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The rapid development of digital imaging and computer vision has extended the potential of using these technologies in the diagnosis of human diseases. Medical image analysis is a non-invasive way to identify human diseases which are usually manually marked by medical experts or automatically detected by the Computer-Aided Diagnostic (CAD) system. The fundus images provide facts and information about visual disorders (diabetic retinopathy, glaucoma, age-related macular degeneration, etc.), brain disease (Alzheimer's), and heart-related diseases (cardiovascular, hypertension, and stroke). Extensive research has been done in the last two decades in developing automated methods for the identification of various human disorders from fundus images. This survey paper provides the reader with a broad review of the fundus image processing for the identification of various human disorders. In this paper, human diseases that can be diagnosed through fundus images are reviewed. Several publicly available fundus datasets which are helpful in the screening of these abnormalities are briefly discussed. This work aims to show the importance of retinal images in the diagnosis of different human diseases. The main challenges and difficulties faced in effective diagnosis are presented and discussed. We believe that this work will guide the researchers in addressing the challenges in existing solutions and assist doctors in the proper diagnosis of various diseases.

In this paper, a metal frame antenna is proposed for CubeSat communications. A $100\text{mm}\times 100\text{mm}\times 5\text{mm}$ metal frame is integrated with loop antenna on a $60\text{mm}\times 70\text{mm}$ substrate. The proposed antenna was simulated using HFSS to show its far-filed performance. The simulation results show that the antenna on CubeSat can achieve a maximum gain of 10.48dBi and dual band performance on S-band. In simulation, the reflection coefficients of the proposed antenna are −20.6dB at 2.4GHz with a narrow −10dB bandwidth of 35MHz, and −21.3dB at 2.1GHz with a narrow −10dB bandwidth of 40MHz. The measured results proved that the fabricated antenna operates on dual band centered at 2.1GHZ and 2.5GHz with −19.53dB and −16.61dB return loss respectively. The measured radiation pattern is well matched with simulation to shows good feasibility of the fabricated antenna.

Background and objective Urinary tract infections (UTIs) are usually treated with empirical therapy by physicians based on previous knowledge of the predictability of causative agents and their antimicrobial susceptibilities. The objective of this study was to determine the frequency of various pathogens causing UTIs and their antimicrobial resistance profile in patients presenting to the outpatient department (OPD) of a tertiary care hospital. Materials and methods This descriptive cross-sectional study was conducted in the urology OPD of a tertiary care hospital in Pakistan. The study was conducted over a period of six months, and it included 1,000 patients (of ages 12 years or above) who were clinically suspected for UTIs. Patients with comorbidities and immunocompromised patients were excluded from the study. Recipients of corticosteroid therapy or those with a history of intake of broad-spectrum antibiotics in the previous 15 days were also excluded. The modified Kirby-Bauer disc diffusion method was used for determining antimicrobial resistance against various antimicrobials. Results Out of 1,000 tested specimens, 530 (53%) isolates were found to be culture-positive. E.coli was the most common species isolated from the cultures with a prevalence of 77.4%, followed by Klebsiella (6.4%), Enterobacter (6.0%), Pseudomonas (3.8%), Staphylococcus saprophyticus (3.4%), Citrobacter (1.1%), and Morganella (0.4%). Antimicrobial resistance against commonly used antimicrobials was found to be alarmingly high. Conclusion E.coli was the most commonly isolated microorganism from the urine samples of UTI patients. Antimicrobial resistance against UTI-causing organisms is of great concern. The Surveillance of trends of antimicrobial susceptibility pattern for organisms causing UTIs is highly important. Antibiotics should be prescribed according to proper guidelines to prevent increasing antimicrobial resistance.

Introduction Cholangiocarcinoma (CCA) are sub-divided into intrahepatic (iCCA) or extrahepatic (eCCA). eCCA are further subdivided into perihilar (pCCA) and distal (dCCA). Current and previous versions of the WHO International Coding of Disease and Oncology classifications (ICD) have separate topography codes for iCCA and eCCA, but none for pCCA. Over recent decades, multiple studies report rising incidence rates of iCCA with declining rates of eCCA, without reference to pCCA. We hypothesised the lack of a specific code for pCCA has led to errors CCA coding, specifically with miscoding of pCCA as iCCA. Methods Clinical notes of cases coded as hepatobiliary carcinoma using ICD-10 criteria (C22.1/Intrahepatic Bile Duct carcinoma, C24.0/Extrahepatic Bile Duct carcinoma, C23X/Malignant Neoplasm Gall Bladder, C22.0/Malignant Neoplasm Liver Cell Carcinoma) over a 2 year period (2015–2017), were reviewed by two independent clinicians at three independent UK regional HepatoPancreatoBiliary centres. The agreed final diagnosis was compared to the originally allocated ICD-10 code. Results Of the 625 CCA cases fully reviewed, 226 were coded as C22.1/iCCA. 98 (43%) of these were true iCCA and coded correctly, while 76 cases (34%) were actually pCCA. 92% all pCCA cases were incorrectly coded as iCCA. Conclusion CCA coding misclassification in UK HPB centres is common, particularly the miscoding of pCCA, which is extrahepatic and the commonest form of CCA, as iCCA. This may be contributing to apparent rising incidence rates of iCCA. Our findings confirm the need to implement distinct topographical codes for iCCA, pCCA and dCCA in future iterations of ICD.

