bluuebunny/crossref_metadata_2025 huggingface dataset:
A-29 Consistency of Clinical Profiles Across Repeat Concussions
Authors: Manderino L M , Preszler J , French J , Kegel N , Blaney N , Collins M W , Kontos A P
Published: July 2022

Purpose: To evaluate the association between concussion profiles within individual patients across repeat concussions. Methods: Retrospective chart review of 100 adolescents (57.3% male) aged 10–21 years presenting to a concussion clinic within 30 days of injury for two separate injuries between 2011 and 2021. Clinicians conducted multidomain assessments including vestibular/ocular motor screening, neurocognitive testing, symptoms and medical/injury history to adjudicate the following concussion clinical profiles: vestibular, ocular, post-traumatic migraine, cognitive fatigue, and anxiety/mood. Chi-square tests with odds ratios (OR) and 95% confidence intervals (CI) were conducted to examine the association of each profile from the first to the second concussion. Results: Chi-square analyses supported associations between the first and second concussions (time between injuries = 667.1 ± 529.2 days) for the vestibular (χ2 = 10.08, p < 0.01, OR = 3.75, 95% CI = 1.63–8.62), ocular (χ2 = 6.51, p < 0.05, OR = 3.51, 95% CI = 1.30–9.46), and migraine (χ2 = 11.056, p < 0.001, OR = 4.01, 95% CI = 1.73–9.29) profiles, such that having that profile at first concussion was associated with increased likelihood of having the same profile at second concussion. Chi-square analyses for cognitive fatigue and anxiety/mood were not significant. Conclusions: Vestibular, ocular, and migraine profiles at first injury predicted their presence at second injury, which may reflect consistent underlying risk factors (e.g., sex migraine history) for these profiles. Conversely, no association was supported for anxiety/mood and cognitive fatigue profiles across injuries. The present findings are the first to demonstrate that certain profiles are likely to recur after repeat concussion. This information can be used by clinicians to inform earlier, targeted treatment recommendations for associated profiles.
A-32 Association Between Adolescent Patient Emotional Factors and Adherence to a Sport-Related Concussion Treatment
Authors: Mian R K , Brayton R P , Price A M , Knell G
Published: July 2022

Purpose: To determine the association between Anxiety Sensitivity Index (ASI) and Positive and Negative Affect Schedule (PANAS) and adherence to an exercise treatment for sport-related concussion (SRC). We hypothesized Positive Affect (PA) score would be positively associated, while ASI and Negative Affect (NA) score would be negatively associated with odds of treatment adherence. Methods: This was a prospective (2020–2021) analysis of adolescents (aged 14–17) diagnosed with SRC by a pediatric specialty concussion clinic and subsequently prescribed daily exercise. Adherence to the exercise protocol was defined as consistently increasing physical activity volume (measured by accelerometer) during recovery. Multivariable logistic regressions evaluated the independent associations between treatment adherence and ASI; PA score; NA score. Results: The mean (standard deviation [SD]) recovery time was 16.1 (9.0) days. Among the 32 (56.1%) adherent and 25 (43.9%) not adherent participants, the majority were aged 15 years (29.8%), male (50.9%), non-Hispanic White (70.2%), and had no concussion history (61.4%). After adjusting for age and sex, the odds of treatment adherence for each additional unit increase in ASI, PA score, and NA score was 1.03 (95% CI: 0.96–1.10), 1.14 (95% CI: 0.97–1.35), and 1.18 (95% CI: 0.95–1.47), respectively. Conclusions: Despite lack of statistical significance, it appears that PA score and NA score may contribute to exercise treatment adherence for SRC. As this study may be underpowered, future studies should aim to have a larger sample and investigate the discriminate utility of PANAS to identify those who may or may not adhere to SRC exercise treatments.
A-33 Criteria For Determining Clinical Recovery From Concussion: A Preliminary Survey Of Sports Neuropsychologists
Authors: Moser R S , Choi D M , Mayer B
Published: July 2022

Purpose: To arrive at a consensus of best practices currently employed by sports neuropsychologists regarding specific criteria for determining concussion recovery. Methods: A survey was sent to 120 sports neuropsychologists listed in a public membership directory of the Sports Neuropsychology Society. The survey included demographic, Likert-style, and multiple-choice questions regarding the importance of given criteria in determining concussion recovery for youth (up to age 18) or adult (18+ years). Results: A sample of 22 participants (95% White, 59% male, 68% working with youth and adults, 45% seeing ≥50 patients yearly, 86% ≥10 years of experience) was obtained. The two highest rated criteria for youth and adults were: 1) symptom-free with exercise, and 2) back to work/school without symptoms or accommodations. The two lowest rated criteria were: 1) physician exam without concerns, and 2) opinions from another healthcare professional. Of those who treat adults, 71% reported 1 week symptom free is sufficient. For youth, 63% rated ≥1 week, 31% rated 2–3 weeks, and 6% rated ≥1 month is preferred. Conclusions: Most respondents have worked with youth and adult athletes for at least 10 years. Responses were mostly consistent regarding importance of the various surveyed criteria. There may be a tendency to wait for longer symptom-free periods for youth. Interestingly, the opinions of another health care professional or physician were less important than all other criteria in the survey. The two most important criteria appear to be resolution of symptoms during physical exertion and return to functional activities without symptoms or accommodations.
A-34 An Investigation of Sports Concussion Reporting in Collegiate Club Rugby Players
Authors: Patoilo M , Porter B , Hanayik T , Rorden C , McCall M
Published: July 2022

