bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Effectiveness of the Pipeline Flex Embolization Device With Shield Technology for the Treatment of Intracranial Aneurysms: Midterm Results From a Multicenter Study
Authors: Trivelato Felipe Padovani , Wajnberg Eduardo , Rezende Marco Túlio Salles , Ulhôa Alexandre Cordeiro , Piske Ronie Leo , Abud Thiago Giansante , de Castro-Afonso Luís Henrique , Abath Carlos Gustavo Coutinho , Nakiri Guilherme Seizem , Araújo João Francisco Santoro , Silva José Laércio Júnior , Tosello Renato Tavares , Vanzin José Ricardo , Manzato Luciano Bambini , Baccin Carlos Eduardo , da Mota Bruno Anderson Araújo , Abud Daniel Giansante 
Published: August 2019

Abstract

BACKGROUND
The safety and efficacy of the first generation of the Pipeline Embolization Device (PED; Medtronic Inc) have been proven in large case series. Ischemic events are one of the most common complications following treatment of aneurysms with flow diverters. The new PED Flex with Shield technology (PED Shield; Medtronic Inc) was introduced to minimize the rate of complications.

OBJECTIVE
To evaluate the outcomes of patients harboring aneurysms treated with the PED Shield.

METHODS
This was an observational, prospective, single-arm multicenter study of patients treated with the PED Shield. The primary safety endpoint was the absence of major neurological complications and death. The secondary effectiveness endpoint was angiographic occlusion at 6 and 12 mo. Technical complications were also reported.

RESULTS
Between November 2017 and December 2018, 151 patients from 7 centers with 182 aneurysms were enrolled. The mean aneurysm size was 7.0 mm; 27 (14.8%) aneurysms were large, and 7 (3.8%) were giant. In 141 of 151 patients (93.4%), the primary endpoint was reached. The overall rate of periprocedural complications was 7.3%. Of the aneurysms, 79.7% met the study's secondary endpoint of complete occlusion at 6 mo and 85.3% at 12 mo.

CONCLUSION
The PED Shield is a safe and effective treatment for intracranial aneurysms. The results regarding total occlusion and ischemic complications did not differ from those obtained in case series using previous versions of the PED. Long-term follow-up and comparative studies are required to provide stronger conclusions regarding the reduced thrombogenicity of this device.
Patchwork States: The Localization of State Territoriality on the South Sudan–Uganda Border, 1914–2014*
Authors: Leonardi Cherry 
Published: August 2019

Abstract
This paper takes a localized conflict over a non-demarcated stretch of the Uganda–South Sudan boundary in 2014 as a starting point for examining the history of territorial state formation on either side of this border since its colonial creation in 1914. It argues that the conflict was an outcome of the long-term constitution of local government territories as patches of the state, making the international border simultaneously a boundary of the local state. Some scholars have seen the limited control of central governments over their borderlands and the intensification of local territorialities as signs of African state fragmentation and failure. But the article argues that this local territoriality should instead be seen as an outcome of ongoing state-formation processes in which state territory has been co-produced through local engagement and appropriation. The paper is thus of wider relevance beyond African or postcolonial history, firstly in contributing a spatial approach to studies of state formation which have sought to replace centre–periphery models with an emphasis on the centrality of the local state. Secondly it advances the broader field of borderlands studies by arguing that international boundaries have been shaped by processes of internal territorialisation as well as by the specific dynamics of cross-border relations and governance. Thirdly it advocates a historical and processual approach to understanding territory, arguing that the patchwork of these states has been fabricated and reworked over the past century, entangling multiple, changing forms and scales of territory in the ongoing constitution of state boundaries.
On the Rise of FinTechs: Credit Scoring Using Digital Footprints
Authors: Berg Tobias , Burg Valentin , Gombović Ana , Puri Manju 
Published: August 2019

Abstract
We analyze the information content of a digital footprint—that is, information that users leave online simply by accessing or registering on a Web site—for predicting consumer default. We show that even simple, easily accessible variables from a digital footprint match the information content of credit bureau scores. A digital footprint complements rather than substitutes for credit bureau information and affects access to credit and reduces default rates. We discuss the implications for financial intermediaries’ business models, access to credit for the unbanked, and the behavior of consumers, firms, and regulators in the digital sphere. (JEL G20, G21, G29)
Immunotherapy for non-small cell lung cancer
Authors: Vafadar Sam 
Published: August 2019