With advances in fog and edge computing, various problems such as data processing for large Internet of Things (IoT) systems can be solved in an efficient manner. One such problem for the next generation smart grid (SG) IoT system comprising of millions of smart devices is the data aggregation problem. Traditional data aggregation schemes for SGs incur high computation and communication costs, and in recent years, there have been efforts to leverage fog computing with SGs to overcome these limitations. In this article, a new fog-enabled privacy-preserving data aggregation scheme (FESDA) is proposed. Unlike existing schemes, the proposed scheme is resilient to false data injection attacks by filtering out the inserted values from external attackers. To achieve privacy, a modified version of the Paillier cryptosystem is used to encrypt the consumption data of the smart meter (SM) users. In addition, FESDA is fault-tolerant, which means, the collection of data from other devices will not be affected even if some of the SMs malfunction. We evaluate its performance along with three other competing schemes in terms of aggregation, decryption, and communication costs. The findings demonstrate that FESDA reduces the communication cost by 50%, when compared with the privacy-preserving fog-enabled data aggregation scheme.

Promotion of the critical and creative thinking is a important competency from students learning a second language. it is proposed that second language barriers in writing skills may due to the lack of ideas rather than complex in lexical items and syntax. the current study attempts to check whether asking questions prior to writing will improve the secondary students studying in a school. The results that are adopted from another study, from T-test showed that sampe who received two weeks treatment demonstrated 18% improvement in their writing skill. The findings suggested that questioning technique is an effective technique in promotion students to write.

Background: The interim analysis of the multicentre New EPOC trial in patients with resectable colorectal liver metastasis showed a significant reduction in progression-free survival in patients allocated to cetuximab plus chemotherapy compared with those given chemotherapy alone. The focus of the present analysis was to assess the effect on overall survival. Methods: New EPOC was a multicentre, open-label, randomised, controlled, phase 3 trial. Adult patients (aged ≥18 years) with KRAS wild-type (codons 12, 13, and 61) resectable or suboptimally resectable colorectal liver metastases and a WHO performance status of 0–2 were randomly assigned (1:1) to receive chemotherapy with or without cetuximab before and after liver resection. Randomisation was done centrally with minimisation factors of surgical centre, poor prognosis cancer, and previous adjuvant treatment with oxaliplatin. Chemotherapy consisted of oxaliplatin 85 mg/m 2 administered intravenously over 2 h, l-folinic acid (175 mg flat dose administered intravenously over 2 h) or d,l-folinic acid (350 mg flat dose administered intravenously over 2 h), and fluorouracil bolus 400 mg/m 2 administered intravenously over 5 min, followed by a 46 h infusion of fluorouracil 2400 mg/m 2 repeated every 2 weeks (regimen one), or oxaliplatin 130 mg/m 2 administered intravenously over 2 h and oral capecitabine 1000 mg/m 2 twice daily on days 1–14 repeated every 3 weeks (regimen two). Patients who had received adjuvant oxaliplatin could receive irinotecan 180 mg/m 2 intravenously over 30 min with fluorouracil instead of oxaliplatin (regimen three). Cetuximab was given intravenously, 500 mg/m 2 every 2 weeks with regimen one and three or a loading dose of 400 mg/m 2 followed by a weekly infusion of 250 mg/m 2 with regimen two. The primary endpoint of progression-free survival was published previously. Secondary endpoints were overall survival, preoperative response, pathological resection status, and safety. Trial recruitment was halted prematurely on the advice of the Trial Steering Committee on Nov 1, 2012. All analyses (except safety) were done on the intention-to-treat population. Safety analyses included all randomly assigned patients. This trial is registered with ISRCTN, number 22944367. Findings: Between Feb 26, 2007, and Oct 12, 2012, 257 eligible patients were randomly assigned to chemotherapy with cetuximab (n=129) or without cetuximab (n=128). This analysis was carried out 5 years after the last patient was recruited, as defined in the protocol, at a median follow-up of 66·7 months (IQR 58·0–77·5). Median progression-free survival was 22·2 months (95% CI 18·3–26·8) in the chemotherapy alone group and 15·5 months (13·8–19·0) in the chemotherapy plus cetuximab group (hazard ratio [HR] 1·17, 95% CI 0·87–1·56; p=0·304). Median overall survival was 81·0 months (59·6 to not reached) in the chemotherapy alone group and 55·4 months (43·5–71·5) in the chemotherapy plus cetuximab group (HR 1·45, 1·02–2·05; p=0·036). There was no significant difference in the secondary outcomes of preoperative response or pathological resection status between groups. Five deaths might have been treatment-related (one in the chemotherapy alone group and four in the chemotherapy plus cetuximab group). The most common grade 3–4 adverse events reported were: neutrophil count decreased (26 [19%] of 134 in the chemotherapy alone group vs 21 [15%] of 137 in the chemotherapy plus cetuximab group), diarrhoea (13 [10%] vs 14 [10%]), skin rash (one [1%] vs 22 [16%]), thromboembolic events (ten [7%] vs 11 [8%]), lethargy (ten [7%] vs nine [7%]), oral mucositis (three [2%] vs 14 [10%]), vomiting (seven [5%] vs seven [5%]), peripheral neuropathy (eight [6%] vs five [4%]), and pain (six [4%] vs six [4%]). Interpretation: Although the addition of cetuximab to chemotherapy improves the overall survival in some studies in patients with advanced, inoperable metastatic disease, its use in the perioperative setting in patients with operable disease confers a significant disadvantage in terms of overall survival. Cetuximab should not be used in this setting. Funding: Cancer Research UK.