Purpose: The current study investigates concussion-reporting among U.S. collegiate club rugby players. There is robust evidence that a large proportion of college-aged athletes have sustained unreported concussions and non-disclosure is partially influenced by sport. Despite college rugby being the fastest growing collegiate sport in America, there is no research on concussion-reporting in U.S. college-aged club rugby players. It is predicted that these players self-report significantly fewer professionally diagnosed concussions than total concussions sustained. Methods: Participants completed a survey about health, sports, and concussion history as part of a larger study on cognitive performance following concussion. Participants included 14 male, club rugby athletes (M = 19.62 years old, SD = 0.96, range = 18–21) recruited from a university in the southeast United States. Exclusion criteria included an existing or prior learning disability diagnosis, ADHD, or other serious neurological issues. Results: Participants self-reported experiencing a significantly higher number of concussions (M = 2.29, SD = 1.44) than were documented by a professional (M = 0.93, SD = 0.73); t(13) = 2.85, p = 0.01). Details were provided for 32 total concussions, and 69% (N = 22) were considered rugby related. Of note, 28.6% of participants (N = 4) reported having none of their concussions diagnosed by a professional, and 35.7% of participants (N = 5) indicated their first concussion was never diagnosed. Conclusions: Concussion non-disclosure is a significant issue among college-aged U.S. club rugby athletes. As rugby continues to be a high-contact and internationally popular sport, additional research is needed to understand these reporting behaviors. Current findings highlight the need for efforts to better understand how coaches and those who work with these athletes can promote and increase accurate concussion-reporting.
A-36 Tracking Compliance To A Home Exercise Program For Concussion Using Ecological Momentary Assessment: A Pilot Study
Authors: Price A M , Jones C A , Boucher S J , Ellis C S , Burkhart S O
Published: July 2022

Purpose: The management of pediatric concussions creates a clinical challenge due to unknown patient compliance with prescribed therapies and interventions. The purpose of this pilot study was to describe the logistical use of ecological momentary assessment (EMA) to track compliance to a physical therapy facilitated vestibular/ocular motor home exercise program (HEP) in patients diagnosed with concussion. Methods: A convenience sample of 20 concussed patients (aged 13–18 years [mdn = 14.5, IQR = 14.0–16.8]) was included in this initial pilot study. All participants were evaluated within seven days of injury. Participants were instructed to complete one daily HEP compliance log until medical clearance on their parent or guardians’ mobile device using an EMA application. Results: Participants were evaluated a median 3.5 (IQR = 1.3–6.5) days post injury, recovered in a median 15.5 (IQR = 11.0–25.0) days, and completed a mean 5.85 (SD = 3.9) total EMA logs representing a 47% completion rate. Participants reported completing a mean 1.21 (SD = 0.77) HEPs per day with a range of 0.0 to 3.0. Self-reported HEP compliance did not significantly correlate with recovery time in days (P = 0.26). Conclusions: The overall response rate for EMA logs was 47% and participants reported completing 1.2 HEPs per day. Analysis of this preliminary data did not reveal a correlation between HEP compliance and recovery time in days. Participants reported the primary barrier to completing daily questionnaires was access to their parent or guardians’ mobile device at the time of the prompt. Overall, the data derived from EMA appears useful for tracking the progression of this heterogenous injury.
A-37 Ocular Motor Impairments in Concussion Professional Football Players
Authors: Ree-Fedun Q , Naidu D , Mrazik M , David C , Hansen J , Wagner R , Arends T
Published: July 2022

Purpose: The purpose of this study was to examine baseline and post-concussion injury characteristics of ocular eye movements using the Sync Think visual eye tracking apparatus in professional football players in the Canadian Football League (CFL). Methods: The visual tracking testing protocol uses an integrated stimulus presentation-eye tracking apparatus (EyeLink CL; SR Research, Ontario, Canada) with which eye movements were recorded at 500 Hz using infrared video-oculography. The standard deviation of radial errors (SDRE) and tangential errors (SDTE) were used to determine poor visual tracking. Participants were (n = 748) rostered players in the Canadian Football League. All participants completed assessments at baseline. Sixteen players completed post-concussion assessments and 98 players completed post-exertional assessments during the 2021 season to evaluate the impact of physical exertion on ocular movement metrics. Results: Participants with diagnosed concussions (n = 16+) demonstrated significantly poorer performance on measures of both gaze stability and smooth pursuit (p < 0.001). The poorer results were correlated with significantly higher subjective ratings of dizziness (p < 0.01) and fogginess (p < 0.001). In contrast, healthy participants who completed the same ocular motor assessments demonstrated no significant differences compared to baseline test performance. Conclusions: Findings suggest that subtle differences in oculomotor functioning arise from sport concussion in professional football players. Further research with larger sample sizes and correlation with other cognitive and physical outcomes is warranted.
A-41 Establishing Empirically-Based Normative Cut-Offs For Identifying Anxiety Following Sports-Related Concussion
Authors: Schatz P , Legido G , Womble M N , Elbin R J
Published: July 2022

