Forecasting number of vulnerabilities using long short-term neural memory network

Cyber-attacks are launched through the exploitation of some existing vulnerabilities in the software, hardware, system and/or network. Machine learning algorithms can be used to forecast the number of post release vulnerabilities. Traditional neural networks work like a black box approach; hence it is unclear how reasoning is used in utilizing past data points in inferring the subsequent data points. However, the long short-term memory network (LSTM), a variant of the recurrent neural network, is able to address this limitation by introducing a lot of loops in its network to retain and utilize past data points for future calculations. Moving on from the previous finding, we further enhance the results to predict the number of vulnerabilities by developing a time series-based sequential model using a long short-term memory neural network. Specifically, this study developed a supervised machine learning based on the non-linear sequential time series forecasting model with a long short-term memory neural network to predict the number of vulnerabilities for three vendors having the highest number of vulnerabilities published in the national vulnerability database (NVD), namely microsoft, IBM and oracle. Our proposed model outperforms the existing models with a prediction result root mean squared error (RMSE) of as low as 0.072

Replantation services in a Malaysian Public Hospital

Replantation services are a highly specialized field and are usually rendered by a tertiary centre in most hospitals around the world. Usuallv these centres would have an existing established plastic surgery unit or dedicated hand depaftment. In a developing country like Malaysia, replantation services also do exist and are mainly taken care by few centres with established hand units. This service is offered by our hospital, which is a public hospital with no established plastic surgery or hand surgery unit. This service was started in early 2005 and we would like to share our experiences. Majority of the cases are from industrial injuries and most of these cases are from remote areas. We have about 11 cases of partial amputation injuries and 7 total amputations. For the revascularization cases, we obtained 100% success rate. and about 80% of replantation cases. We would like to share our experience of success and failures in building up a highly specialized field of orthopaedic sub-specialization

Microsurgical services at the Department of Orthopaedic

Microsurgery is an area of specialization needed in the field of reconstruction. lt enables complex procedures like replantation, revascularization, free flaps and vascularised bone grafts to be done. The microsurgical services in our department started after the arrival of the microsurgical microscope in 2003. With the availability of such a service, we are able to independently deal with most of the complex and complicated injuries of the limbs with neurovascular involvement. This case series is our early experiences in handling such cases which require microsurgical expertise. To date, this centre has managed amputated, partially amputated limbs and vascular injuries with a reasonable success rate

Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis

INTRODUCTION Osteochondroma is a benign cartilaginous disease of the bone. Its exophytic growth can occasionally result in periarticular deformity and pain. We describe a case of large osteochondroma of the lateral malleolus causing deformity and pain in a growing child. METHODS A 12 year-old boy with multiple hereditary exostosis, presented with a huge left ankle osteochondroma which became painful for the past 1 year with worsening deformity of the lateral malleolus. He could not participate in sport activities due to the ankle deformity and pain. Examination revealed multiple small bony swelling over both wrists, knees and scapulae. Local examination revealed a bony swelling at the left lateral malleolus measuring 8X8 cm with varus deformity of the ankle. However, the range of ankle motion was full. Radiograph revealed a large sessile bony outgrowth on the distal lateral tibia compressing the lateral malleolus with thinning of the bone and widening of the syndesmotic joint (Figure 1). He underwent excision of the tumour and anatomical reconstruction of the syndesmotic ligament via anterior approach. Multiple drill holes were made at the base of the lesion and the tumour was osteotomized. The ankle syndesmosis had 2 cm widening and reconstruction was performed using tightrope(Arthrax) with endobuttons. Postoperatively, he was immobilised with backslab for 2 weeks and allowed full-weight bearing after 6 weeks. RESULTS At one year follow-up, the lateral malleolus has remodelled and the syndesmotic joint has anatomically reduced with the tightrope (Figure 2). No recurrence was detected. The pain resolved and he had no residual deformity. DISCUSSIONS Multiple osteochondromas is an autosomal dominant disorder with a very high penetrance. The lesions usually develop within the first two decades of life and cease to grow with the closure of the physeal plate [1]. Most are asymptomatic throughout their lives but they may present with ankle pain, a palpable mass and unrestricted ankle motion [2]. Pain in osteochondromas are commonly caused by compressive effect, bursitis, arthritis and tendon, nerve or vessel impingements [3,4]. Ankle involvement is not uncommon and has been reported from 25% to 54% in patients with multiple hereditary exostosis [5]. Untreated or partially excised lesions may potentially lead to plastic deformation of the distal tibia and fibula and pronation deformity of the ankle in skeletally immature patients [2]. Lateral malleolus erosion and impending fracture has been reported which required excision and cast immobilisation [6]. From our literature review, this is the first reported case of syndesmotic reconstruction in an ankle osteochondroma with syndesmotic widening. Syndesmotic reconstruction should be considered if widening is significant. If left untreated, syndesmotic instability may lead to early ankle pain and osteoarthritis. Due to the high growth potential in children, the lateral malleolus and the distal tibia have high propensity to remodel to normal alignment. CONCLUSION Excision of osteochondroma and anatomical reconstruction of the syndesmotic joint with tightrope suture has a good outcome with no complications. This method is particularly advantageous in a growing child as no removal of hardware is required