NB-IoT is a promising cellular technology for enabling low cost, low power, long-range connectivity to IoT devices. With the bandwidth requirement of 180 kHz, it provides the flexibility to deploy within the existing LTE band. However, this raises serious concerns about the performance of the technology due to severe interference from multi-tier 5G HetNets. Furthermore, as NB-IoT is based on HD-FDD, the symmetric allocation of spectrum band between the downlink and uplink results in underutilization of resources, particularly in the case of asymmetric traffic distribution. Therefore, an innovative RRM strategy needs to be devised to improve spectrum efficiency and device connectivity. This article presents the detailed design challenges that need to be addressed for the RRM of NB-IoT and proposes a novel framework to devise an efficient resource allocation scheme by exploiting cooperative interference prediction and flexible duplexing techniques.

The design changes on the physical (PHY) layer, i.e. the limited system bandwidth of one physical resource block (PRB), single antenna support, lower-order modulations, etc. inhibit the mapping of traditional long term evolution (LTE) radio resource management techniques to narrowband internet of things (NB-IoT) systems. Consequently, possible interference due to massive connectivity may severely degrade the expected system performance. In this regard, we propose an interference avoidance scheduling algorithm for NB-IoT systems. The algorithm entails a cooperative strategy in which the base stations share their respective scheduling tables which are then used to compute the interference for future transmitting user equipment (UEs). The computed interference values are then used as input to individual base station schedulers to perform scheduling. Each base station's scheduler then allocates the radio resources to the UEs with the lowest possible interference. Extensive simulations are carried out to analyze the performance of our proposed algorithm and compare it to the conventional Round-Robin scheduling scheme. The results show that our proposed algorithm provides up to 36 % throughput improvement to the NB-IoT UE as compared to Round-Robin. Similarly, for the same device's locations, the UEs are experiencing relatively better maximum coupling loss (MCL) which results in lower repetition numbers per coverage class.

In the original article Moritz Schmelzle’s last name is spelled wrong. It is correct as reflected here.

Die-level thinning, handling, and integration of singulated dies from multi-project wafers (MPW) are often used in research, early-stage development, and prototyping of flexible devices. There is a high demand for thin silicon devices for several applications, such as flexible electronics. To address this demand, we study a novel post-processing method on two silicon devices, an electrochemical impedance sensor, and Complementary Metal Oxide Semiconductor (CMOS) die. Both are drawn from an MPW batch, thinned at die-level after dicing and singulation down to 60 µm. The thinned dies were flip-chip bonded to flexible substrates and hermetically sealed by two techniques: thermosonic bonding of Au stud bumps and anisotropic conductive paste (ACP) bonding. The performance of the thinned dies was assessed via functional tests and compared to the original dies. Furthermore, the long-term reliability of the flip-chip bonded thinned sensors was demonstrated to be higher than the conventional wire-bonded sensors.

Background Hilar cholangiocarcinoma is staged using the AJCC staging system. Numerous other prognostically important histopathological and demographic characteristics have been reported. The objective of this meta-analysis was to assess statistically the effect of postresectional tumour characteristics on overall survival of patients undergoing attempted radical curative resection for hilar cholangiocarcinoma. Methods Relevant studies were identified by searching the Ovid MEDLINE and PubMed databases. The search was limited to studies published between 2009 and 2017. Papers referring to intrahepatic or distal cholangiocarcinoma were excluded from review. Data extraction used standard Parmar modifications to determine pooled univariable hazard ratios (HRs). Results Twenty-four articles, containing 4599 patients, were assessed quantitatively. In pooled analyses, age (HR 1·16, 95 per cent c.i. 1·04 to 1·28), T category (HR 1·49, 1·30 to 1·70), lymph node involvement (HR 1·78, 1·65 to 1·93), microvascular invasion (HR 1·49, 1·34 to 1·68), perineural invasion (HR 1·54, 1·40 to 1·68) and tumour differentiation (HR 1·54, 1·38 to 1·72) were significant prognostic factors, with low heterogeneity. Portal vein resection (HR 1·54, 1·15 to 1·70) and resection margin status (HR 1·77, 1·57 to 1·99) had significant effects, but with high heterogeneity. Sex, tumour size and preoperative carbohydrate antigen 19-9 levels did not have a statistically significant effect on postoperative prognosis. Conclusion Several tumour biological variables not included in the seventh edition of the AJCC classification affect overall survival. These require incorporation into prognostic models to ensure a personalized approach to prognostication and treatment.