Purpose: The State–Trait Anxiety Inventory (form Y-1; STAI) is widely used for identifying anxiety in non-clinical and clinical samples. Cutoff scores ≥40 are widely used to identify clinically significant anxiety. However, these scores correspond with the 50th–60th percentile in STAI normative tables. Given that anxiety is recognized as a common post-concussion symptom, and as a post-injury clinical profile, establishing statistically appropriate cutoffs for clinical anxiety is warranted. Methods: We compared rates of individuals falling above static (≥40) versus empirically-derived (>1, >1.5, >2 standard deviations) cutoffs, using a sample of 137 acutely concussed high school and college athletes (59% male, mean age 16.11 ± 1.56 years) who completed the STAI within 7 days of injury (mean 3.79 ± 1.4 days). Results: Approximately 47% of concussed athletes fell above the static cutoff of ≥40, whereas use of empirically-derived cutoffs identified 18% (1SD), 8% (1.5SD) and 3% (2SD). These empirically-derived cutoffs reflect the normal curve, and distribution of scores expected to fall outside 1, 1.5, and 2SD. Conclusions: Use of a static cutoff of ≥40 on the STAI identifies approximately 50% of high school and college athletes as anxious. As such, use of empirically-derived cutoffs are recommended over static cutoffs for clinical anxiety when using the STAI.
A-43 Effects of Subthreshold Exercise on Post-concussive Symptom Endorsement and Cognition: A Pilot Randomized Clinical Trial
Authors: Soden D , Meyer J E , Briskin S M , Dundr J M , Brennan B , Smith P M , Bailey C M
Published: July 2022

Purpose: The current study examined the effects of subthreshold exercise on symptom endorsement and neurocognitive functioning in adolescents with persisting concussion symptoms (>1 month). Methods: Sixteen participants (age M = 16.2, SD = 1.4) with persisting concussion symptoms were randomly assigned to control or subthreshold exercise intervention groups (Leddy et al., 2019). Participants engaged in concussion education before assignment to 6 weeks (3x weekly) of intervention: control (stretching) or subthreshold exercise. Both groups completed evaluations at baseline, midpoint, and follow-up, including a hybrid battery of assessments (yielding composites of processing speed and memory), a concussion symptom scale (PCS-R), and psychological inventories. Results: Both the intervention group and control group reported significant reduction in concussive symptom severity during the study period (PCS-R Change M = -21.29, SD = 13.54). Baseline endorsement of anxiety significantly differed across groups (p < 0.05); when controlling for anxiety, the intervention group demonstrated greater reduction in symptom endorsement compared to controls (F(1,13) = 7.30, p < 0.05, partial eta2 = 0.40). In contrast, after controlling for performance validity and the baseline anxiety difference, there was no significant difference (p > 0.05) in processing speed performance (partial eta2 = 0.14) or memory performance (partial eta2 = 0.11) by intervention group. Both groups remained generally intact normatively from the baseline to the follow-up evaluation across measures. Conclusions: Current results support the use of subthreshold exercise to reduce persisting symptoms of concussion post-acutely; additionally, results suggest that anxiety significantly impacted response to intervention. Lastly, there was no effect on cognitive indices by the intervention, suggesting that subthreshold exercise may have less impact on cognition than symptom endorsement in the post-acute phase of recovery.
A-44 Experiences of Adversity and Validity of Baseline Concussion Testing
Authors: Sorensen A , Salas Atwell M , Koroukian S , Bailey C , Briggs F
Published: July 2022

Purpose: This study examined the relationship between individual-level experiences of social adversity and baseline computerized concussion testing validity (Immediate Post-Concussion Assessment and Cognitive Testing; ImPACT). Methods: This study involved 6495 student-athletes born between 1995 and 2005 who completed a baseline ImPACT test between 10 and 18 years old and could be identified in the Child-Household Integrated Longitudinal Data (CHILD) System, a continuously updated integrated and comprehensive data system that captures detailed individual-level demographic, social service usage, and educational outcomes on every child born or living in Cuyahoga County, Ohio from 1989 to present. Multivariable logistic regression models were conducted with experiences of SNAP/TANF enrollment, substantiated abuse or neglect incidents, and extreme neighborhood deprivation occurring in the sensitive developmental periods of early childhood and adolescence as key predictors of baseline test validity. Results: Our findings suggest that social mobility may play an important role in baseline validity. Youth with upward social mobility (poverty or neighborhood deprivation in early childhood only) were not significantly different than youth without such experiences (OR = 0.91, p = 0.74). Youth with persistent adversity across childhood or downward social mobility (poverty or high neighborhood deprivation in adolescence only) had 50–72% lower odds of achieving a valid baseline test (persistent poverty: OR = 0.59, p = 0.05; adolescent poverty only: OR = 0.50, p = 0.004; adolescent neighborhood deprivation only: OR = 0.28, p < 0.0001). Conclusions: These findings suggest certain patterns of social adversity may predispose youth to invalid computerized concussion baseline testing scores, potentially increasing their risk of inaccurate injury management and poor outcomes.
A-47 Affective Comorbidity Neurocognitive Variability in College Athletes at Baseline
Authors: Thomas G , Riegler K , Bradson M , Arnett P
Published: July 2022

