Secure Biomedical Document Protection Framework to Ensure Privacy Through Blockchain

In the recent health care era, biomedical documents play a crucial role, and they contain much evidence-based documentation associated with many stakeholders data. Protecting those confidential research documents is more difficult and effective, and a significant process in the medical-based research domain. Those bio-documentation related to health care and other relevant community-valued data are suggested by medical professionals and processed. Many traditional security mechanisms such as akteonline and Health Insurance Portability and Accountability Act (HIPAA) are used to protect the biomedical documents as they consider the problem of non-repudiation and data integrity related to the retrieval and storage of documents. Thus, there is a need for a comprehensive framework that improves protection in terms of cost and response time related to biomedical documents. In this research work, blockchain-based biomedical document protection framework (BBDPF) is proposed, which includes blockchain-based biomedical data protection (BBDP) and blockchain-based biomedical data retrieval (BBDR) algorithms. BBDP and BBDR algorithms provide consistency on the data to prevent data modification and interception of confidential data with proper data validation. Both the algorithms have strong cryptographic mechanisms to withstand post-quantum security risks, ensuring the integrity of biomedical document retrieval and non-deny of data retrieval transactions. In the performance analysis, Ethereum blockchain infrastructure is deployed BBDPF and smart contracts using Solidity language. In the performance analysis, request time and searching time are determined based on the number of request to ensure data integrity, non-repudiation, and smart contracts for the proposed hybrid model as it gets increased gradually. A modified prototype is built with a web-based interface to prove the concept and evaluate the proposed framework. The experimental results revealed that the proposed framework renders data integrity, non-repudiation, and support for smart contracts with Query Notary Service, MedRec, MedShare, and Medlock

Operative outcome of high energy pilon fractures: a retrospective comparison between internal fixation and Ilizarov external fixation

Background: Pilon fractures are serious injuries with many devastating soft-tissue complications associated with them. Deciding a definite treatment plan has always proved a challenge. Comparative studies between the various surgical techniques used for pilon fractures are uncommon and consensus is yet to be reached regarding the best surgical option. Purpose of this study is to retrospectively compare the operative results (complications, functional and radiographic outcomes) of pilon fractures treated either with internal fixation or Ilizarov ring fixators.Methods: Forty-six patients with pilon fractures were retrospectively studied; twenty-one of them had minimal invasive fixation by ankle spanning Ilizarov fixators and 25 patients had internal fixations by either minimal invasive plate osteosynthesis (MIPO) or by open reduction.  The patients were followed-up for a mean of 34 months (range, 24-51 months).Results: The internal fixation group had a higher incidence of soft-tissue complications and deep infections. In comparison the Ilizarov group had only superficial pin-tract infections but no other soft-tissue complications. Although the Ilizarov group had a higher incidence of malreduction and malunion in their series compared to the internal fixation group, there was no significant difference in the AOFAS ankle function score (p-value 0.2922) between the two groups after a follow-up of 2-4 years.Conclusions: The moderately long term functional outcome appears to be similar in both internal fixation and Ilizarov groups. But the Ilizarov technique is less likely to cause any serious peri-operative soft-tissue complications or deep infection. Familiarity of the surgeon with a particular technique should also be considered during surgical decision making.

Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

Background: Unstable intertrochanteric fractures belonging to 31A2 and A3 varieties are difficult challenges for orthopaedic surgeons, particularly in the elderly patients. Osteosynthesis by dynamic hip screw or proximal femoral nail are often plagued by complications like screw cut-out, excessive collapse and fixation failures due to osteoporotic bones. Because of these complications, patients are often kept confined to the bed which may increase the risks of pressure sores, venous thrombosis and pulmonary infections. So, it is desirable to mobilize these elderly patients as quickly as possible following surgery. In recent decades, primary hemi-arthroplasty has emerged as a valuable treatment option for mobilizing these patients early.Methods: We present our retrospective study on 27 patients above 60 years of age, who were managed with cemented bipolar hemi-arthroplasty after sustaining unstable intertrochanteric fractures. All the patients were operated through modified Hardinge approach. The fractured fragments were secured by stainless steel wiring, particularly the greater trochanter, wherever necessary.Results: Twenty-three patients (85%) were able to stand up with walkers by third post-operative day and were able to walk by fifth post-operative day. There was one case of hip dislocation; it was reduced under anaesthesia. No other complications were encountered at an average follow-up of 3.1 years. The Harris hip score was ‘good’ or ‘excellent’ in more than 60% patients.Conclusions: Cemented hemi-arthroplasty appears to be a reliable treatment method for unstable intertrochanteric fractures in the elderly and it allows early weight-bearing and rehabilitation in most patients following surgery.

Management of infected non-unions of long bones using limb reconstruction system (LRS) fixator

Background: Due to increasing number of high-energy traumatic events, the incidence of complex and compound fractures are also in the rise. Such fractures are often exposed to various environmental contaminants, inadequate debridement and sometimes erroneous decision making leading to cases of infected nonunions. Eradication of infection in such cases and achieving union may sometimes pose serious challenge to orthopaedic surgeons. Presence of comminution, bone gap or deformity can seriously complicate the situation. No definite surgical technique has been found to be full proof in dealing with these infected nonunion cases. In this scenario the limb reconstruction system (LRS) fixator is emerging as a useful option for infected nonunions with deformity or gap nonunion.Methods: Twenty seven cases of infected nonunions involving tibia (n=19), femur (n=7) and humerus (n=1) were treated by LRS fixators after debridement of the infected nonunion site. Flap cover procedure was done as per necessity. Bone gaps and limb length discrepancies were dealt with bone transport or limb lengthening by the LRS instrument. Weight-bearing and removal of fixator was decided according to the radiological evidence of healing.Results: All the nonunions and the regeneration sites healed uneventfully, although the union time was varied (range, 21-52 weeks). Commonest complication was pin-tract infection and pain. The mean lower extremity functional score (LEFS) was 60.3 out of 80. Conclusions: LRS fixator is an excellent tool for management of infected nonunions which is easy to apply, comfortable for the patient with minimum complications and predictable as well as reproducible outcomes

