Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer

Efficient Cryptographic Protocol Design for Secure Sharing of Personal Health Records in the Cloud

The sharing of Personal Health Records (PHR) in the cloud is the most promising platform to exchange health-related information. However, personal medical and health information storage is outsourced to third parties, potentially exposing patients' privacy to unauthorized individuals or groups. This paper intends to propose a new SSPHR (Secure Sharing PHR) method in the cloud. The proposed SSPHR method can preserve the privacy of PHRs and also ensures patient-centric control on PHRs. The encrypted PHRs are stored on the untrusted cloud servers and it grants selective access to different users on different PHRs portions. In addition, a semi-trusted proxy known as Setup and Re-encryption Server (SRS) is presented to arrange the public/private key pairs and to generate the re-encryption keys. This paper introduces a new Modified El-Gamal encryption for preserving health records and it includes key generation, encryption, and decryption process. Finally, the proposed model performance is compared and proven against other existing methods.

Optimization assisted Kalman filter for cancer chemotherapy dosage estimation

Cancer is regarded to be the earth's most deadly disease, with one of the highest mortality rates among people. "Surgery, radiotherapy, chemotherapy, hormone therapy, and immunotherapy" were all options for treat cancer. Chemotherapy is a medication that is most often deployed for treating cancer, as cancer cells develop and proliferate faster than other cells in the body. Even though chemotherapy is an effective method to treatment various kinds of cancers, the treatment includes risk as it causes side effects due to improper drug usage. The application of a controller-based strategy for determining the optimal rate of drug injection during treatment has risen dramatically in recent years. Thereby, this work develops a robust controller for controlling the dosage of drugs that is carried out under parameter estimation. In addition, a Modified Regularized Error Function-based Extended Kalman filter (MREF-EKF) is introduced for estimating the tumor cells and it can be exploited for diverse conditions. Moreover, the overfitting issue that occurs during drug dosage estimation is also solved using this approach. Further, to improve the performance of the developed approach, the initial state of EKF is fine-tuned via Mean fitness-based Particle Swarm Update (MF-PSU), which is the enhanced version of Particle Swarm Optimization (PSO). At last, the supremacy of the presented approach is proved with respect to convergence analysis and error analysis. For instance, our method outperforms existing GWO + e_k + m, AGWO + e_k + m, and PSO + e_k + m approaches in convergence analysis at noise level 0.41 by 0.009%, 0.002%, and 4.9% respectively. In error analysis, the error values for tumor cells have reached a minimum error value of zero for all noise levels (0.41, 0.43, and 0.55). The findings of this study can help for a better understanding of our presented robust controller's effectiveness in controlling the dosage of drugs.

Anatomical versus functional motor points of selected upper body muscles

INTRODUCTION

In this study we aimed to identify nerve entry points (NEPs) of superficial skeletal muscles obtained by dissection of 20 human cadavers and compared them with motor points (MP) obtained previously by electrical stimulation.

METHODS

The biceps brachii (BB), trapezius (TZ), latissimus dorsi (LD), pectoralis major (Pmaj), and pectoralis minor (Pmin) muscles were dissected from human cadavers. NEP data (mean ± standard deviation) from each muscle were calculated. F-tests with Bonferroni corrections were used to compare NEPs and MPs.

RESULTS

The number of NEPs was 2 in BB, 1 in Pmin, 4 in TZ, and 3 in LD, whereas the total number in Pmaj varied from 3 to 5. NEPs and MPs were statistically equal only in Pmin and in the descending part of TZ.

DISCUSSION

The findings show crucial differences between NEPs and MPs, possibly impacting the effectiveness of several medical treatment strategies. Muscle Nerve 57: 460-465, 2018.

A new technique to repair huge tracheo-gastric fistula following esophagectomy

We reported the management of a life-threatening condition as a large tracheo-gastric fistula involved the carina, the left and the right bronchus that complicated Ivor Lewis esophagogastrectomy for esophageal cancer. An urgent right thoracotomy was performed and the tracheal defect was covered with a reversed pedicled pericardial patch reinforced with an intercostal muscle flap. Cervical esophagostomy and a feeding jejunostomy completed the operation. Five months later, the continuity of gastrointestinal tract was restored using a transverse colon.

Pathological clavicular fracture as first presentation of renal cell carcinoma: a case report and literature review

Renal cell carcinoma (RCC) accounts for approximately 3% of all cancer cases. RCCs usually metastasize to the lungs, bones, liver, or brain. Only <1% of patients with bone metastases manifested clavicular RCC metastases. Thus, clavicular metastasis as the initial presentation of RCC is extremely rare. We report a patient with RCC metastasis to the left clavicle, which was first presented with pain caused by a pathological fracture. Magnetic resonance image revealed a renal tumor, and technetium-99m–methylene diphosphonate bone scintigraphy showed multiple osseous metastases. The patient eventually underwent surgery to remove the lateral end of the left clavicle and right kidney. Histopathology revealed renal tumor and clear cell carcinoma in the clavicle. Finally, we review 17 cases of clavicular metastases originating from different malignancies.