Purpose: Research on the neurocognitive effects of comorbid mood/anxiety disturbance in college athletes is limited. Previous work demonstrated that athletes with comorbid depression/anxiety performed worse on measures of attention/processing speed at baseline compared to healthy controls (HCs). However, this work only examined mean performance. The current study expands upon this work by examining intraindividual variability (IIV) in relation to affective disturbance. Methods: 835 (M = 624, F = 211) collegiate athletes completed baseline neuropsychological testing. Athletes were separated into 4 groups (HCs [n = 582], Depression Only [n = 137], Anxiety Only [n = 54], Comorbid Depression/Anxiety [n = 62]) based on self-reported anxiety and depression. IIV was examined via intraindividual standard deviation (ISD) with higher scores indicating greater variability. ISD was examined globally and within composites of attention/processing speed (A/PS) and memory. Results: Linear regression results revealed that the comorbid group exhibited greater variability within the memory composite compared to HCs, (t(829) = 3.28, p = 0.001, d = 0.39), the depression group, (t(829) = −2.62, p = 0.009, d = 0.35), and the anxiety group (t(829) = −2.76, p = 0.006, d = 0.49). The depression group and anxiety group did not differ from HCs on memory ISD. None of the groups differed on A/PS or global ISD. Conclusions: Athletes with comorbid depression/anxiety demonstrated greater variability in performance on memory tasks. Greater dispersion is predictive of greater cognitive decline following concussion; therefore, it is important that we interpret neuropsychological performance beyond measures of central tendency. These findings also highlight the importance of having baseline data available for athletes with affective disturbance as these underlying secondary factors may influence performance, place athlete at risk for poorer outcomes, and skew future post-concussion comparisons.
CD147 Targeting by AC-73 Induces Autophagy and Reduces Intestinal Fibrosis Associated with TNBS Chronic Colitis
Authors: Butera Alessia , Quaranta Maria Teresa , Crippa Luca , Spinello Isabella , Saulle Ernestina , Di Carlo Nazzareno , Campanile Doriana , Boirivant Monica , Labbaye Catherine
Published: July 2022

Background and Aims

Intestinal fibrosis is a common complication of inflammatory bowel diseases. Medical treatment of intestinal fibrosis is an unmet therapeutic need. CD147 overexpression can induce myofibroblast differentiation associated with extracellular matrix deposition, favouring the development of fibrosis. To understand whether CD147 may promote intestinal fibrosis, we analysed its expression and blocked its function by using its specific inhibitor AC-73 [3-{2-[([1,1’-biphenyl]-4-ylmethyl) amino]-1-hydroxyethyl} phenol] in the murine TNBS [trinitrobenzenesulfonic acid]-chronic colitis model associated with intestinal fibrosis.

Methods

TNBS chronic colitis was induced by weekly intrarectal administration of escalating doses of TNBS. Ethanol-treated and untreated mice were used as controls. Separated groups of TNBS, ethanol-treated or untreated mice received AC-73 or vehicle administered intraperitoneally from day 21 to day 49. At day 49, mice were killed, and colons collected for histological analysis, protein and RNA extraction. CD147, α-SMA and activated TGF-β1 protein levels, CD147/ERK/STAT3 signalling pathway and autophagy were assessed by Western blot, collagen and inflammatory/fibrogenic cytokines mRNA tissue content by quantitative PCR.

Results

In mice with chronic TNBS colitis, CD147 protein level increased during fibrosis development in colonic tissue, as compared to control mice. CD147 inhibition by AC-73 treatment reduced intestinal fibrosis, collagen and cytokine mRNA tissue content, without significant modulation of activated TGF-β1 protein tissue content. AC-73 inhibited CD147/ERK1/2 and STAT3 signalling pathway activation and induced autophagy.

Conclusions

CD147 is a potential new target for controlling intestinal fibrosis and its inhibitor, AC-73, might represent a potential new anti-fibrotic therapeutic option in IBD.
Guidelines for the management of male urinary tract infections in primary care: a lack of international consensus—a systematic review of the literature
Authors: Soudais Benjamin , Ribeaucoup Florian , Schuers Matthieu
Published: July 2022

Background

The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus. The main objective of this study was to describe the different guidelines for the diagnosis and management of mUTIs in primary care, to assess their methodological quality, and to describe their evidence-based strength of recommendation (SoR).

Methods

An international systematic literature review of the electronic databases Medline (PubMed) and EMBASE, and gray-literature guideline-focused databases was performed in 2021. The Appraisal of Guidelines for Research and Evaluation (AGREE II) assessment tool was used by 2 independent reviewers to appraise each guideline.

Results

From 1,678 records identified, 1,558 were screened, 134 assessed for eligibility, and 29 updated guidelines met the inclusion criteria (13 from Medline, 0 from EMBASE, and 16 from gray literature). Quality assessment revealed 14 (48%) guidelines with high-quality methodology. A grading system methodology was used in 18 (62%) guidelines. Different classifications of mUTIs are described, underlining a lack of international consensus: an anatomic classification (cystitis, prostatitis, pyelonephritis) and a symptomatic classification (approach based on the intensity and tolerance of symptoms). The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10–14 days of fluoroquinolones (FQ), which has become the international gold standard. Guidelines from Scandinavian countries propose short courses (3–5 days) of FQ-sparing treatments: pivmecillinam, nitrofurantoin, or trimethoprim. Guidelines from French-speaking countries use a watchful waiting approach and suggest treating mUTIs with FQ, regardless of fever.