Acute vascular complications (flap necrosis and congestion) with one stage and two stage distally based sural flap for wound coverage around the ankle

anatomy has improved in the last decade. It has lead to technique modification such as the staged procedure in performing sural flaps and improvement in the flap survival rate. The aim of this study was to evaluate the acute vascular complications (flap necrosis or congestion) of 29 patients who underwent distal base sural flap for coverage of wound around the ankle. Methods: Twenty-four males and five females with a mean age of 37.1 years old underwent sural flap surgery to cover wounds at around the ankle. There were 12 cases of open fracture, five infected fractures, four spoke injuries, four degloving injuries and four diabetic foot ulcers. Twentythree cases were done as a single stage procedure while six as a two-stage procedure. The flaps were tunnelled under the skin in three cases. Results: Twenty one flaps healed uneventfully, seven acute vascular complications occur in a single stage group: five developed partial necrosis, one had congestion with epidermolysis, and one had complete flap necrosis. Complications were treated by dressing or skin grafting and only one required a repeat flap surgery. Conclusions: Acute vascular complications may be minimised when sural flap is done in stages for elderly, diabetic, smokers and/or patients with large wound around the ankle. Even if the flap appears necrotic, the underlying structure may still be covered as the fasciosubcutaneous layer of the flap may still survive

Gram negative infection following plating of Tibia resulted with exposed bone and implant

We report four cases of gram negative infection following plating of the tibia that resulted in expose bone and metal implant which were treated in our center from March 2003 till December 2008. The incidence of Gram negative implant related infection is increasing and probably has poorer outcome. Treatment of this condition requires both bone and soft tissue reconstruction technique that is done in three stages (debridement, soft tissue reconstruction and bone reconstruction). All patient achieved union at the end of follow up.The mean union time is 9.25 months (ranges from 6 to 12 months) after the injury. At the end of follow up, only one patient had persistent infection but able to ambulate normally following fracture union)

Factors Associated with the Outcome of Open Tibial Fractures

Background: Although open tibial fractures are common in Malaysia, the outcomes for these patients have not been evaluated in the literature. This retrospective study was conducted to examine the factors associated with infection and non-union in open tibial fractures managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009. Methods: From 1 January until 31 December 2009, the Department of Orthopaedics of HTAA managed 58 patients with open tibial fracture who had a minimum of a one year follow-up period. The median age was 24.5 years (range: 4 to 72 years). The open tibial fractures were graded using the Gustilo open fracture classification as follows: 4 grade I, 21 grade II, 24 grade IIIA and 9 grade IIIB. All open fractures were subjected to a standard treatment protocol at HTAA, which includes the use of prophylactic antibiotics, emergency debridement, fracture stabilisation, wound coverage, and bone reconstruction when required. The mean time from injury to the initial debridement was 29.7 hours (range: 13 to 216 hours). Results: Seventeen (29%) cases were complicated by infection, and 10 patients (17%) developed non-union. The grade of the open fracture was significantly associated with infection, and age and the time interval between the injury and the initial wound debridement were significantly associated with non-union. Conclusions: The high rates of infection and non-union, particularly in severe open fractures, indicate that there is a need to improve the management of open tibial fractures treated at HTAA. The time to initial debridement is an important factor that can be readily amended to improve the outcome. Further studies with larger sample sizes are likely needed to replicate and confirm our findings

Factors associated with the outcome of open tibial fractures

Background: Although open tibial fractures are common in Malaysia, the outcomes for these patients have not been evaluated in the literature. This retrospective study was conducted to examine the factors associated with infection and non-union in open tibial fractures managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009. Methods: From 1 January until 31 December 2009, the Department of Orthopaedics of HTAA managed 58 patients with open tibial fracture who had a minimum of a one year follow-up period. The median age was 24.5 years (range: 4 to 72 years). The open tibial fractures were graded using the Gustilo open fracture classification as follows: 4 grade I, 21 grade II, 24 grade IIIA and 9 grade IIIB. All open fractures were subjected to a standard treatment protocol at HTAA, which includes the use of prophylactic antibiotics, emergency debridement, fracture stabilisation, wound coverage, and bone reconstruction when required. The mean time from injury to the initial debridement was 29.7 hours (range: 13 to 216 hours). Results: Seventeen (29%) cases were complicated by infection, and 10 patients (17%) developed non-union. The grade of the open fracture was significantly associated with infection, and age and the time interval between the injury and the initial wound debridement were significantly associated with non-union. Conclusions: The high rates of infection and non-union, particularly in severe open fractures, indicate that there is a need to improve the management of open tibial fractures treated at HTAA. The time to initial debridement is an important factor that can be readily amended to improve the outcome. Further studies with larger sample sizes are likely needed to replicate and confirm our findings. Keywords: assessment, case management, fractures, open, patient outcome, tibi