ABSTRACT
Immunotherapy is a new genre of treatment for patients with advanced cancer. Initially approved for use in metastatic melanoma, immunotherapy has found a significant place in treating non-small cell lung cancer (NSCLC). Clinical trials using several combinations of immunotherapy are underway to help to determine the best treatment for specific patient groups. This article reviews approved uses of immunotherapy for NSCLC, immune-related toxicities, and explores the future direction of this treatment.
Current and emerging treatments for sickle cell disease
Authors: Monus Taylor , Howell Christopher M. 
Published: August 2019

ABSTRACT
Sickle cell disease (SCD) is a group of inherited blood disorders affecting the hemoglobin, shortening the lifespan of erythrocytes, and causing them to take on a distinctive sickled shape that can lead to vaso-occlusion. Current treatment aims to reduce morbidity and mortality through hydroxyurea, erythrocyte transfusion, and hematopoietic stem cell transplantation. This article reviews the disease process, typical presentations, complications, and acute and chronic treatment options.
Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction: A Single-Center Experience
Authors: Haddock Nicholas T. , Cho Min-Jeong , Teotia Sumeet S. 
Published: August 2019

Background:
As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction.

Methods: One thousand seventy
flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups.

Results:
Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism.

Conclusions:
Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Complications and Quality of Life following Reduction Mammaplasty in Adolescents and Young Women
Authors: Nuzzi Laura C. , Firriolo Joseph M. , Pike Carolyn M. , DiVasta Amy D. , Labow Brian I. 
Published: August 2019

Background:
Adolescent reduction mammaplasty remains controversial because of concerns of postoperative breast growth, complications, and the effect on well-being. The authors sought to prospectively quantify early and late complications following reduction mammaplasty in adolescents and young women, and examine the intersection of surgical complications and postoperative health-related quality of life.

Methods:
From 2008 to 2017, female patients aged 12 to 21 years undergoing reduction mammaplasty were asked to complete the 36-Item Short-Form Health Survey (version 2), the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, and the Eating-Attitudes Test-26 preoperatively and postoperatively at 6 months and 1, 3, 5, and 7 years. Clinical evaluations using standardized forms assessed baseline and postoperative symptomatology, complications, and surgical outcomes.

Results:
In the authors’ sample of 512 participants, the most common complications included hypertrophic scarring (20.0 percent) and altered sensation of the nipple (8.4 percent) or breast (7.8 percent). Patient age, body mass index category, and amount of tissue resected did not significantly increase the odds of developing a complication. Significant postoperative improvements on the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, the Eating-Attitudes Test-26, and in all 36-Item Short-Form Health Survey domains (i.e., physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) were largely seen irrespective of whether complications occurred.

Conclusions:
Although complications following reduction mammaplasty were common, the vast majority were minor. Patients had significant postoperative improvements in their physical and psychosocial well-being regardless of whether they experienced a complication. Concerns for potential complication, especially in younger and overweight or obese patients, should not preclude otherwise healthy adolescents and young women from the benefits of reduction mammaplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Long-Term Static and Dynamic Effects of Surgical Release of the Tear Trough Ligament and Origins of the Orbicularis Oculi in Lower Eyelid Blepharoplasty
Authors: Wong Chin-Ho , Mendelson Bryan 
Published: August 2019

Background:
Release of the tear trough ligament and the origins of the orbicularis oculi is a key maneuver with many lower blepharoplasty techniques. The long-term static and dynamic effects of this release have not been studied previously.

Methods:
From December of 2012 to June of 2017, 105 patients were treated with the extended transconjunctival lower eyelid blepharoplasty with release of the tear trough ligament and fat redistribution as described previously. The long-term effect of the release was assessed by evaluating the effectiveness in correcting the tear trough deformity, the effect on the lower eyelid position, and the dynamic changes of the patient’s smile.

Results:
The mean patient age was 41 years (range, 23 to 62 years). The mean follow-up was 31 months (range, 12 to 53 months). The tear trough was effectively corrected with this maneuver. This release did not compromise the tarsoligamentous support of the lower eyelid, with no increase in scleral show in 99 percent of patients and with no patients developing ectropion. Functionally, the change in the action of the orbicularis oculi as a result of detachment of its origins resulted in a change in appearance of the smile. Elimination of the tethering at the tear trough ligament and the downward pull toward the medial suborbital maxilla resulted in elevation of the lid-cheek junction with smiling. Reduced efficiency of orbicularis contraction resulted in a diminished pretarsal bulge and in reduction of crow’s feet with smiling.