Conclusions

This lack of scientific evidence leads to consensus and disagreement: 14 days of FQ for febrile mUTIs is accepted despite a high risk of antimicrobial resistance, but FQ-sparing treatment and/or short treatment for afebrile mUTIs is not. The definition of afebrile UTIs/cystitis is debated and influences the type and duration of antibiotic treatment recommended.
New Non-native PseudocrypticCyclorhipidionSpecies (Coleoptera: Curculionidae: Scolytinae: Xyleborini) Found in the United States as Revealed in a Multigene Phylogeny
Authors: Smith Sarah M , Cognato Anthony I
Published: July 2022

Pseudocryptic species, those that are difficult to diagnose using traditional taxonomic methods, are serious impediments for recognizing the introduction of non-native species. Rapid identification of species facilitates a rapid response to newly introduced species which can lessen their damaging effects. This situation is acute for known pest species such as xyleborine ambrosia beetles which are difficult to identify given minute morphological, often variable, diagnostic characters. These beetles have been introduced into non-native temperate regions and have caused economic and ecological havoc. In this study, we produced DNA-based phylogenies using four genes for individuals of Cyclorhipidion bodoanum (Reitter, 1913), C. distinguendum (Eggers, 1930), and C. pelliculosum (Eichhoff, 1878) sampled from their introduced and native Asian ranges and as well as other Cyclorhipidion species. In addition, we review subtle morphological characters for diagnostic potential for these similar species. Bayesian phylogenetic analysis produced well-resolved and supported phylogeny that provided evidence for multiple introductions of C. bodoanum and C. distinguendum into the United States and the occurrence of pseudocryptic species. The ambrosia beetles Cyclorhipidion tenuigraphum (Schedl, 1953) and C. nemesis Smith & Cognato, sp. nov. are reported in North America for the first time. We find that the pattern of elytral interstrial setae is an unrealized source for the identification of Cyclorhipidion species. This study resulted in the recognition of six species adventive to the United States with the revised status of C. californicum (Wood, 1975). All species known from North American are diagnosed, illustrated and a key is provided.
The Control Theory as Multidimensional Concept
Authors: Cupido Marjolein
Published: July 2022

The judgment in Ntaganda constitutes a landmark decision in which the Appeals Chamber of the International Criminal Court (ICC) for the first time accepted an accused’s criminal liability based on indirect co-perpetration. And yet, the concept of indirect co-perpetration continues to remain heavily contested. In this article, I use the Ntaganda Trial and Appeals Chamber judgments as a starting point for disentangling the control theory. I argue that the concept of control is a multidimensional theory. It is based on both empirical and normative considerations and constitutes a mixture of individual and collective liability. The meaning of control is not uniform: it varies along several dimensions that are applied depending on the facts of the case. The ICC’s flexible application of the notion of control does not fit well with the uniform framework it has drawn up in establishing the liability of indirect co-perpetrators. There is a gap between the law in the books and the law in action, which triggers questions about the possibilities and limitations of judicial creativity at the ICC. To enable better public accountability, transparency and legal certainty, I propose a model of factor-based reasoning at the ICC that can streamline and better justify what currently is a very fluid liability theory generating problematic case law.
Reconsidering International Compensation in Historical Context
Authors: Barnes Ashley
Published: July 2022

There is growing interest in the push for individuals to seek direct remedies, notably compensation, for violations of international law. Yet, there is more for scholars to glean from the historical antecedents of compensation for individuals as a recurring idea in international law. The notion of ‘international claims’ can be traced back to the late 18th century. International claims commissions began as ad hoc arrangements that tended to follow wars. In contrast to existing historical accounts, however, the author shows there is more at work in the international law precedents for present-day mass claims than a simple rise and fall of a single idea of compensation, with the occasional isolated contemporary resurfacing. The author contends instead that the history of compensation is deeply linked to its context—meaning different things in different periods—and reflected in four models of compensation (Collateral Private Claims, Arbitration–Diplomatic Protection, Reparations and Institutional-Transition).
Assessing the effects of fiscal policy news under imperfect information
Authors: Corrado Luisa , Silgado-Gómez Edgar
Published: July 2022

We study the transmission of fiscal policy under imperfect information where government spending is composed of permanent and transitory components. Agents learn about the previous processes by only observing overall public spending and a noisy signal. Under this theoretical setting, we construct a novel measure of fiscal policy news and show that the estimated variable agrees with the historical narrative evidence for the US economy. Our measure captures sluggish information shocks rather than revisions with the benefit of being generated by a theoretical model. We then document the effects of this proxy on economic activity by using local projection methods. The results indicate that real activity indicators exhibit delayed positive effects. We also notice that public debt shrinks and tax revenues increase after 2 years due to the delayed output expansion in the aftermath of the fiscal news shock.
Comparison of Sequential Dalbavancin With Standard-of-Care Treatment for Staphylococcus aureus Bloodstream Infections
Authors: Molina Kyle C , Lunowa Cali , Lebin Madelyn , Segerstrom Nunez Andrea , Azimi Sara F , Krsak Martin , Mueller Scott W , Miller Matthew A
Published: July 2022

Background

Dalbavancin (DAL) is a long-acting lipoglycopeptide with activity against Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA). This study investigates DAL as sequential therapy in S. aureus bloodstream infections (BSIs).

Methods

We conducted a retrospective cohort study from 2014 to 2021 comparing sequential DAL with standard-of-care therapy (SoC) for S. aureus BSI. The primary outcome was 90-day clinical failure (90-day all-cause mortality or 90-day recurrence). Secondary outcomes were incidence of acute kidney injury, creatinine phosphokinase elevations, catheter-related thrombosis, and hospital-acquired infections. Analyses were adjusted using inverse probability of treatment weighting (IPTW).

Results

Overall, 225 patients (45 DAL, 180 SoC) were included. DAL patients had a higher incidence of community-acquired infection and persons who use drugs; SoC patients had more comorbidities and a longer duration of bacteremia. MRSA incidence was similar between the DAL and SoC groups. The median length of stay was 16 days among DAL recipients compared with 24 days among SoC recipients. Central catheter placement was 17.8% compared with 57.2% in the SoC group. Ninety-day clinical failure occurred in 13.3% and 18.3% of participants in the DAL and SOC groups, respectively. In IPTW-adjusted analysis, sequential DAL was not associated with 90-day clinical failure (adjusted odds ratio, 0.94; 95% CI, 0.333–2.32).