Clinical decision-making around the management of liver-limited stage IV colorectal cancer involves careful assessment of the potential risks and benefits of surgery. This balance can often be optimised through appropriate patient selection to ensure long-term benefit of any operation, with fastidious perioperative care to minimize risk. We reviewed selected relevant articles from the existing literature. Multi-platform imaging is routinely used to determine distribution of disease and whether lesions are technically resectable, but what remains less clear is how to identify patients in whom resection is likely to deliver long-term benefits. A number of prognostic markers have been identified, with growing interest in direct assessment of tumour biology; genotyping of RAS status is routine in specific situations. Following a multidisciplinary team decision to proceed to surgery, patients undergo perioperative assessment and optimisation. Cardiopulmonary exercise testing helps to stratify perioperative risk: patients with low uptake of oxygen at the anaerobic threshold are known to have worse perioperative outcomes, and prehabilitation may offer the chance to reduce this risk. Intraoperative anaesthetic management is on a patient-by-patient basis but sub-normal hydration, epidural anaesthesia and steroids play a key role. Enhanced recovery after surgery programmes have improved perioperative outcomes while providing a potential economic benefit. Despite very good perioperative results, surgical management is not curative for the majority of patients, highlighting the need to further refine patient selection and definition of treatment aim on a patient-by-patient basis.

Chronic inflammation is an aberrantly prolonged form of a protective response to a loss of tissue homeostasis and it is involved in several steps of the carcinogenesis process. As a result, many cancers are inflammation-related. The systemic inflammatory response is associated with survival in advanced and localized cancers. Two categories of scores have been proposed to monitor the systemic inflammatory response, those derived from protein measurement and those based on counting inflammatory cells. This review aims to provide a critical appraisal of these 2 categories of surrogate markers. The 3 scale modified Glasgow prognostic score (mGPS) is based on the combination of C-reactive protein and albumin and is graded 0 to 2. It has been validated worldwide showing an independent prognostic value in patients with cancer in a variety of tumour types and tumour stages. Leukocytes-based scores are mainly neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). Elevated NLR and/or PLR and lower LMR seem to be associated with decreased survival, but the studies about these markers are very heterogeneous. The main limit is the variety of thresholds used to dichotomize patients, so that reproducibility and reliability of leukocytes-based scores can be questioned. Hence, there is no sufficient evidence to support their use in clinical practice. Comprehensive management of patients with operable and advanced cancer should integrate the host systemic inflammatory response by calculating the mGPS. It could be a helpful tool to tailor patients' management.

Background Scoring systems were developed to stratify patients with colorectal liver metastases considered for liver resection into different risk groups. Such scores have never been evaluated in recurrent liver metastases. The aim of this study was to evaluate whether these scores are applicable to patients with recurrent colorectal liver metastases and treated with curative intent. Methods We retrospectively analyzed data from 375 consecutive patients who underwent liver surgery for colorectal liver metastases between June 2010 and August 2015. Seventy-three patients developed liver-limited recurrence treated with curative intent. The predictive value of 6 scores (Fong, Sofocleous, Nagashima, Nordlinger, Konopke, and the Basingstoke index) was assessed in this set of patients. Results Median follow-up was 36.2 months. Overall survival and progression-free survival were 33.6 and 5.6 months, respectively. When scores were applied for OS, none showed a significant stratification between patients, although Nagashima's score showed a significant difference in overall survival between patients from the low-risk group and those from the intermediate- and high-risk groups (40.8 vs 30.5 months, P = 0.039). For PFS, only Fong's score showed a statistically significant stratification (6.6 vs 4.7 months, P = 0.027). Conclusion Scoring systems are of limited-value in stratifying patients operated on for recurrent colorectal liver metastases.

Background The prognosis of patients undergoing liver resection for colorectal liver metastases (CLM) seems to be altered when the primary tumour is right-sided. However, data are lacking and conflicting. We aimed to evaluate the influence of the primary tumour location on oncologic outcomes following such surgery. Methods We retrospectively analysed prospectively collected data from 376 consecutive patients who underwent liver surgery for CLM between June 2010 and August 2015. We compared the outcomes of patients with right colon tumours and those with left colorectal tumours. The splenic flexure was used as the cut-off point to determine the anatomic primary site. Results Among the 364 patients eligible, 74 (20.3%) had a right-sided primary tumour. These patients were older, had a poorer American Society of Anaesthesiologists status and had fewer node-positive primary tumours. The CLM characteristics were similar between both groups. Median PFS was not significantly different between the two groups at 9.9 months, as well as the pattern of recurrence. Median OS was shorter for patients with right-sided primary tumour (34.6 versus 45.3 months, p = 0.035). Similar results were observed when patients with rectal tumour were excluded from analysis (34.6 vs. 47.5 months, p = 0.007). Primary tumour site was an independent prognosis factor in multivariate analysis. Conclusion Right-sided location of the primary tumour is associated with worse OS after surgery for CLM, but seems to have no influence on PFS, and on the pattern of recurrence.