Efficacy and safety of mavrilimumab in giant cell arteritis:a phase 2, randomised, double-blind, placebo-controlled trial

OBJECTIVES: Granulocyte-macrophage colony-stimulating factor (GM-CSF) is implicated in pathogenesis of giant cell arteritis. We evaluated the efficacy of the GM-CSF receptor antagonist mavrilimumab in maintaining disease remission. METHODS: This phase 2, double-blind, placebo-controlled trial enrolled patients with biopsy-confirmed or imaging-confirmed giant cell arteritis in 50 centres (North America, Europe, Australia). Active disease within 6 weeks of baseline was required for inclusion. Patients in glucocorticoid-induced remission were randomly assigned (3:2 ratio) to mavrilimumab 150 mg or placebo injected subcutaneously every 2 weeks. Both groups received a 26-week prednisone taper. The primary outcome was time to adjudicated flare by week 26. A prespecified secondary efficacy outcome was sustained remission at week 26 by Kaplan-Meier estimation. Safety was also assessed. RESULTS: Of 42 mavrilimumab recipients, flare occurred in 19% (n=8). Of 28 placebo recipients, flare occurred in 46% (n=13). Median time to flare (primary outcome) was 25.1 weeks in the placebo group, but the median was not reached in the mavrilimumab group (HR 0.38; 95% CI 0.15 to 0.92; p=0.026). Sustained remission at week 26 was 83% for mavrilimumab and 50% for placebo recipients (p=0.0038). Adverse events occurred in 78.6% (n=33) of mavrilimumab and 89.3% (n=25) of placebo recipients. No deaths or vision loss occurred in either group. CONCLUSIONS: Mavrilimumab plus 26 weeks of prednisone was superior to placebo plus 26 weeks of prednisone for time to flare by week 26 and sustained remission in patients with giant cell arteritis. Longer treatment is needed to determine response durability and quantify the glucocorticoid-sparing potential of mavrilimumab. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number: NCT03827018, Europe (EUdraCT number: 2018-001003-36), and Australia (CT-2018-CTN-01 865-1)

Quantifying the Impact of Immune History and Variant on SARS-CoV-2 Viral Kinetics and Infection Rebound: A Retrospective Cohort Study

BACKGROUND: The combined impact of immunity and SARS-CoV-2 variants on viral kinetics during infections has been unclear. METHODS: We characterized 1,280 infections from the National Basketball Association occupational health cohort identified between June 2020 and January 2022 using serial RT-qPCR testing. Logistic regression and semi-mechanistic viral RNA kinetics models were used to quantify the effect of age, variant, symptom status, infection history, vaccination status and antibody titer to the founder SARS-CoV-2 strain on the duration of potential infectiousness and overall viral kinetics. The frequency of viral rebounds was quantified under multiple cycle threshold (Ct) value-based definitions. RESULTS: Among individuals detected partway through their infection, 51.0% (95% credible interval [CrI]: 48.3-53.6%) remained potentially infectious (Ct CONCLUSIONS: SARS-CoV-2 viral kinetics are partly determined by immunity and variant but dominated by individual-level variation. Since booster vaccination protects against infection, longer clearance times for BA.1-infected, boosted individuals may reflect a less effective immune response, more common in older individuals, that increases infection risk and reduces viral RNA clearance rate. The shifting landscape of viral kinetics underscores the need for continued monitoring to optimize isolation policies and to contextualize the health impacts of therapeutics and vaccines. FUNDING: Supported in part by CDC contract #200-2016-91779, a sponsored research agreement to Yale University from the National Basketball Association contract #21-003529, and the National Basketball Players Association

A rare truncating BRCA2 variant and genetic susceptibility to upper aerodigestive tract cancer

© The Author 2015. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] Funding This work was supported the National Institutes of Health (R01CA092039 05/05S1) and the National Institute of Dental and Craniofacial Research (1R03DE020116). Notes The authors thank all of the participants who took part in this research and the funders and technical staff who made this study possible. We acknowledge and thank Simone Benhamou (INSERM, France) for sample contributions. We also acknowledge and thank The Cancer Genome Atlas initiative, whose data contributed heavily to this study.Peer reviewedPublisher PD

The 12p13.33/RAD52 locus and genetic susceptibility to squamous cell cancers of upper aerodigestive tract

Acknowledgments: The authors thank all of the participants who took part in this research and the funders and support and technical staff who made this study possible. We also acknowledge and thank The Cancer Genome Atlas initiative whose data contributed heavily to this study. Funding: Funding for study coordination, genotyping of replication studies and statistical analysis was provided by the US National Institutes of Health (R01 CA092039 05/05S1) and the National Institute of Dental and Craniofacial Research (1R03DE020116). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Design, synthesis and membrane ion transport properties of cystine- and serine-based cyclo-4-oxa-heptane-1,7-bisamides

A new class of cyclobisamides, having the general profile of amino acid (cystine or serine)-ether composites, as potentially efficient ion transporters has been designed and synthesized. In model membranes, the adamantane harboring composites exhibited 57-66% of gramicidin A activity in ion transport