bluuebunny/crossref_metadata_2025_split huggingface dataset:
You Will or UWOn’t: Trustees’ Compliance with Unexplained Wealth Orders
Authors: Stringer-Fehlow Mariel , Steen Peter 
Published: March 2019

Abstract
Much has been written about Unexplained Wealth Orders (UWOs) since they came into existence on 31 January 2018; however, very little attention has been paid—at least in the legal press—to the potential impact such Orders could have on Trustees (both offshore and onshore). Following recent decisions by Supperstone J in late 2018 (National Crime Agency v Mrs A [2018] EWHC 534 (Admin)), we now know a little more about how the Court will approach UWOs, in particular where there is an offshore/trust element. This article focuses on highlighting the most pertinent issues which will likely need to be addressed by trustees and beneficiaries: should either party be served with a UWO, or be connected to someone who is served? The UWO legislation remains in its infancy, however, it is clear that enforcement agencies increasingly regard UWOs as useful tools in their armoury. The interface between UWOs and trusts is likely to create heightened tension between beneficiaries under intense pressure from the English Court, and offshore trustees looking to protect themselves and their beneficiaries. This article is aimed at increasing the awareness of trustees and advisers of the potential impact of UWOs, and in particular the fact that UWOs will not just affect those in the United Kingdom. The respondent to a UWO does not need to live in the United Kingdom, and the property which can be the subject of a UWO also does not need to be located in the United Kingdom, so offshore individuals need to also be aware of UWOs and their potential ramifications.
Successful Management of Gamma-hydroxybutyrate (GHB) Withdrawal Using Baclofen as a Standalone Therapy: A Case Report
Authors: Habibian Sonia , Ahamad Keith , McLean Mark , Socias Maria Eugenia 
Published: March 2019

Background:
Gamma-hydroxybutyrate (GHB)—a GABA-B agonist—can lead to a use disorder, and a withdrawal syndrome similar to that of alcohol. At present, evidence is lacking for how to best manage GHB withdrawal, and often clinicians rely on alcohol withdrawal management approaches, using medications like benzodiazepines (BZD). However, BZD doses needed to control GHB withdrawal symptoms are typically much higher than those required for alcohol, posing significant safety risks. Novel approaches include the use of baclofen as an adjunct to BZD, allowing reductions in BZD requirements. While the use of baclofen as monotherapy may result in even greater risk reductions, research to support this approach is limited.

Case:
We present a case of a 26-year-old female with severe GHB use disorder and history of severe withdrawal symptoms, whose withdrawal was successfully, managed using baclofen alone.

Conclusion:
In keeping with other case reports, baclofen appears to have potential to be used in the management of GHB withdrawal. Here, we presented a case of severe GHB withdrawal which was managed solely by baclofen. Clinical research is needed to evaluate baclofen's potential as a standalone treatment for GHB withdrawal.
Update on transarterial approaches to locoregional treatment in hepatocellular carcinoma
Authors: Delhaye Corentin , Hendlisz Alain , Vouche Michael 
Published: March 2019

Purpose of review
This review explores current knowledge and recent data about vascular-centered locoregional treatments and proposes alternate algorithms.

Recent findings
Hepatocellular carcinoma represents the sixth most common neoplasm worldwide. Currently, the Barcelona Clinic Liver Cancer (BCLC) staging is the most commonly used in Europe for treatment allocation. According to this classification, European Society for Medical Oncology (ESMO) guidelines currently recommend transarterial chemoembolization for intermediate stage HCC and systemic treatments, such as, sorafenib in more advanced stages. However, strong evidences are still lacking to conclude to the superiority of one technique over another, as the optimal treatment choice remains challenging and should take into consideration more clinical, biological and imaging findings than reported in the BCLC staging system, such as patient age or clinical status, tumor characteristics (including distribution and heterogeneity), tumor vascularization and concomitant portal hypertension or biliary anomalies.

Summary
Many controversies remain, in particular, the relative place of bland embolization versus chemoembolization, the clinical benefit of drug-eluting bead chemoembolization (DEB-TACE) over conventional chemoembolization (cTACE), as well as the real place of radioembolization in general setting as well as innovative applications, such as radiation segmentectomy and radiation lobectomy.
Laparoscopic-assisted Versus Open D2 Gastrectomy for Advanced Gastric Cancer in Highly Selective Patients
Authors: Huang Xin , Du Hao , Aihemaiti Maimaiti , Liu Teng , Chen Ningyuan , Yu Wenbin , Hu Sanyuan , Liu Shaozhuang 
Published: March 2019

Objectives:
The feasibility and efficacy of laparoscopic-assisted D2 gastrectomy (LAD2G) for advanced gastric cancer (AGC) remain controversial. We conducted a prospective cohort study to provide a comprehensive comparison of LAD2G and open D2 gastrectomy (OD2G) for AGC.