Background Next generation sequencing technology has facilitated mapping of the colorectal cancer genotype and furthered our understanding of metastogenesis. The aim of this study was to investigate for conserved and different mutations in the exomes of synchronously resected primary colorectal tumour and liver metastases. This information could potentially be utilised to guide the treatment of advanced disease with the help of biological information from the primary tumour. Methods We performed exome sequencing of synchronously resected primary colorectal cancer and colorectal liver metastases as well as normal colonic mucosa and liver parenchyma, from four patients who had received neo-adjuvant chemotherapy, at a depth of 50X using the Ion Proton platform. Raw data was mapped to the reference genome prior to variant calling, annotation and downstream analysis. Results Exome sequencing identified 585 non-synonymous missense single nucleotide variants (SNVs), of which 215 (36.8%) were unique to the primary tumour, 226 (38.6%) unique to the metastasis and 81 (13.8%) present in patient matched pairs. SNVs identified in the ErbB pathway appear to be concordant between primary and metastatic tumours. Conclusion Only 13.8% of the metastatic exome can be predicted by the genotype of the primary tumour. We have demonstrated concordance of a number of SNVs in the ErbB pathway, which may inform selection of therapeutic agents in advanced colorectal cancer.

In future remote healthcare monitoring system, it is necessary to constantly monitor the patients physiological parameters. For example, a pregnant woman parameters such as blood pressure and heart rate of the woman and heart rate and movements of fetal to control their health condition. To support the high-intensity and short-lived demands of these emerging applications, Narrowband Internet of Things (NB-IoT) is a promising technology that provides long-range communications at a low data rate for sensors with reduced device processing complexity and long battery lifetime. This paper aims to investigate the realistic performance of NB-IoT in terms of effective throughput, patient served per cell and latency in healthcare monitoring system with both in-band and stand-alone deployment.

As the demand for flexible hybrid electronics has increased extensively e.g. for the internet of things (IoT), electronic skin and wearables applications, the implementation of devices based on low-cost materials such as PET, paper, and unpackaged bare dies have become crucial for economical mass production. To facilitate flexibility for instance in wearables, the rigid silicon-based components are also deemed to become ultra-thin, which raises major challenges in terms of handling and reliable integration. In this paper, the hybrid integration of ultra-thin dies on PET and paper-based printed substrates is investigated. Silicon dies with different thicknesses from 10 to 50 μm with an internal daisy-chain structure were made and flip-chip bonded to screen-printed substrates. The bonding was conducted by using two types of anisotropic conductive adhesives, i.e. anisotropic conductive films (ACF) and anisotropic conductive paste (ACP). The effect of die encapsulation on the reliability of the assembly was also assessed by employing a protective foil. For reliability analysis, a cyclic bending test was carried out to identify the failure cycle. The successful integration of ultra-thin chip on the low-cost printed flexible substrate was obtained by optimizing the bonding parameters with both ACF and ACP. It was revealed that in flexible hybrid electronics; the thinner the die, the higher is the reliability, as the thinner dies promise superior flexibility, and can withstand higher bending stresses. Moreover, it was found that encapsulation of the thin die in a foil dramatically increases the long-term reliability of the bonded chip.

With the advent of smart health, smart cities, and smart grids, the amount of data has grown swiftly. When the collected data is published for valuable information mining, privacy turns out to be a key matter due to the presence of sensitive information. Such sensitive information comprises either a single sensitive attribute (an individual has only one sensitive attribute) or multiple sensitive attributes (an individual can have multiple sensitive attributes). Anonymization of data sets with multiple sensitive attributes presents some unique problems due to the correlation among these attributes. Artificial intelligence techniques can help the data publishers in anonymizing such data. To the best of our knowledge, no fuzzy logic-based privacy model has been proposed until now for privacy preservation of multiple sensitive attributes. In this paper, we propose a novel privacy preserving model F-Classify that uses fuzzy logic for the classification of quasi-identifier and multiple sensitive attributes. Classes are defined based on defined rules, and every tuple is assigned to its class according to attribute value. The working of the F-Classify Algorithm is also verified using HLPN. A wide range of experiments on healthcare data sets acknowledged that F-Classify surpasses its counterparts in terms of privacy and utility. Being based on artificial intelligence, it has a lower execution time than other approaches.