Conclusions:
The maneuver is effective in correcting the tear trough deformity while not weakening the lower eyelid tarsoligamentous support. Functionally, the patient’s smile became more youthful and rejuvenated, with less wrinkling and elevation of the lid-cheek junction with smiling.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Efficacy of Botulinum Toxin in Treating Asian Indian Patients with Masseter Hypertrophy: A 4-Year Follow-Up Study
Authors: Shome Debraj , Khare Stuti , Kapoor Rinky 
Published: August 2019

Background:
Asian Indians usually have wide lower faces because of masseter hypertrophy. The authors evaluated the efficacy of botulinum toxin type A in long-term management of bilateral masseter hypertrophy in Asian Indian patients.

Methods:
Fifty patients were enrolled in the study and injected with 30 U of botulinum toxin type A to each side of the face, at baseline. Based on masseter muscle thickness and response to the injections, 25 patients underwent a second injection session at week 12, and the other 25 patients underwent additional third sessions, at week 24 after the first injection, respectively. Standardized photography and ultrasonography were performed to assess facial contour and masseter muscle thickness at baseline and at 1-, 2-, 3-, and 4-year follow-ups. A p value < 0.05 was considered statistically significant.

Results:
The authors observed 12 percent (p < 0.0001) average masseter muscle size reduction at week 12. The maximum reduction (26.6 percent; p < 0.0001) was observed at week 24 for the patients who received two injections and maintained an average 24.43 percent (p < 0.0001) reduction until follow-up at year 4. Patients who received three injections exhibited very high reduction (42.52 percent; p < 0.0001) of masseter volume at week 36 and maintained an average 40.64 percent (p < 0.0001) reduced volume until year 4.

Conclusions:
Botulinum toxin type A treatment is effective for long-term management of bilateral masseter hypertrophy. Doses repeated at 12-week intervals accentuate masseter volume reduction and also help maintain reduced masseter volume for 4-year follow-up, with satisfactory facial contour.
Reconstruction of Posterior Mandibulectomy Defects in the Modern Era of Virtual Planning and Three-Dimensional Modeling
Authors: Chang Edward I. , Boukovalas Stefanos , Liu Jun , Largo Rene D. , Hanasono Matthew M. , Garvey Patrick B. 
Published: August 2019

Background:
Posterior mandibulectomy defects can be reconstructed using either soft tissue or vascularized bone. The authors hypothesize that advances in computer-aided design and manufacturing (CAD-CAM) have resulted in osteocutaneous free flaps now proving superior to soft-tissue flaps.

Methods:
The authors conducted a retrospective review of all free flap reconstructions of posterior mandibulectomy defects where the condyle was resected from 2005 to 2016.

Results:
Overall, 291 patients (mean age, 56.9 years; mean body mass index, 26.2 kg/m2) underwent posterior mandible reconstruction with 169 soft-tissue flaps and 122 osteocutaneous free flaps (90 free-hand versus 32 CAD-CAM). Forty patients (13.7 percent) required two free flaps to reconstruct the defect, most commonly a fibula osteocutaneous flap for the mandibulectomy defect and a soft-tissue flap for external coverage. Postoperatively, there were no differences in the incidence of trismus between soft-tissue versus vascularized bone flaps; however, malocclusion was most common in patients with soft-tissue flaps (p < 0.001). Patients with CAD-CAM bone reconstruction experienced significantly less malocclusion (p < 0.001), were more likely to progress to a regular diet (p = 0.001), and trended to having superior speech (p = 0.057) compared with the other cohorts. There were six total flap losses, with no difference between soft-tissue and bony flaps.

