Medial longitudinal arch development of school children : The College of Podiatry Annual Conference 2015: meeting abstracts

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Search for long-lived particles decaying to e±μ∓νe^\pm \mu^\mp \nu

International audienceLong-lived particles decaying to ${e ^\pm } {\mu ^\mp } {\nu }$, with masses between 7 and $50 \,\text {GeV/}c^2$ and lifetimes between 2 and $50 \,\text {ps}$, are searched for by looking at displaced vertices containing electrons and muons of opposite charges. The search is performed using $5.4 \,\text {fb} ^{-1}$ of $p p$ collisions collected with the LHCb detector at a centre-of-mass energy of $\sqrt{s} = 13 \,\text {TeV}$. Three mechanisms of production of long-lived particles are considered: the direct pair production from quark interactions, the pair production from the decay of a Standard-Model-like Higgs boson with a mass of $125 \,\text {GeV/}c^2$, and the charged current production from an on-shell $W$ boson with an additional lepton. No evidence of these long-lived states is obtained and upper limits on the production cross-section times branching fraction are set on the different production modes

Observation of Multiplicity Dependent Prompt χc1(3872)\chi_{c1}(3872) and ψ(2S)\psi(2S) Production in pppp Collisions

The production of $χ_{c1}$(3872) and $ψ$(2S) hadrons is studied as a function of charged particle multiplicity in pp collisions at a center-of-mass energy of 8 TeV, corresponding to an integrated luminosity of 2 fb-1. For both states, the fraction that is produced promptly at the collision vertex is found to decrease as charged particle multiplicity increases. The ratio of $χ_{c1}$(3872) to $ψ$(2S) cross sections for promptly produced particles is also found to decrease with multiplicity, while no significant dependence on multiplicity is observed for the equivalent ratio of particles produced away from the collision vertex in b-hadron decays. This behavior is consistent with a calculation that models the $χ_{c1}$(3872) structure as a compact tetraquark. Comparisons with model calculations and implications for the binding energy of the $χ_{c1}$(3872) state are discussed

Measurement of the charm mixing parameter yCP−yCPKπy_{CP} - y_{CP}^{K\pi} using two-body D0D^0 meson decays

International audienceA measurement of the ratios of the effective decay widths of D0→π-π+ and D0→K-K+ decays over that of D0→K-π+ decays is performed with the LHCb experiment using proton–proton collisions at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 6  fb-1. These observables give access to the charm mixing parameters yCPππ-yCPKπ and yCPKK-yCPKπ, and are measured as yCPππ-yCPKπ=(6.57±0.53±0.16)×10-3, yCPKK-yCPKπ=(7.08±0.30±0.14)×10-3, where the first uncertainties are statistical and the second systematic. The combination of the two measurements is yCP-yCPKπ=(6.96±0.26±0.13)×10-3, which is four times more precise than the previous world average

First observation of the decay Λb0→ηc(1S)pK−\Lambda_b^0 \to \eta_c(1S) p K^-

International audienceThe decay Λb0→ηc(1S)pK- is observed for the first time using a data sample of proton-proton collisions, corresponding to an integrated luminosity of 5.5  fb-1, collected with the LHCb experiment at a center-of-mass energy of 13 TeV. The branching fraction of the decay is measured, using the Λb0→J/ψpK- decay as a normalization mode, to be B(Λb0→ηc(1S)pK-)=(1.06±0.16±0.06-0.19+0.22)×10-4, where the quoted uncertainties are statistical, systematic and due to external inputs, respectively. A study of the ηc(1S)p mass spectrum is performed to search for the Pc(4312)+ pentaquark state. No evidence is observed and an upper limit of B(Λb0→Pc(4312)+K-)×B(Pc(4312)+→ηc(1S)p)B(Λb0→ηc(1S)pK-)<0.24 is obtained at the 95% confidence level

Measurement of χc1_{c1}(3872) production in proton-proton collisions at s \sqrt{s} = 8 and 13 TeV

International audienceThe production cross-section of the χ$_{c1}$(3872) state relative to the ψ(2S) meson is measured using proton-proton collision data collected with the LHCb experiment at centre-of-mass energies of $\sqrt{s}$ = 8 and 13 TeV, corresponding to integrated luminosities of 2.0 and 5.4 fb$^{−1}$, respectively. The two mesons are reconstructed in the J/ψπ$^{+}$π$^{−}$ final state. The ratios of the prompt and nonprompt χ$_{c1}$(3872) to ψ(2S) production cross-sections are measured as a function of transverse momentum, p$_{T}$, and rapidity, y, of the χ$_{c1}$(3872) and ψ(2S) states, in the kinematic range 4 < p$_{T}$< 20 GeV/c and 2.0 < y < 4.5. The prompt ratio is found to increase with p$_{T}$, independently of y. For the prompt component, the double ratio of the χ$_{c1}$(3872) and ψ(2S) production cross-sections between 13 and 8 TeV is observed to be consistent with unity, independent of p$_{T}$ and centre-of-mass energy.[graphic not available: see fulltext