Background Human equilibrative nucleoside transporters (hENTs) are transmembranous proteins that facilitate the uptake of nucleosides and nucleoside analogues, such as gemcitabine, into the cell. The abundance of hENT1 transporters in resected pancreatic ductal adenocarcinoma (PDAC) might make hENT1 a potential biomarker of response to adjuvant chemotherapy. The aim of this study was to see whether hENT1 expression, as determined by immunohistochemistry, was a suitable predictive marker for subsequent treatment with gemcitabine-based adjuvant chemotherapy. Methods A systematic review was performed, searching databases from January 1997 to January 2016. Articles pertaining to hENT1 immunohistochemical analysis in resected PDAC specimens from patients who subsequently underwent adjuvant gemcitabine-based chemotherapy were identified. Eligible studies were required to contain survival data, reporting specifically overall survival (OS) and disease-free survival (DFS) with associated hazard ratios (HRs) stratified by hENT1 status. Results Of 42 articles reviewed, eight were suitable for review, with seven selected for quantitative meta-analysis. The total number of patients included in the meta-analysis was 770 (405 hENT1-negative, 365 hENT1-positive). Immunohistochemically detected hENT1 expression was significantly associated with both prolonged DFS (HR 0·58, 95 per cent c.i. 0·42 to 0·79) and OS (HR 0·52, 0·38 to 0·72) in patients receiving adjuvant gemcitabine but not those having fluoropyrimidine-based adjuvant therapy. Conclusion Expression of hENT1 is a suitable prognostic biomarker in patients undergoing adjuvant gemcitabine-based chemotherapy.

Background: Activating mutations in KRAS have been suggested as potential predictive and prognostic biomarkers. However, the prognostic impact of specific point mutations remains less clear. This study assessed the prognostic impact of specific KRAS mutations on survival for patients with colorectal cancer. Methods: Retrospective review of patients KRAS typed for advanced and recurrent colorectal cancer between 2010 and 2015 in a UK Cancer Network. Results: We evaluated the impact of KRAS genotype in 392 patients. Mutated KRAS was detected in 42.9% of tumours. KRAS mutations were more common in moderate vs well-differentiated tumours. On multivariate analysis, primary tumour T stage (HR 2.77 (1.54–4.98), P=0.001), N stage (HR 1.51 (1.01–2.26), P=0.04), curative intent surgery (HR 0.51 (0.34–0.76), P=0.001), tumour grade (HR 0.44 (0.30–0.65), P=0.001) and KRAS mutation (1.54 (1.23–2.12), P=0.005) were all predictive of overall survival. Patients with KRAS codon 12 mutations had worse overall survival (HR 1.76 (95% CI 1.27–2.43), P=0.001). Among the five most common codon 12 mutations, only p.G12C (HR 2.21 (1.15–4.25), P=0.01) and p.G12V (HR 1.69 (1.08–2.62), P=0.02) were predictive of overall survival. Conclusions: For patients with colorectal cancer, p.G12C and p.G12V mutations in codon 12 were independently associated with worse overall survival after diagnosis.

Background: Antimicrobial Resistance of Multidrug Resistant (MDR) Acinetobacter and Pseudomonas against Polymyxin E and Tigecycline is increasing exponentially. However, a wide range of susceptibility profiles to these drugs have been noted in different parts of the world. Objective: To determine the antimicrobial susceptibility of MDR Acinetobacter and Pseudomonas against Polymyxin E and Tigecycline. Materials & Methods: This cross-sectional study was conducted in Medical Intensive Care Units (MICU) of Holy Family Hospital for a duration of 1 year after ethical approval from Institutional Research Forum (IRF) of Rawalpindi Medical University. Hospital records of patients admitted in MICU were included using consecutive sampling technique. Organisms that were not MDR Acinetobacter or MDR Pseudomonas were excluded. Antimicrobial resistance of included isolates was noted against Polymyxin E & Tigecycline. Variables like gender, age, organism, site of isolation and antimicrobial resistance against Polymyxin E & Tigecycline were noted. Data was entered and analyzed using SPSS v20. Results: Mean age of isolation of MDR Acinetobacter was 35.79±15.55 years while mean age of isolation of MDR Pseudomonas was 26.54±7.83 years. The difference was very highly statistically significant. MDR Acinetobacter & MDR Pseudomonas both were more commonly isolated from male as compared to female patients. MDR Acinetobacter & MDR Pseudomonas were most commonly isolated from catheter tips, followed by blood. However, MDR Pseudomonas was not isolated from urine. Antimicrobial resistance against Polymyxin E & Tigecycline was surprisingly high. Conclusion: The antimicrobial resistance of MDR Acinetobacter or MDR Pseudomonas was alarmingly high. Therefore, proper strategies should be formulated regarding use of antimicrobial agents.