Conclusions

This study provides preliminary evidence that select patients with S. aureus BSI treated with sequential DAL have similar clinical failure rates, with significant reductions in catheter placement and hospital length of stay compared with SoC. Further prospective evaluation is needed.
In Praise of Hunter v Moss—“Not ‘Turmoil’ At All”
Authors: Wai Ronald
Published: July 2022

Hunter v Moss has been viewed with sizable scorn. Its judgement has been described as “confused”, “meaningless”, and “doctrinally wrong”. I disagree with this view—quite emphatically, in fact. In my view, the Hunter judgement is extremely profound. My article investigates what Hunter’s critics have argued, outlines their arguments’ failings, and pinpoints the outstanding contribution Hunter made to equity and trust law.
The tension of the iliopsoas tendon more than doubles during extension of the dysplastic hip in open reduction
Authors: Mojica Edward S. , Pardo García Juan María , Huebschmann Nathan A. , Castañeda Pablo
Published: July 2022

The role of the iliopsoas as an obstructing and re-dislocating factor in developmentally dislocated hips is unclear. The purpose of this article is to determine the change in the iliopsoas’ tension during flexion and extension when performing an open reduction. We evaluated 34 hips undergoing an anterior open reduction for a developmental dislocation. At the time of surgery, we identified the iliopsoas, and before sectioning it as part of the open reduction, we measured the tension while cycling the reduced hip through flexion and extension. We performed statistical analysis using Pearson and Spearman correlation tests. We created an initial tension artificially at 20 N with the hip held in 90º of flexion, which then doubled to a mean of 42 N when placed in extension. We found a significant increase in tension when the hip went below 20º of flexion. We also found the correlation between the angle of the hip and the force of tension to be statistically significant (P = 0.003). This study provides quantitative support that the tension of the iliopsoas tendon increases significantly in extension when performing an open reduction of a developmentally dislocated hip.
The Antepsoas (ATP) Surgical Corridor for Lumbar and Lumbosacral Arthrodesis: A Radiographic, Anatomic, and Surgical Investigation
Authors: Tannoury Chadi , Das Avilash , Saade Aziz , Bhale Rahul , Chen Kathleen , Tannoury Tony
Published: July 2022

Study Design.

Retrospective review of prospectively collected data.

Objective.

To investigate the size of prepsoas surgical corridors, developed between the iliopsoas and prespinal vessels, at all disk levels between L1 and S1 granted by left and right lateral antepsoas (ATP) approaches. Secondary aims include evaluation of presurgery radiographic prepsoas windows between L1 and S1 with respect to the intraoperative findings.

Summary of Background Data.

The ATP technique is an evolving alternative to the transpsoas and direct anterior exposures for lumbar fusion. However, the vascular morphometric data of the ATP approach remain underexplored, especially at L5–S1.

Materials and Methods.

Patients indicated for ATP lumbar-lumbosacral fusion between September 2018 and February 2020 were enrolled (n=121). Data were collected prospectively, including the following (in mm): intraoperative manual measurements of the premobilization psoas-vessel (pre-PV) window, the final postmobilization psoas-vessel (post-PV) window, and the preoperative radiographic psoas-to-vessel distance at the respective studied disk levels.

Results.

A total of 121 patients (75 female, mean age: 55.3 yr, 81.8% right-sided approach) underwent a total of 279 levels of spinal fusion. Irrespective of the ATP access laterality, we noted ample postmobilization psoas-vessel (post-PV differential) corridors: largest at L4–L5 (36–38 mm) followed by L5–S1 (31–35 mm), L3–L4 (32–33 mm), L2–L3 (28–30 mm), and L1–L2 (20–24 mm). Similarly, the relative increases of the psoas-vessel corridors (post-PV and pre-PV differentials, averaged: 31 mm at L5–S1, 32 mm at L4–L5, 26 mm at L3–L4, 25 mm at L2–L3, and 14 mm at L1–L2) were also significant in both lateral approaches. In right flank approaches, the right vascular structures projected more dorsally compared with left-sided vasculature (P<0.05).

Conclusion.

The ATP access offers generous bilateral prepsoas surgical windows to L1–S1 intervertebral disks, allowing for a safe anterior column release, decompression, instrumentation, and fusion.
Anatomical Basis for Malar Augmentation Injection With the Zygomatic Ligamentous System
Authors: Duan Jing , Zhao Wei-Rui , Luo Cheng-En , Luo Sheng-Kang
Published: July 2022

BACKGROUND

The malar augmentation injection has gained popularity in recent years, but the exact location of each injection site has not been clearly identified.

OBJECTIVE

To discover ideal injection sites by comprehensively considering the distributions of ligaments, muscles, and vessels.

MATERIALS AND METHODS

Eighteen cadaver heads were dissected to investigate the zygomatic ligamentous system and to measure the position of muscles. Sixty-six cadaver heads were subjected to computed tomographic scanning and three-dimensional vessel reconstruction. Radiological evaluation of the fillers was performed before and after experimental injection in one hemiface and dissected to confirm safe delivery. Five patients were enrolled in a prospective clinical study. 2D and 3D photographs were taken before and after the injections for comparison.