Materials and Methods:
Between April 2016 and December 2017, patients with clinical stage T2-4aN0-3M0 gastric cancer were enrolled and assigned to either LAD2G or OD2G group. The primary endpoint was short-term surgical and chemotherapy outcomes. The postoperative pain and perioperative anxiety were compared as the secondary endpoint to indicate perioperative life quality.

Results:
A total of 110 patients in LAD2G group and 238 patients in OD2G group were included. The 2 groups showed similar number of retrieved lymph nodes (29.85±6.52 vs. 30.60±5.37, P=0.069) and postoperative morbidity (21.01% vs. 21.82%, P=0.888). A total of 84.4% of patients in LAD2G group and 75.6% in OD2G group received adjuvant chemotherapy (AC) (P=0.069). The mean time interval to AC was shorter in LAD2G group (34±13.74 vs. 40.78±18.78 d, P<0.001). Furthermore, LAD2G was superior to OD2G in terms of earlier postoperative recovery, faster relief of postoperative pain, and lower postoperative anxiety.

Conclusions:
LAD2G is feasible for AGC in experienced centers. Patients after LAD2G tended to have earlier initiate of AC. LAD2G could provide more rapid postoperative recovery and relief of postoperative pain, along with lower postoperative anxiety.
Outcomes of Adjuvant Radiotherapy Following Negative Surgical Margins for Cutaneous Squamous Cell Carcinoma
Authors: Miller Jonathan , Chang Timothy , Schwartz David , Peters Margot , Baum Christian 
Published: March 2019

BACKGROUND
The role of adjuvant radiotherapy (ART) for cutaneous squamous cell carcinoma (cSCC) following negative surgical margins is unclear.

OBJECTIVE
To retrospectively examine the clinical outcomes in a cohort of patients with cSCC who completed ART after Mohs micrographic surgery or wide local excision with negative margins.

METHODS AND MATERIALS
After the institutional review board approval, a retrospective review was conducted of all patients with cSCC treated in the Mayo Clinic Department of Radiation Oncology from March 10, 1998, through April 26, 2013. Inclusion criteria were age >18 years, resection with negative histologic surgical margins, and completion of ART.

RESULTS
Thirty-two patients met the inclusion criteria: 15 patients died, 12 without evidence of disease related to cSCC. Three patients developed recurrent disease, all with poorly differentiated cSCC, > 2 cm in clinical diameter, perineural invasion, and Brigham and Women's (BWH) stage T2b/T3; 2 of 3 patients were immunosuppressed; and 2 of 3 patients died of cSCC-related causes.

CONCLUSION
These data suggest that the combination of surgical resection and ART is a reasonable option for Brigham and Women's T2b/T3 tumors.
Squamous Cell Carcinoma In Situ With Occult Invasion: A Tertiary Care Institutional Experience
Authors: Newsom Emily , Connolly Karen , Phillips William , Lee Erica , Rossi Anthony , Navarrete-Dechent Cristian , Busam Klaus , Dusza Stephen W. , Nehal Kishwer 
Published: March 2019

BACKGROUND
The rate of occult invasive disease within biopsy-proven squamous cell carcinoma in situ (SCCIS) is not well defined.

OBJECTIVE
To examine the rate of occult invasion in SCCIS.

METHODS
An institutional-wide pathology database was retrospectively searched for “squamous cell carcinoma in situ” over a 6-year period, and the treatment modality and final pathology results were analyzed for evidence of invasion. In addition, consecutive tumor blocks from Mohs micrographic surgery (MMS) cases of SCCIS were prospectively analyzed for invasion.

RESULTS
The rate of occult invasion for biopsy-proven SCCIS treated with excision was 4.0% (N = 49) and for the MMS margins was 3.5% (N = 310). For the prospective MMS tumor block analysis, the rate of occult invasion was 10.1% (N = 69). No clinical factors (age, sex, location, or size) correlated with increased risk of invasion. All invasive SCCs detected were superficial and well differentiated.