Narrowband Internet of Things (NB-IoT) is a promising cellular technology for enabling future low power wireless area networks (LPWANs). NB-IoT aims to provide seamless connectivity to massive IoT devices that require low throughput, low power, and long-range communication. NB-IoT is based on Long Term Evolution (LTE) with a system bandwidth of 180 KHz. Due to such limited bandwidth requirement, NB-IoT can be deployed within the LTE band. However, considering the future heterogeneous wireless networks (HetNet) comprising of multiple small cells operating under a macro cell environment. In this case, when NB-IoT is deployed, the inter-cell interference becomes worse due to the interference from the macro cell users as well. This raises serious concerns on the performance of NB-IoT. Therefore, in this paper, an extensive investigation of NB-IoT performance in terms of throughput and power consumption is presented in different HetNet deployment strategies. Moreover, an evaluation of cooperative resource allocation scheme for NB-IoT is also discussed in detail. The results show a significant impact on the performance of NB-IoT in HetNet environment. It is observed that, with the cooperative scheme, the gains of up to 24% in average throughput and reduction of 72% in energy consumption can be achieved.

IT Service Management System is an application to implement and manage Information Technology Infrastructure Library (ITIL) best practices framework. This framework aims to align the IT services with the business needs by insuring the quality of services provided to business. This IT service Management system links people, processes and technology within the Central Bank of Sudan as the main site of the project. The Central Bank of Sudan is the main bank that governs Sudan's banks rules and regulations. The bank was formed in 1960 with headquarters located in the Khartoum capital of Sudan in addition to eighteen (18) branches spread throughout the country. The Information Technology Administration within the Central Bank of Sudan manage and operate the IT infrastructure that host and support all systems that used internally and for external banks. The objective of this study focused on finding IT service management system that can support international IT service management platform that can apply ITIL standard processes like Incident Management, Service Request Management, Problem Management, Change Request Management, Configuration Management Database and Knowledge Management. The methodology used in this system is the Rapid Application Development (RAD), a condensed development process that produces a high quality system with low investment costs. The proposed system went through to alpha, beta and acceptability tests by IT development team first and second line of support agents to ensure proper module functionality with favorable results. The study concluded in align services provided by the Information system department with business need through manageable and controllable standard. As a recommendation, the system should be implemented at the Central Bank of Sudan. More integrations and benchmarking must be done to ensure modules functionalities and higher security. The system can be the first step to take ISO20000 certificate as it covers many of IS020000 requirements

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) have been identified as potential prognostic factors for overall survival (OS) in primary colorectal cancer, and there is a growing interest in their use in colorectal liver metastases (CLMs). However, optimal cut-off values for these ratios have not been defined by making comparison between series difficult. This study aimed to confirm the prognostic value of inflammatory scores in patients undergoing resection for CLM. We retrospectively analysed data from 376 consecutive patients who underwent liver surgery for CLM between June 2010 and August 2015. We assessed the reproducibility of previously published ratios and determined new cut-off values using the Cut-off Finder web-based tool. Relations between cut-off values and OS were analysed with Kaplan–Meier log-rank survival analysis and multivariate Cox models. Three hundred and forty-three patients had full preoperative blood tests for calculation of NLR, PLR and LMR. The number of cut-off values which showed a significant discrimination for OS was 49/249 (19.7%) for NLR, 28/316 (8.9%) for PLR and 22/214 (10.3%) for LMR, all with a scattered nonlinear distribution. This study showed that inflammatory scores expressed as ratios do not seem to be consistently reliable prognostic markers in patients with resectable CLM.

Recent advancements in cellular technologies allow discrete computing devices embedded with sensors to communicate over long distances with low-cost and low-energy consumption. This could drastically impact the future internet of thing (IoT) ecosystem. In this regard, Third Generation Partnership Project (3GPP) has introduced a new cellular-based technology called Narrowband Internet of Things (NB-IoT) which is one of the potential technologies for enabling IoT application in vehicular, health-care, industry 4.0, etc. However, NB-IoT technology is still in its infancy and so far it is unclear whether it is sufficiently reliable to complement or replace existing short-range and cellular technologies to enable such use-case scenarios. Therefore, this paper presents a preliminary investigation of the coverage of NB-IoT in three different scenarios i.e., outdoor, indoor, and underground with empirical measurements, one of the key performance indicators in which operators are most interested. The measurements were conducted on Tallinn University of Technology (TalTech) campus and nearby residential areas within a range of 700 m. The obtained results indicate that NB-IoT is able to provide good connectivity to meet the IoT application requirements in outdoor and indoor environments. However, for an underground scenario with the beam enabled for 700 m, it is only possible to provide connectivity to the devices up to 400 m. Furthermore, it is also observed that NB-IoT is able to provide connectivity to devices with a received signal strength indicator (RSSI) value as low as −105 dBm as compared to −95 dBm as in long-term evolution (LTE).

uRLLC (ultra-Reliable Low Latency Communications) requires a new paradigm in 5G cellular networks to satisfy extreme latency and reliability thresholds. Further, such constraints have a wide range due to different use case scenarios. Consequently, how to configure suitable radio frame structure that matches to the latency and reliability requirements of the given use-case is an open question. This article addresses the above-mentioned issue and provides a preliminary investigation and a feasible solution by exploiting antenna port selection index (APSI) calculated using fuzzy logic algorithm, which is further communicated through physical uplink control channel. Closed-form expressions of outage probability for the number of users, under given latency and reliability constraints have been provided with the mathematical proof and the results were simulated based on the prior availability of APSI. It is shown that outage probability improves up to 30% in case of dynamic radio frame configuration.