RESULTS

Site 1 was defined along the zygomatic arch, except the first 1/4 length and the midline of the arch. Site 2 was on the body of the zygoma, superior to the level of the infraorbital foramen and medial to the jugale. Site 3 was defined in the anteromedial midface approximately 30 mm below the lateral canthus.

CONCLUSION

Injections at these 3 sites can be performed within the range of the ligaments to achieve effective lifting effects and minimize potential complications.
High-Frequency Ultrasound for Long-term Safety Assessment of Poly-L-Lactic Acid Facial Filler
Authors: Li Anqi , Long Anyin , Fang Rouyu , Mao Xuming , Sun Qiuning
Published: July 2022

BACKGROUND

Injectable poly-l-lactic acid (PLLA) is a new type of biodegradable dermal filler that has been utilized for soft tissue filling. However, there is no convenient and reliable method to assess the long-term safety of PLLA filler.

OBJECTIVE

To assess the long-term safety of PLLA injection into nasolabial folds by high-frequency ultrasound and to select the ultrasonic probes with the most appropriate frequency.

MATERIALS AND METHODS

After a 30-month PLLA injection into the deep dermis of the nasolabial fold, subjects were examined by high-frequency ultrasound with the 20 MHz and 50 MHz probes.

RESULTS

Twenty subjects with nasolabial fold contour deficiency were enrolled in this study. After a 30-month PLLA injection in nasolabial folds, PLLA degraded entirely in 16 subjects (16/20, 80%), and abnormal echo in the skin was observed in 4 subjects (4/20, 20%) caused by undegraded PLLA microparticles, PLLA microparticles deposition, fibrous nodules, and granuloma. The 20-MHz probe is more appropriate than the 50-MHz probe for evaluating the adverse effects of PLLA injection.

CONCLUSION

High-frequency ultrasound is a rapid, reliable, and noninvasive method to monitor the degradation condition of PLLA and the formation of papules and nodules associated with PLLA injection.
Reduced Tripartite Motif-Containing Protein 29 Deteriorates the Severity of Severe Acute Pancreatitis
Authors: Ji Suzhen , Wang Leilei
Published: July 2022

Objectives

Severe acute pancreatitis (SAP) is the most serious subtype of acute pancreatitis, manifested as multiple-organ failure resulting in high morbidity and mortality. Based on the role of tripartite motif-containing protein 29 (TRIM29) in immune responses, we aimed to explore its effect on SAP.

Methods

Peripheral blood monocyte cells from the SAP or non-SAP patients, as well as bone marrow–derived macrophages from wild-type, TRIM29−/−, or stimulator of interferon genes (STING)−/− mice after injecting 50 mg/kg of cerulein to induce SAP, were isolated to analyze the role of TRIM29 and STING in the SAP.

Results

Tripartite motif-containing protein 29 was significantly reduced in SAP patients. Compared with wild-type mice, TRIM29 deficiency mice displayed more severe symptom of acute pancreatitis after cerulein injection, which were lost in TRIM29−/−STING−/− mice. Moreover, interferon and its related genes, as well as STING degradation, were decreased in TRIM29−/− mice.

Conclusions

Our study demonstrated that TRIM29 negatively regulated the severity of SAP by degrading STING at its downstream, suggesting that TRIM29 and STING might serve as therapeutic targets for SAP.
Long-Term Follow-Up and Immunomonitoring of Relapsing Type 1 Autoimmune Pancreatitis Treated With Rituximab
Authors: Le Cosquer Guillaume , Ribes David , Faguer Stanislas , Jeune Muriel , Alric Laurent , Bournet Barbara , Buscail Louis
Published: July 2022

Objectives

To evaluate the efficacy and safety of rituximab in relapsing type 1 autoimmune pancreatitis  especially the long-term clinical and immunologic impacts.

Methods

All consecutive patients with type 1 autoimmune pancreatitis were retrospectively included. The rituximab protocol was induction therapy of 375 mg·m−2 intravenous weekly for 4 weeks, followed by 500 mg intravenous every 6 months for 2 years. The follow-up included clinical examinations, biological tests, positron emission tomography scan, and immunomonitoring of lymphocyte CD 19+.

Results

Among the 43 patients included, 15 received rituximab induction therapy, followed by maintenance in 10 cases because of 1 or more relapses after steroids (whether or not followed by immunosuppressants) and multiple organ involvement. All patients had a clinical, biological and morphological response, a deep and persistent drop in serum immunoglobulin G4 levels, an extinction of both pancreatic and extra pancreatic hypermetabolic positron emission tomography scan signals, and a depletion of B lymphocyte CD19+. No relapse occurred during the follow-up (62.8 ± standard error of the mean of 11.1 months).

Conclusions

Rituximab is an effective treatment for type 1 autoimmune pancreatitis that provides a rapid strong clinical, biological, and morphological response, which persists after discontinuation without any safety issues.
The Landscape of Acute Pancreatitis Trials Registered in ClinicalTrials.gov
Authors: Jiang Jiao , Huang Shu , Xia Huifang , Zou Kang , Zeng Xinyi , Zhang Han , Zhong Chunyu , Tan Shali , Peng Yan , Lü Muhan , Tang Xiaowei
Published: July 2022

Objectives

Clinical studies are important in informing evidence-based practice for patients with acute pancreatitis (AP). To determine whether registered studies adequately meet this need, we leveraged the ClinicalTrials.gov database to provide an overview of studies pertaining to AP.

