, side, limb dominance and sex. We prospectively included 590 patients and evaluated 1111 hips with semi-automated CT analysis. We calculated overall, side- and sex-specific parameters for imaging signs of cam [omega and alpha angle (α°)] and pincer-type morphology [acetabular version (ACvers), lateral centre-edge angle (LCEA) and cranio-caudal coverage]. Hip shape was symmetrical and did not depend on limb dominance. The 95% RefInt limits were sex-different for all cam-type parameters and extended beyond current abnormal thresholds. Specifically, the upper limits of RefInt for α° at 12:00, 1:30 and 3:00 o’clock positions were 56°, 70° and 58°, respectively, and 45° for LCEA. Acetabular morphology varied between age groups, with a trend toward an LCEA/ACvers increase over time. Our morphometric measurements can be used to estimate normal hip morphology in asymptomatic individuals. Notably they extended beyond current thresholds used for FAI imaging diagnosis, which was most pronounced for cam-type parameters. We suggest the need to reassess α° RefInt and consider a 60° threshold for the 12:00/3:00 positions and 65-70° for other antero-superior positions. • Hip shape is symmetrical regardless of limb dominance. • Pincer/cam morphology is frequent in asymptomatic subjects (20 and 71%, respectively). • LCEA and acetabular version increases with age (5-7° between opposite age groups). • Femoral morphology is stable after physeal closure (in the absence of pathology). • Alpha and omega angle thresholds should be set according to sex.

Analyzing medical volume datasets requires interactive visualization so that users can extract anatomo-physiological information in real-time. Conventional volume rendering systems rely on 2D input devices, such as mice and keyboards, which are known to hamper 3D analysis as users often struggle to obtain the desired orientation that is only achieved after several attempts. In this paper, we address which 3D analysis tools are better performed with 3D hand cursors operating on a touchless interface comparatively to a 2D input devices running on a conventional WIMP interface. The main goals of this paper are to explore the capabilities of (simple) hand gestures to facilitate sterile manipulation of 3D medical data on a touchless interface, without resorting on wearables, and to evaluate the surgical feasibility of the proposed interface next to senior surgeons (N=5) and interns (N=2). To this end, we developed a touchless interface controlled via hand gestures and body postures to rapidly rotate and position medical volume images in three-dimensions, where each hand acts as an interactive 3D cursor. User studies were conducted with laypeople, while informal evaluation sessions were carried with senior surgeons, radiologists and professional biomedical engineers. Results demonstrate its usability as the proposed touchless interface improves spatial awareness and a more fluent interaction with the 3D volume than with traditional 2D input devices, as it requires lesser number of attempts to achieve the desired orientation by avoiding the composition of several cumulative rotations, which is typically necessary in WIMP interfaces. However, tasks requiring precision such as clipping plane visualization and tagging are best performed with mouse-based systems due to noise, incorrect gestures detection and problems in skeleton tracking that need to be addressed before tests in real medical environments might be performed.

BACKGROUND: Pantothenate kinase-associated neurodegeneration is a progressive neurological disorder occurring in both childhood and adulthood. The objective of this study was to design and pilot-test a disease-specific clinical rating scale for the assessment of patients with pantothenate kinase-associated neurodegeneration. METHODS: In this international cross-sectional study, patients were examined at the referral centers following a standardized protocol. The motor examination was filmed, allowing 3 independent specialists in movement disorders to analyze 28 patients for interrater reliability assessment. The scale included 34 items (maximal score, 135) encompassing 6 subscales for cognition, behavior, disability, parkinsonism, dystonia, and other neurological signs. RESULTS: Forty-seven genetically confirmed patients (30 ± 17 years; range, 6-77 years) were examined with the scale (mean score, 62 ± 21; range, 20-106). Dystonia with prominent cranial involvement and atypical parkinsonian features were present in all patients. Other common signs were cognitive impairment, psychiatric features, and slow and hypometric saccades. Dystonia, parkinsonism, and other neurological features had a moderate to strong correlation with disability. The scale showed good internal consistency for the total scale (Cronbach's a = 0.87). On interrater analysis, weighted kappa values (0.30-0.93) showed substantial or excellent agreement in 85% of the items. The scale also discriminated a subgroup of homozygous c.1583C>T patients with lower scores, supporting construct validity for the scale. CONCLUSIONS: The proposed scale seems to be a reliable and valid instrument for the assessment of pediatric and adult patients with pantothenate kinase-associated neurodegeneration. Additional validation studies with a larger sample size will be required to confirm the present results and to complete the scale validation testing. © 2017 International Parkinson and Movement Disorder Society.

Purpose: This study analyzes the mediating role of positive psychological capital in the relationship between authentic leadership and organizational commitment. Design/methodology/approach: This quantitative study presents a model in which were considered as variables mediating the relationship between authentic leadership and organizational commitment, the four dimensions of positive psychological capital (optimism, resilience, self-efficacy, hope). Findings: The results showed that positive psychological capital mediates the relationship between authentic leadership and organizational commitment. However, they also indicate that this mediation is only made for three of the four dimensions of positive psychological capital (self-efficacy, hope and optimism). They also show that resilience negatively affects organizational commitment. Originality/value: The value of this study is to strengthen the interest in the study of positive psychological capital as a mediating variable and the importance of development that each of its dimensions and the impact they may have on other variables, as demonstrated by the results.

There is a wide discrepancy in reported prevalence rates for cam, pincer, and mixed femoroacetabular impingement (FAI), particularly among distinct populations, namely asymptomatic or symptomatic subjects and athletes. No systematic analysis to date has yet compared studies among these groups to determine differences in radiographic signs of FAI.A systematic review of existing literature was performed to determine the prevalence of radiographic signs of FAI among athletes, asymptomatic subjects, and symptomatic patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to systematically search PubMed, MEDLINE, CINAHL, and Cochrane databases.We identified 361 studies in our literature search. After considering the exclusion criteria, 60 were included in this systematic review: 15 in athletes, 10 in purely asymptomatic patients, and 35 in symptomatic, non-athlete populations. Cam impingement was significantly (p=0.0003) more common in athletes versus asymptomatic subjects but not compared to symptomatic patients (p=0.107). In addition, cam FAI was significantly more common in symptomatic versus asymptomatic cases (p=0.009). The percentage of patients with cam-type FAI showed significant differences across groups (p=0.006). No significant differences were found between pincer-type FAI morphology prevalence when comparing athletes to symptomatic patients. However, mixed-type FAI was significantly more common in athletes versus asymptomatic subjects (p=0.03) and in asymptomatic versus symptomatic subjects (p=0.015). The percentage of patients with mixed-type FAI showed significant differences across groups (p=0.041). The mean alpha angle was significantly greater in the symptomatic group versus either the asymptomatic or athlete group (p0.001). Significant differences in mean alpha angles were noted across groups (p=0.0000).Imaging suspicion of FAI is common among athletes, asymptomatic, and symptomatic populations. However, significant differences in type and imaging signs of FAI exist among these groups that need to be considered in patients' decision making.