CONCLUSION
The rate of occult invasion for biopsy-proven SCCIS ranged from 3.5% to 10.1%. The detected rate of invasion varies based on the method of excision and pathology processing of specimens. The rate of invasion should be considered when managing SSCIS.
Efficacy and Safety of PrabotulinumtoxinA for the Treatment of Glabellar Lines in Adult Subjects: Results From 2 Identical Phase III Studies
Authors: Beer Kenneth R. , Shamban Ava Theresa , Avelar Rui L. , Gross John E. , Jonker Anneke ,   and the EV-001/EV-002 Study Group
Published: March 2019

BACKGROUND
PrabotulinumtoxinA is a 900-kDa botulinum toxin Type A produced by Clostridium botulinum.

OBJECTIVE
To investigate the efficacy and safety of prabotulinumtoxinA for the treatment of glabellar lines.

MATERIALS AND METHODS
Adult subjects (n = 330 in EV-001; n = 324 in EV-002) with moderate to severe glabellar lines at maximum frown on the 4-point Glabellar Line Scale (GLS; 0 = no lines, 1 = mild, 2 = moderate, and 3 = severe) were enrolled in 1 of 2 identical 150-day, double-blind, placebo-controlled, single-dose, Phase III studies. Subjects were randomized 3:1 to receive 20-U prabotulinumtoxinA or placebo. The primary efficacy end point was the proportion of responders on Day 30 where the investigator and subject independently agreed that a ≥2-point improvement had occurred on the GLS at maximum frown from Day 0. Adverse events (AEs) were evaluated throughout the study.

RESULTS
Responder rates in the prabotulinumtoxinA and placebo groups were 67.5% and 1.2% in EV-001 and 70.4% and 1.3% in EV-002; absolute differences between groups were 66.3% and 69.1% in EV-001 and EV-002, respectively (both p < .001). No serious AE in either study was assessed as study drug related.

CONCLUSION
In these studies, a single dose of 20-U prabotulinumtoxinA was safe and effective for the treatment of glabellar lines.
An Observational Study of the Safety and Efficacy of Tissue Stabilized–Guided Subcision
Authors: Geronemus Roy G. , Kilmer Suzanne L. , Wall Simeon H. , Green Jeremy B. , Cohen Joel L. , Weiss Robert A. , Alster Tina S. , Kaminer Michael S. , Gupta Anjali 
Published: March 2019

BACKGROUND
Cellulite is a common female cosmetic concern for which there are few treatment options with long-term effectiveness data. The aim of this multisite prospective registry study was to collect observational data on the real-life clinical use of a tissue stabilized–guided subcision (TS-GS) system for long-term improvement of cellulite appearance.

METHODS
Fifty-three subjects were enrolled and received a single treatment using the TS-GS system. Physicians treated the subjects according to their standard of care. Global Aesthetic Improvement Scale (GAIS) was completed by the patient and clinician assessing overall aesthetic improvement after 180 days. Treatment parameters, pain scores, quality of life data, and expected treatment effects and adverse events were also recorded throughout the study.

RESULTS
The patient and physician GAIS scores at Day 180 revealed an overall improvement in 91% and 96% of patients, respectively. Quality of life and self-confidence scores also improved through 180 days. No serious adverse events were reported. Expected treatment effects were similar to those reported in the pivotal trial supporting FDA clearance.

CONCLUSION
This study demonstrated significant improvement in the appearance of cellulite after a single treatment session in patients with moderate-to-severe cellulite. These results are consistent with the previously published the pivotal study data.
Efficacy and Safety of Prabotulinumtoxin A and Onabotulinumtoxin A for Crow's Feet: A Phase 3, Multicenter, Randomized, Double-Blind, Split-Face Study
Authors: Cheon Hye In , Jung Nari , Won Chong Hyun , Kim Beom Joon , Lee Yang Won 
Published: March 2019

BACKGROUND
Prabotulinumtoxin A has been shown to have efficacy for the treatment of upper-limb spasticity and improvement of moderate to severe glabellar lines. However, the efficacy and safety of prabotulinumtoxin A for crow's feet have not been evaluated.

OBJECTIVE
This study compared the efficacy and safety of prabotulinumtoxin A and onabotulinumtoxin A in the treatment of crow's feet.

