Deep Learning-Based Robust Morphed Face Authentication Framework for Online Systems

The amalgamation of artificial intelligence(AI)with various areas has been in the picture for the past few years.AI has enhanced the functioning of several services,such as accomplishing better budgets,automating multiple tasks,and data-driven decision-making.Conducting hassle-free polling has been one of them.However,at the onset of the coronavirus in 2020,almost all worldly affairs occurred online,and many sectors switched to digital mode.This allows attackers to find security loopholes in digital systems and exploit them for their lucrative business.This paper proposes a three-layered deep learning(DL)-based authentication framework to develop a secure online polling system.It provides a novel way to overcome security breaches during the face identity(ID)recognition and verification process for online polling systems.This verification is done by training a pixel-2-pixel Pix2pix generative adversarial network(GAN)for face image reconstruction to remove facial objects present(if any).Furthermore,image-to-image matching is done by implementing the Siamese network and comparing the result of various metrics executed on feature embeddings to obtain the outcome,thus checking the electorate credentials.

GRADE: Deep learning and garlic routing-based secure data sharing framework for IIoT beyond 5G

The rise of automation with Machine-Type Communication(MTC)holds great potential in developing Industrial Internet of Things(IIoT)-based applications such as smart cities,Intelligent Transportation Systems(ITS),supply chains,and smart industries without any human intervention.However,MTC has to cope with significant security challenges due to heterogeneous data,public network connectivity,and inadequate security mechanism.To overcome the aforementioned issues,we have proposed a blockchain and garlic-routing-based secure data exchange framework,i.e.,GRADE,which alleviates the security constraints and maintains the stable connection in MTC.First,the Long-Short-Term Memory(LSTM)-based Nadam optimizer efficiently predicts the class label,i.e.,malicious and non-malicious,and forwards the non-malicious data requests of MTC to the Garlic Routing(GR)network.The GR network assigns a unique ElGamal encrypted session tag to each machine partaking in MTC.Then,an Advanced Encryption Standard(AES)is applied to encrypt the MTC data requests.Further,the InterPlanetary File System(IPFS)-based blockchain is employed to store the machine's session tags,which increases the scalability of the proposed GRADE framework.Additionally,the proposed framework has utilized the indispensable benefits of the 6G network to enhance the network performance of MTC.Lastly,the proposed GRADE framework is evaluated against different performance metrics such as scalability,packet loss,accuracy,and compromised rate of the MTC data request.The results show that the GRADE framework outperforms the baseline methods in terms of accuracy,i.e.,98.9%,compromised rate,i.e.,18.5%,scalability,i.e.,47.2%,and packet loss ratio,i.e.,24.3%.

Epidural anesthesia is effective for extracorporeal shock wave lithotripsy of pancreatic and biliary calculi

AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.RESULTS: Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade Ⅰ to Ⅲ. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia. CONCLUSION: Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection.

Endoscopic management of postcholecystectomy biliary leakage

BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. Endotherapy is an established method of treatment. However, the optimal intervention is not known. METHOD: Eighty-five patients with postcholecystectomy biliary leaks from July 2000 to March 2009 were retrospectively evaluated. RESULTS: The study population was 20 males and 65 females with a mean age of 42.47 years. Patients presented with abdominal pain (46), jaundice (23), fever (23), abdominal distension (42), or bilious abdominal drain (67). Endoscopic retrograde cholangiopancreatography detected a leak at the cystic duct stump in 45 patients, stricture with middle common bile duct leak in 4, leak from the right hepatic duct in 3, and a ligated common bile duct in 32. Twelve also had bile duct stones. One had a broken T-tube with stones Endotherapy was possible in 53 patients. Three patients with stones, one with a broken T-tube with stones, and 4 with stricture of the common bile duct with a leak were managed with sphincterotomy and stenting. Eight patients with a cystic duct stump leak with stones were managed with sphincterotomy and stone extraction. Three outpatients and 12 inpatients with a cystic duct stump leak were managed with sphincterotomy and stent and sphincterotomy and nasobiliary drain, respectively. Five patients with a cystic duct stump leak were managed with stenting. Sixteen with coagulopathy were managed with only nasobiliary drain (9) or stent (7). Leak closure was achieved in 100% patients Four developed mild pancreatitis which improved with conservative treatment.CONCLUSIONS: Endoscopic intervention is a safe and effective method of treatment of postcholecystectomy biliary leaks. However, management should be individualized based on factors such as outpatients or inpatients, presence of stone, stricture, ligature, or coagulopathy.