Methods

ClinicalTrials.gov was searched and the search term used was AP. Analysis was restricted to studies registered before January 12, 2021.

Results

Of 363,632 trials overall, 234 (0.06%) were eventually included for analysis. Interventional studies and observational studies comprised 67.5% and 32.5% of these studies respectively. Most studies were initiated 2007 or later. Endoscopic retrograde cholangiopancreatography was the single most frequent cause of AP specified in these studies (16.7%). Nearly 72% of these studies had a sample size greater than 50. With respect to study design, 87.3% of interventional studies were randomized, 53.5% were blinded. The top 3 countries with the largest number of registered studies were China (n = 59), followed by the United States (n = 53) and India (n = 12).

Conclusions

Our results indicate that the research activity falls short of what is needed in terms of the burden of AP. The distribution of these AP-related studies by global regions indicates that there exists regional disparities.
Comparing Outcomes and Cost Between Pancreas Transplant and Standard of Care in Patients With Type 1 Diabetes
Authors: Jarmi Tambi , Thao Viengneesee , Borah Bijan J. , Brennan Emily , Moriarty James P. , Spaulding Aaron C.
Published: July 2022

Objectives

Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes. We analyzed the outcome of pancreas transplant alone (PTA) versus standard of care in the United States from 2008 to 2018. We also developed an economic model to analyze the cost-effectiveness of pancreas transplant versus continuing standard of care.

Methods

We used the Scientific Registry of Transplant Recipients database and analyzed PTA recipient survival. Using those results, we developed a Markov model that followed a cohort of 40-year-old patients with type 1 diabetes over a 10-year time horizon. The primary outcomes were (i) the survival benefit of a pancreas transplant, (ii) quality-adjusted life-years (QALYs), and (iii) total costs.

Results

We found no difference in survival advantage of PTA compared with standard of care (hazard ratio, 1.09; 95% confidence interval, 0.56–2.14). However, pancreas transplant ($172,823, 6.87 QALY) was cost-saving compared with standard of care ($232,897, 6.04 QALY) for type 1 diabetes. Pancreas transplantation was cost-effective in 95% of 10,000 simulations in probabilistic sensitivity analysis, using a $100,000/QALY willingness-to-pay threshold.

Conclusions

Although there is no difference in survival for PTA compared with standard of care, PTA is a cost-saving therapy for type 1 diabetes.
Risk Factors for Delayed Gastric Emptying After Pancreaticoduodenectomy
Authors: Bilgiç Çağri , Sobutay Erman , Bilge Orhan
Published: July 2022

Objectives

Delayed gastric emptying (DGE) is a complication that affects the length of hospitalization and associated cost after pancreaticoduodenectomy (PD). The reported risk factors for DGE were controversial. This study aimed to identify risk factors for the development of DGE after PD.

Methods

The patients who underwent PD between October 2010 and October 2020 were retrospectively examined. Multivariate analysis was performed to predict the variables causing DGE.

Results

In total, 225 patients underwent PD. The pylorus preserving PD was applied to 151 patients (67%), whereas standard PD to 74 (33%). The DGE was detected in 26 patients (11.5%). The majority of cases were classified as grade A (57.7%), whereas 38.4% as grade B and 3.9% as grade C. In the multivariate analysis, diabetes mellitus (odds ratio [OR], 3.48; 95% confidence interval [CI], 1.45–8.34; P = 0.05), the preoperative biliary stent (OR, 2.5; 95% CI, 1.04–5.99; P = 0.039), and the pylorus resection (OR, 3.05; 95% CI, 1.28–7.25; P = 0.012) were independently associated with DGE.

Conclusions

We demonstrated that implementation of the preoperative stent, pylorus resection, and diabetes mellitus are independent risk factors for DGE. Pylorus preservation should remain the standard of care in PD.
Benefit From Nonsurgical Treatment for Asymptomatic Pancreatolithiasis
Authors: Yamamoto Satoshi , Inui Kazuo , Katano Yoshiaki , Miyoshi Hironao , Kobayashi Takashi , Tachi Yoshihiko
Published: July 2022

Objective

Clinical guidelines consider abdominal pain an indication for nonsurgical treatment of pancreatolithiasis. We examined benefit from nonsurgically treating asymptomatic pancreatolithiasis.

Methods

We retrospectively reviewed 165 patients with pancreatolithiasis who underwent nonsurgical treatment between 1992 and 2020. Symptoms were absent in 41, while 124 had abdominal pain. In the asymptomatic group, the median follow-up duration was 8 months (range, 0–166 months), and the median age was 61 years (range, 32–80 years). In patients with pain, the median follow-up duration was 43 months (range, 0–293 months), while the median age was 57 years (range, 22–80 years). The male:female ratio was 3.6:1 for asymptomatic patients and 5.9:1 for those with pain. We compared treatment outcome, stone recurrence rate, and changes in pancreatic exocrine function (bentiromide-p-aminobenzoic acid test results) between groups.

Results

Nonsurgical treatment for patients with asymptomatic pancreatolithiasis had a 63% stone clearance rate, lower than 84% for symptomatic pancreatolithiasis but comparable to outcomes at other institutions. Pancreatic exocrine function values during the year after treatment were mean, 52% (standard deviation, 16%) in the asymptomatic group, similar to mean, 57% (standard deviation, 17%) in the symptomatic group.

Conclusions

Nonsurgical treatment in asymptomatic pancreatolithiasis may preserve pancreatic exocrine function as well as in symptomatic pancreatolithiasis.