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Cloud-based telemedicine uses powerful data processing technology to improve remote healthcare services. This helps make healthcare more accessible, efficient, and beneficial for both patients and healthcare providers. However, the security and privacy of patients sensitive data, especially when outsourcing to the cloud, remain significant concerns. To address this issue, patient data is stored in encrypted format on the cloud server. A searchable encryption mechanism is employed to enable efficient search on the encrypted data without compromising information confidentiality. While most searchable encryption schemes support conjunctive field keyword search in both single receiver and multi-receiver scenarios, they often result in partial information leakage related to the searched keywords. Additionally, a new scheme based on the Lagrange polynomial concept was developed to support conjunctive field-free search in a single receiver scenario. However, it is unsuitable for multi-receiver scenarios and suffers from certification management challenges. To overcome these limitations, we propose an innovative approach called "Multi-receiver Certificateless Public-key Searchable Encryption: Field-free Subset Conjunctive and Disjunctive." Our scheme is constructed upon reciprocal maps and leverages Lagrange polynomials as a fundamental tool. It offers several advantages, including cipher-index indistinguishability against chosen keyword attacks, utilizing the hardness of the decisional linear Diffie-Hellman assumption. Theoretical and experimental analyses demonstrate that our proposed scheme achieves comparable performance to existing works in terms of computational efficiency and communication overhead. [ABSTRACT FROM AUTHOR]

Public Key Encryption with Keyword Search (PEKS) is a promising cryptographic primitive that allows searching over encrypted data in secure data outsourcing services. Initially, several PEKS schemes were developed for conjunctive keyword search, but they relied on certain assumptions regarding keyword fields. To address this limitation, an Efficient Public-Key Encryption with Field-free Conjunctive Keyword Search (PEFCK) scheme was introduced in 2015. PEFCK enables conjunctive keyword search without any specific ordering of the keywords. However, PEFCK is vulnerable to keyword guessing attacks (KGA), which compromise its security. To overcome the KGA vulnerability, we propose a new scheme called Public Key Authenticated Encryption with Field-free Subset Conjunctive and Disjunctive Keyword Search (PAEFSCDKS), which leverages the mathematical concept of Lagrange Polynomials. This scheme incorporates three key features: 1) Sender Authentication: The sender encrypts the keywords using both the receiver's public key and its private key, ensuring sender authenticity and integrity. 2) Secure Channel-free: Unlike traditional approaches, our scheme does not require a secure channel to transfer data from the receiver to the cloud server. This eliminates the need for additional secure communication overhead. 3) Subset Conjunctive and Disjunctive Keyword Search: The receiver can perform queries that involve both subset conjunctive and disjunctive keywords, enabling more flexible and powerful searches. Furthermore, we demonstrate that our proposed scheme achieves provable security under index indistinguishability and trapdoor indistinguishability against both internal and external adversaries. Finally, through performance analysis, we show that our proposed scheme outperforms similar PEKS schemes in terms of both theoretical and experimental evaluations. [ABSTRACT FROM AUTHOR]

Evaluation of safety is of paramount importance with adoption of novel surgical technology. Although robotic surgery has become widely used in oncologic surgery, analysis of safety is lacking in comparison to traditional techniques. Standardized assessment of robotic surgical outcomes and adverse events following oncologic surgery is necessary for quality improvement with innovative technology. Between 2003 and 2016, 10,013 unique robotic operations were performed in 9,858 patients. Our prospectively maintained database was retrospectively reviewed for hospital readmissions and Clavien–Dindo grade ≥ 2 complications within 30 days. Multivariable logistic regression was used to identify predictors of surgical complications and hospital readmissions. Cases were stratified by discipline: genitourinary (n = 8240), gynecologic (n = 857), thoracic (n = 457), gastrointestinal (n = 322), hepatobiliary (n = 60), ear/nose/throat (n = 44) and general (n = 33). Intraoperative complications occurred in 42 surgeries (0.4%). Postoperative complications occurred in 946 patients [9.4%, highest grade 2 (n = 574), 3 (n = 288), 4 (n = 72), 5 (n = 10)]. Most frequent complications were ileus (154, 16.3%), anemia (91, 9.6%), cardiac arrhythmia (62, 6.6%), deep vein thrombosis/pulmonary embolus (47, 5.0%), wound infection (45, 4.8%) and urinary leak (43, 4.5%). 405 patients (4.0%) required readmission. Most common causes for hospital readmission were ileus (44, 10.9%), urinary leak (23, 5.7%), urinary tract infection (23, 5.7%), intra-abdominal abscess/fluid collection (23, 5.7%), and small bowel obstruction (19, 4.7%). On multivariable analysis, longer operative time and older age predicted complications and readmissions (p ≤ 0.02). Robotic-assisted surgery appears a safe for oncologic surgery with acceptable hospital readmission and complication rates. Older age and longer operative time were associated with complications and readmission. [ABSTRACT FROM AUTHOR]

Optimal management of node-positive prostate cancer patients after prostatectomy remains a challenge. We evaluated clinically localized patients who demonstrated node positivity and identified predictors for secondary treatment. From 2010 to 2015, clinically localized prostate cancer patients who underwent robot prostatectomy with extended lymphadenectomy and node-positive disease on pathologic analysis were identified. Clinical N1, M1 or salvage cases were excluded. Patients were stratified based on secondary treatments. Kaplan-Meier method was used to determine the time to biochemical and metastatic recurrence. Multivariate logistic regression was used to identify predictors for additional treatment. 145 patients (45 no additional therapy, 47 adjuvant, 53 salvage) had a median follow-up of 31.2 months. Salvage patients had higher median pre-operative prostate-specific antigen (10.8 vs. 9.7 vs. 8.2, p = 0.1), higher percentage of pathologic Gleason ≥8 (50.9 vs. 38.3% and 22.2%, p < 0.01), and higher median-positive nodes (3 vs. 1 and 1, p < 0.0001) compared to adjuvant and no treatment groups, respectively. Pathologic Gleason ≥8 (OR = 3.5, p = 0.007) and positive nodes ≥2 (OR = 3.3, p = 0.006) were associated with additional therapy. In the no treatment group, two-year estimated BCRFS was 74.3%. Two-year metastatic recurrence-free rates for no treatment, adjuvant and salvage groups were 100, 87.5, and 80.9%, respectively (p = 0.01). Observation is a viable alternative for low metastatic burden patients. In the largest series of node-positive patients from robotic prostatectomy and extended lymphadenectomy, those with pathologic Gleason ≥8 and positive lymph nodes ≥2 were more likely to receive additional treatment. [ABSTRACT FROM AUTHOR]