Conclusions:
Although reconstruction of posterior mandibulectomy defects should be based on the patient’s comorbidities, surgeon comfort, and available resources, patients undergoing reconstruction of posterior mandibulectomy defects reconstructed with CAD-CAM–assisted fibulas experienced superior postoperative function compared with soft-tissue flaps or free-hand fibula flaps.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Volumetric Analysis in Autologous Fat Grafting to the Foot
Authors: Ruane Edward J. , Minteer Danielle M. , Wyse Aaron J. , Gusenoff Beth R. , Gusenoff Jeffrey A. 
Published: August 2019

Background:
Pedal fat grafting is a safe, minimally invasive approach to treat pedal fat pad atrophy. Prior randomized controlled trials demonstrate that the fat as measured directly under the metatarsal heads disappears between 2 and 6 months after fat grafting, despite patients having relief for 2 years. The authors aim to use magnetic resonance imaging to further assess three-dimensional volume of fat in the foot after autologous fat grafting to help explain the mechanism for improved pain.

Methods:
A prospective study was performed using magnetic resonance imaging before and at 6 months after pedal fat grafting to assess changes in the three-dimensional morphology of the fat.

Results:
Seventeen patients (six men and 11 women) underwent injections with a mean volume of 5.8 cc per foot. At 6 months, patients demonstrated increased tissue thickness (p = 0.008) and volume (p = 0.04). Improvements were seen in pain (p < 0.05) and activity (p < 0.05). Foot pressures and forces were significantly decreased and positively correlated with increased fat pad volume (p < 0.05).

Conclusions:
Pedal fat grafting significantly increases metatarsal fat pad volume. The distribution of the fat may contribute to lasting clinical relief in these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review
Authors: Abi-Rafeh Jad , Zammit Dino , Mojtahed Jaberi Mehrad , Al-Halabi Becher , Thibaudeau Stephanie 
Published: August 2019

Background:
Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model’s complexity, characteristics, advantages, disadvantages, and validation measures taken.

Methods:
A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria.

Results:
Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators.

Conclusions:
A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today’s training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.
Revaluation of magnetic properties of Magneto, MagR and αGFP−TRPV1/GFP−ferritin
Authors: Wang Guangfu , Zhang Peng , Mendu Suresh K. , Wang Yali , Zhang Yajun , Kang Xi , Desai Bimal N. , Zhu J. Julius 
Published: August 2019

ABSTRACT AND INTRODUCTIONMagnetic control of neuronal activity offers many obvious advantages over electric, optogenetic and chemogenetic manipulations. A recent series of highly visible papers reported the development of magnetic actuators (i.e., Magneto, MagR and αGFP−TRPV1/GFP−ferritin) that appeared to be effective in controlling neuronal firing1–3, yet their action mechanisms seem to conflict with the principles of physics4. We found that neurons expressing Magneto, MagR and αGFP−TRPV1/GFP−ferritin did not respond to magnetic stimuli with any membrane depolarization (let alone action potential firing), although these neurons frequently generated spontaneous action potentials. Because the previous study did not establish the precise temporal correlation between magnetic stimuli and action potentials in recorded neurons1–3, the reported magnetically-evoked action potentials are likely to represent mismatched spontaneous firings.
RAD-Behavior (Recombining Atomized, Discretized, Behavior): A new framework for the quantitative analysis of behavioral execution
Authors: Ligon Russell A. , Scholes Edwin , Sheehan Michael J. 
Published: August 2019

ABSTRACTThe ability to precisely describe and numerically evaluate organismal phenotypes is a prerequisite for addressing most questions in evolutionary biology and ecology. The quantification and comparison of behavior, loosely defined as an external response to stimuli, is particularly challenging because the myriad axes of variation that exist make comparisons, both within and among species, difficult. Such evaluations often boil down to comparisons of time-budgets (e.g. relative investment in courtship displays) or probabilities (e.g. likelihood of engaging in a class of behaviors in a particular context) – which we refer to as behavioral strategies. A focus on variation in behavioral strategies underlies most research in evolutionary and ecological studies of behavior. Equally important, however, is perhaps the question of ‘how’ animals are actually performing the complex motor sequences that comprise behaviors (i.e. behavioral execution). What are the patterns of movement, the relative transition rates, and kinematics underlying the behaviors exhibited in particular contexts? Understanding how behavioral execution differs among individuals, populations, and species has the potential to provide new insights into the factors shaping variation in behavior and the processes shaping behavioral evolution at different scales. Here, we propose a broad framework for comparing behavioral execution (RAD-behavior: recombining atomized, discretized behavior) that leverages string-matching/bioinformatic tools to understand phenotypic variation in behavioral execution and which holds the potential to yield novel insights about the evolutionary ecology of behavior at multiple scales.