PATIENTS AND METHODS
A multicenter, randomized, double-blind, active-controlled, split-face study was conducted in subjects with bilateral symmetric, moderate to severe crow's feet at maximum smile. The investigators assessed the severity of crow's feet by using the facial wrinkle scale, and the subjects reported the improvement in severity, their subjective satisfaction, and perceived age. The primary efficacy outcome was the proportion of subjects with Grade 0 or 1 severity of crow's feet at maximum smile at Week 4 as assessed by the investigators.

RESULTS
In the primary efficacy outcome assessment, there was no significant difference between the 2 groups (prabotulinumtoxin A, 65.02%; onabotulinumtoxin A, 62.56%; p = .0956). All secondary efficacy outcomes were also achieved. Adverse events related to injection were mild and recovered spontaneously.

CONCLUSION
Prabotulinumtoxin A and onabotulinumtoxin A have comparable efficacy and safety in the treatment of crow's feet.
Clinical Assessment of 2 Licensed AbobotulinumtoxinA Injection Volumes for the Treatment of Glabellar Lines
Authors: Kaufman Joely , Cohen Joel L. , Peredo Marina I. , Jonas Brandie , Down Rebecca , Nogueira Alessandra 
Published: March 2019

BACKGROUND
Two licensed reconstitution volumes may be used to achieve the recommended abobotulinumtoxinA (ABO) dose for glabellar line correction.

OBJECTIVE
Comparison of efficacy, safety, and subject satisfaction concerning treatment of moderate to severe glabellar lines with 2 different ABO reconstitution volumes.

MATERIALS AND METHODS
Phase IV, prospective, randomized, multicenter, subject- and evaluator-blinded study: 60 subjects received 1 ABO (50 units) treatment, administered as a 1.5- or 2.5-mL reconstitution. Primary objective was Day 30 improvements (≥1-point) in glabellar line severity. Onset of effect, duration, subject satisfaction, and treatment-related adverse events (AEs) were assessed.

RESULTS
At Day 30, 90.0% and 86.7% of subjects achieved ≥1-point improvements with 1.5- and 2.5-mL reconstitutions, respectively. Median time to onset of effect was 48 hours after treatment. At 24 hours, 26.7% achieved ≥1-point improvements with the 2.5-mL reconstitution versus 6.7% with the 1.5-mL reconstitution. Maximum response was at Day 14, and >40% maintained efficacy through Day 120 in each group. High subject satisfaction was sustained throughout observation. Most AEs were mild. No serious AEs were reported.

CONCLUSION
Both ABO reconstitutions were well tolerated and effective in correcting glabellar lines with no significant differences concerning efficacy or duration of effect. No serious AEs were reported.
Internal Mammary Artery and Vein Perforator Vessels as Troubleshooter Recipient Vessels
Authors: Fansa Hisham 
Published: March 2019

Summary:
In autologous breast reconstruction, the internal mammary artery (IMA) and internal mammary vein (IMV) are the standard recipient vessels. Recently, the perforator vessels of the IMA and IMV were found to be a safe alternative as recipient vessels cause less morbidity and allow adequate flap. We describe 2 cases in which the IMA and IMV perforators were used as additional recipient vessels to overcome intraoperatively occurred complications. The IMA and IMV perforators have some advantages over the IMA/IMV: (1) the dissection is done superficially and directly from the mastectomy site. Flap positioning is facilitated. (2) There is no need to remove a rib, which reduces postoperative pain and possible contour deformities. (3) Possible injuries to the pleura are avoided. (4) The IMA is spared for possible cardiac revascularization. Disadvantages can be that (1) the IMA perforators are not always present with the required caliber, (2) the position of the perforators is not suitable to adequately position the flap, and (3) dissection of the IMA perforators and their anastomoses has a learning curve. In the presented cases, the IMA and IMV perforators have proven to offer a simple solution to avoid complications. The additional dissection is done from the same recipient site, and there is no further dissection or incision necessary at the axilla or to explore the cephalic vein. This keeps morbidity and operation time low. Therefore, we suggest keeping the IMA and IMV perforators in mind not only as primary recipient vessels but also as a possible solution for intraoperatively occurred complications.
Monitoring and Dose Assessment for Children Following a Radiation Emergency—Part II: Calibration Factors for Thyroid Monitoring
Authors: Li Chunsheng , Tremblay Marilyn , Capello Kevin , Kurihara Osamu , Youngman Mike , Etherington George , Ansari Armin , López María Antonia , Franck Didier , Dewji Shaheen 
Published: March 2019

