SummaryBackgroundFemoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery, including reshaping the hip, or with physiotherapist-led conservative care. We aimed to compare the clinical effectiveness of hip arthroscopy with best conservative care.MethodsUK FASHIoN is a pragmatic, multicentre, assessor-blinded randomised controlled trial, done at 23 National Health Service hospitals in the UK. We enrolled patients with femoroacetabular impingement syndrome who presented at these hospitals. Eligible patients were at least 16 years old, had hip pain with radiographic features of cam or pincer morphology but no osteoarthritis, and were believed to be likely to benefit from hip arthroscopy. Patients with bilateral femoroacetabular impingement syndrome were eligible; only the most symptomatic hip was randomly assigned to treatment and followed-up. Participants were randomly allocated (1:1) to receive hip arthroscopy or personalised hip therapy (an individualised, supervised, and progressive physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre and was done by research staff at each hospital, using a central telephone randomisation service. Patients and treating clinicians were not masked to treatment allocation, but researchers who collected the outcome assessments and analysed the results were masked. The primary outcome was hip-related quality of life, as measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed in all eligible participants who were allocated to treatment (the intention-to-treat population). This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN64081839, and is closed to recruitment.FindingsBetween July 20, 2012, and July 15, 2016, we identified 648 eligible patients and recruited 348 participants: 171 participants were allocated to receive hip arthroscopy and 177 to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (319 of 348 participants). At 12 months after randomisation, mean iHOT-33 scores had improved from 39·2 (SD 20·9) to 58·8 (27·2) for participants in the hip arthroscopy group, and from 35·6 (18·2) to 49·7 (25·5) in the personalised hip therapy group. In the primary analysis, the mean difference in iHOT-33 scores, adjusted for impingement type, sex, baseline iHOT-33 score, and centre, was 6·8 (95% CI 1·7–12·0) in favour of hip arthroscopy (p=0·0093). This estimate of treatment effect exceeded the minimum clinically important difference (6·1 points). There were 147 patient-reported adverse events (in 100 [72%] of 138 patients) in the hip arthroscopy group) versus 102 events (in 88 [60%] of 146 patients) in the personalised hip therapy group, with muscle soreness being the most common of the...

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EXTRAIT: Sur quelques facteurs intervenant dans la croissance des v61ig~res de Prosobranches. Le velum des vElig6res de Prosobranches recueille routes les particules que ses cils composes peuvent maitriser. Chacune des dix esp6ces d'algues unicellulaires offertes aux larves de Crepidula fornicata et de Nassarius reticulatus subit l'action mEcanique de l'estomac. Saul pour Chlamydornonas parkeae, que les larves ne rEussissent pas ~t d6truire, et pour PhaeodactyIurn tricornuturn dont les frustules sont perforEes, les patois cellulaires sont ramollies ou fragment4es. Les cellules de la glande digestive ing6rent le contenu cellulaire y compris le pigment, mais non Ies d6bris des parois. Les pigments sont reject6s ult6rieurement; ils retardent le cycle de l'activit6 glandulaire. La croissance est relativement bonne avec des

Growth of shells of larvae ofNassarius reticulatus(L.) andCrepidula fornicata(L.) reared in the laboratory under constant temperature (14 °C) and illumination (155 lx) occurs by the addition of successive strips secreted at the mantle edge. Growth lines on the embryonic teloconch also indicate intermittent growth; the protoconch secreted by the shell gland has no such lines. There is evidence that growth periods are short and pauses separating them prolonged. The diameter of the older whorls of the shells of these and six other species examined increase with the volume of the viscera. This change in diameter is made possible by the flexibility of the organic matrix, the funda-mental constituent of the shell. The matrix, secreted as fibres at the mantle edge, forms sheets, and provides sites for the deposition of calcareous concretions; at metamorphosis the concretions apparently initiate the formation of crystals. The concretions also sculpture the surface of the shell producing a pattern sufficiently conspicuous to allow identification of some species with the aid of only the stereomicroscope. For example, large concretions form longitudinal rows over the protoconch and teloconch ofLittorina neritoides(L.) and smaller ones combine to form a more decorative pattern inRissoa sarsiLoven. In other species details of the surface design require a scanning electron micro-scope. Interspecific differences in the arrangement of concretions may be traceable to differences in the pallial glands which secrete the matrix.

The development of the free‐swimming veliger of Amphibola is followed from hatching to settlement, and the larval structures compared with those of post‐metamorphic juveniles and adult snails. Observations of living specimens and light‐microscope sections were combined with scanning electron microscopy to build up a composite picture of veliger structure. Four stages in the development of veligers are recognized, each being characterized by the appearance of organ systems such as the mantle cavity, larval heart, adult heart and kidney, and larval pallial gland. At or after metamorphosis, the larval systems (heart, kidney and pallial gland) disappear, and the developing adult organs move to the positions characteristic of adult snails. Organogenesis in Amphibola veligers is compared with that of prosobranch and opisthobranch larvae, and with that of pulmonate larvae with direct development. The closest similarity is seen to be with opisthobranch veligers.