BackgroundColorectal cancer (CRC) represents a major cause for cancer death and every third patient develops liver metastases (CRLM). Several factors including number and size of metastases and primary tumour lymph-node status have been linked to survival. The primary tumour location along the colo-rectum continuum (sidedness) was analysed in first-line chemotherapy trials, where right-sided CRCs showed decreased survival. This association has not yet been clearly established in patients undergoing resection for CRLM.MethodsClinicopathological differences in CRLM resections according to sidedness in two Austrian centres (2003-2016) are described and survival is compared through Kaplan-Meier and multivariable analysis. A risk-score is presented with time-dependent receiver operating curve analysis and international validation in two major hepatobiliary centres. Furthermore, a systematic meta-analysis of studies on primary tumour location and survival after CRLM resection was performed.Results259 patients underwent hepatectomy. Right-sided CRC patients (n = 59) more often had positive primary tumour lymph-nodes (76.3%/61.3%;p = 0.043) and RAS-mutations (60%/34.9%;p = 0.036). The median overall and disease-free survival was 33.5 and 9.1 months in right-sided versus 55.5 (p = 0.051) and 12.1 months (p = 0.078) in left-sided patients. In multivariable analysis nodal-status (HR 1.52), right-sidedness (HR 1.53), extrahepatic disease (HR 1.71) and bilobar hepatic involvement (HR 1.41) were significantly associated with overall survival. Sidedness was not independently associated with disease-free survival (HR 1.33; p = 0.099). A clinical risk score including right-sidedness, nodal-positivity and extrahepatic involvement significantly predicted overall (p = 0.005) and disease-free survival (p = 0.027), which was confirmed by international validation in 527 patients (p = 0.001 and p = 0.011). Meta-analysis including 10 studies (n = 4312) showed a significant association of right-sidedness with overall survival after resection (HR 1.55;pConclusionsPatients with liver metastases from right-sided CRC experience worse survival after hepatic resection. Sidedness is a simple yet effective factor to predict outcome.

The challenges of conducting surgical oncology trials have resulted to low quantity and poor quality research [1,2]. Considering the definitive role of surgery to offer cure, immediate response to improve surgical research is needed [3]. The European Organization for Research and Treatment of Cancer (EORTC) and the European Society of Surgical Oncology (ESSO) share the vision to achieve excellent surgical research and care for cancer patients. Building on their complimentary expertise, they embarked on a pilot project to map out challenges and initiate a sustainable collaboration to advance cancer surgery research in Europe. This pilot project is EORTC-ESSO 1409 GITCG/ ESSO-01: A Prospective Colorectal Liver Metastasis Database with an Integrated Quality Assurance Program (CLIMB). This article will describe the challenges, milestones and vision of both organizations in setting up this collaboration.

Background: With the opioid epidemic and the increasing number of opioid-related deaths, there is growing awareness in the medical community regarding the dangers of opioid overprescription. As a result, there is a willingness among physicians to abandon old norms and adopt new data-driven prescribing practices. Purpose: To demonstrate patient-reported consumption data of opioid medications after anterior cruciate ligament (ACL) reconstructions (ACLRs), knee arthroscopies, and rotator cuff repairs to provide data-driven guidelines for prescribing opioids after these procedures. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 168 patients who underwent an ACLR, knee arthroscopy, or arthroscopic rotator cuff repair over a 17-month period. Patients were excluded if they had an opioid allergy, had preexisting opioid use, had an acute postoperative complication requiring further surgery, required hospitalization, exhibited drug-seeking behaviors, or were lost to follow-up. Medical records were reviewed to determine the number of opioid pills prescribed and the number of pills taken postoperatively. Prescribing was standardized in that 15 hydrocodone/acetaminophen pills (5/325 mg) were prescribed for all knee arthroscopy procedures and 40 hydrocodone/acetaminophen pills were prescribed for all ACL and rotator cuff procedures. The mean number of pills consumed and percentage of prescribed pills taken were analyzed in association with specific procedures and patient demographics. Results: Overall, the mean (±SD) reported opioid consumption overall was 13.5 ± 13.0 pills, with a utilization rate of 45.6% of the prescription. The mean reported opioid consumption for ACLRs, knee arthroscopies, and rotator cuff repairs was 19.1 ± 15.4, 7.2 ± 5.4, and 17.2 ± 14.3 pills, respectively ( P < .001). This represented a utilization rate of 48%, 47%, and 41%, respectively. Conclusion: This study provides important information regarding opioid utilization after common arthroscopic procedures. For ACLRs, knee arthroscopies, and rotator cuff repairs, by respectively prescribing 20, 10, and 20 pills postoperatively, the amount of unused medications would decrease by 60%, 47%, and 64%, respectively. We recommend prescribing no more than 20, 10, and 20 hydrocodone/acetaminophen pills (5/325 mg) for ACLRs, knee arthroscopies, and arthroscopic rotator cuff repairs, respectively.