Abstract
Past radiological and nuclear accidents have demonstrated that monitoring a large number of children following a radiological and nuclear emergency can be challenging, in accommodating their needs as well as adapting monitoring protocols and applying age-specific biokinetics to account for various ages and body sizes. This paper presents the derived calibration factors for thyroid monitoring of children of all ages recommended by the International Commission on Radiological Protection using four selected detectors at given times following a short-term (acute) intake of 131I by inhalation. These calibration factors were derived by Monte Carlo simulations using the models of various detectors and pediatric voxel phantoms. A collection of lookup tables is presented in this paper which may be directly used as a quick reference by emergency response personnel or technical experts performing thyroid monitoring and assessment without doing time-consuming calculations.
Demonstrating Compliance With Proposed Reduced Lens of Eye Dose Limits in Nuclear Medicine Settings
Authors: Demeter Sandor , Goertzen Andrew L. , Patterson Judy 
Published: March 2019

Abstract
Based on ongoing research on ionizing radiation thresholds for cataracts, the International Commission on Radiological Protection has proposed new guidelines lowering the annual occupational lens of eye dose limit from 150 mSv to 20 mSv. The International Atomic Energy Agency has operationalized these new guidelines. Subsequently, national/regional radiation protection regulators are reviewing their lens of eye dose limits with an aim of moving towards the proposed new limits, resulting in licensees having to demonstrate compliance. In health care settings, fluoroscopic interventional practices generally have higher lens of eye doses and nuclear medicine settings generally have lower doses. A prospective cohort (n = 19) of nuclear medicine technologists wore dedicated lens of eye dosimeters for a 3 mo period synchronized with their body dosimeter schedules. The lens of eye dosimeters were validated to have a linear response in the anticipated dose ranges. The participants worked in a relatively high-volume nuclear medicine practice, which included general and cardiac, positron emission tomography/computed tomography, radiopharmacy, and cyclotron operations. The annualized dose ranges were 0.0–3.68 mSv (lens of eye) and 0.48–4.72 mSv (whole body). There was a good correlation between lens of eye and body dosimeter readings (R
2 = 0.67). There were no significant differences in lens of eye dose by work type, worker sex, or side on which the dosimeter was worn. The findings should be generalizable to other similar practices, especially in North America, and should be sufficient to demonstrate regulatory compliance in nuclear medicine settings with the proposed new lens of eye dose limits.
An Alternative Approach to Estimating Instrument Decision Thresholds for Clearance of Personal Property From Accelerator Facilities
Authors: Schaefer Charles Wesley 
Published: March 2019

Abstract
Personal property exposed to particle beams and stray radiation at high-energy particle accelerators may contain induced volumetric radioactivity. At both the Brookhaven National Laboratory’s (BNL) Collider-Accelerator and National Synchrotron Light Source II Facilities this radioactivity contains both gamma-emitting and beta-emitting radionuclides. The US Department of Energy (US DOE) recently published Technical Standard 6004-2016. This standard provides radionuclide-specific volumetric screening levels (Bq g−1) below which accelerator materials are eligible for clearance and release from radiological control. The standard also establishes several approaches for decision-making relative to the clearance process implemented, one of which is the “Indistinguishable from Background” (IFB) approach. BNL implements the IFB approach for survey of potentially activated accelerator materials. Radiological control technicians perform on-contact measurements using portable scintillators that are sensitive to gamma and x-ray radiation. Instrument decision thresholds are usually estimated by measuring total background counts over a pre-determined counting interval using an integrating count-rate instrument and then applying an appropriate confidence level factor. Measurement results obtained in a low background area are then directly compared to these detection thresholds. This paper presents an alternative statistical approach using logistic regression for estimating instrument decision thresholds for small-mass items using the IFB method and compares them to established release criteria. On-contact Micro-R meter measurements are correlated with analytical data obtained for activated materials weighing 0.3 kg to 3 kg. Analytical sample results show that 60Co and 22Na accounted for more than 90% of total sample radioactivity. 60Co and 22Na emit high-energy gamma rays and are both group one radionuclides as defined in DOE-6004-2016. For this size material the results show that the probability of detecting residual volumetric radioactivity at the Group One screening level concentration of 0.11 Bq g−1 under normal field conditions is about 68%. This increases to 95% at 0.16 Bq g−1. The 95% confidence interval is 0.09 Bq g−1 to 0.23 Bq g−1. Grouping low-mass items during the survey process could mitigate this concern if all items are expected to have similar activity concentrations.