Efficacy of low dose peginterferon alpha-2b with ribavirin on chronic hepatitis C

AIM: To assess the effi cacy of peginterferon alpha 2b at doses of 50 μg weekly and 80 μg weekly (based on body weight) plus ribavirin in HCV genotype 2 and genotype 3 chronic hepatitis C patients. METHODS: During the study period of Jan 2002 to Dec 2003, all patients diagnosed as chronic hepatitis C or HCV related compensated cirrhosis were treated with peginterferon alpha 2b 50 μg S/C weekly (body weight < 60 kg) or 80 μg S/C weekly (body weight > 60 kg) plus ribavirin 800 mg/d for 24 wk. RESULTS: Overall 28 patients, 14 patients in each group (based on body weight) were treated during the period. Out of 28 patients, 75% were genotype 3, 18% were genotype 2 and 7% were genotype 1. The mean dose of peginterferon alpha 2b was 0.91 μg/kg in group 1 and 1.23 μg/kg in group 2 respectively. The end of treatment and sustained virologic response rates were 82% and 78% respectively. Serious adverse effects were seen in 3.5% patients. CONCLUSION: Low dose peginterferon alpha 2b in combination with ribavirin for 24 wk is effective in HCV genotype 2 and 3 chronic hepatitis C patients.

Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction

BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to cholangitis.Contrast-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results,but MRCP and metal stents are costly.There have been no reports on the use of air cholangiography.METHODS:We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type Ⅱ malignant hilar biliary obstruction.A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical controls.RESULTS:Ten patients with unresectable type Ⅱ malignant hilar biliary obstruction were studied.Air cholangiography detected type Ⅱ obstruction in all patients,similar to MRCP.The patients underwent unilateral stenting.Successful endoscopic drainage was achieved in all patients.The mean patency of the stent was 95.8±17.5 days in the study group and 143.9±115.1 days in the control group (P=0.20).The mean survival was 121.8±41.6 days in the study group and 154.9±122.5 days in the control group (P=0.42).KaplanMeier analysis showed an estimated median survival of 100:95% CI (65.9,134.1) days in the study group and 98:95% CI (84.1,111.9) days in the control group (P=0.62).Cholangitis occurred in none of the patients and there were no 30-day deaths nor major complications.Air cholangiographyassisted unilateral plastic stenting was cheaper than contrastfree unilateral metal stenting.CONCLUSION:Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type Ⅱ malignant hilar biliary obstruction for palliating patients,but it is cheaper.

Indian task force for celiac disease:Current status

There are limited data on celiac disease(CD) from India.The limited knowledge about CD in India might be attributed to several factors.The fi rst meeting of the Indian Task Force for Celiac Disease was held in the Asian Institute of Gastroenterology,Hyderabad,India in December 2008.The objectives of the meeting were to focus research on prevalence of CD in the wheat-eating Northern vs the rice-eating Southern Indian population,low-budget serological assays to study the underprivileged population,to involve other medical subspecialties in CD,to suggest proper legislation regarding wheat food labeling,and to organize affordable food substitutes for patients with celiac disease.

Partitioning of Water Distribution Network into District Metered Areas Using Existing Valves

Water distribution network(WDN)leakage management has received increased attention in recent years.One of the most successful leakage-control strategies is to divide the network into District Metered Areas(DMAs).As a multi-staged technique,the generation of DMAs is a difficult task in design and implementation(i.e.,clustering,sectorization,and performance evaluation).Previous studies on DMAs implementation did not consider the potential use of existing valves in achieving the objective.In this work,a methodology is proposed for detecting clusters and reducing the cost of additional valves and DMA sectorization by considering existing valves as much as possible.The procedure of DMAs identification has been divided into three stages,i.e.,a)clusters identification;b)sectorization or boundaries optimization and c)performance evaluation of the partitioned network.The proposed methodology is evaluated on a simple network and a real-world water network with the findings provided and compared to the DMAs,established for a raw water network with no existing valves.It is found that there is an adequate difference in cost of strategy implementation in both the cases for the network under consideration and the existing valve system achieved better network performance in terms of resilience index.

A Case Report on Atypical Presentation of Cerebral Venous Sinus Thrombosis, a Young Adult with Recurrent Fall: A Clinical Quandary

Cerebral Venous Sinus Thrombosis (CVST) is blood clot in draining veins and venous sinuses of brain, causing hindrance in the blood drainage system in brain, disturbing the internal homeostasis of brain, resulting in local oedema, ischemia, venous haemorrhage, damage to brain parenchyma and blood brain barrier. In our case report, we discussed a rare presentation of CVST, a 16-year-old young boy who presented in emergency with history recurrent fall, weakness, tingling numbness. What makes it challenging to diagnose in his unusual presentation without common symptoms and on examination no positive neurological finding. This case brings focus on the importance of knowledge about CVST among emergency physicians. CSVT is considered more commonly as a differential diagnosis of stroke in young age group owning to genetic predisposition, hot humid climate of the state leading to severe dehydration, dietary factors leading to vitamin B12 deficiency & hyper-homocysteinemia etc. Moreover, present COVID-19, inducing a hypercoagulable state among affected individuals gave CVST a new momentous among emergency physicians. An early diagnosis can be very fruitful as it might prevent long term disability and reduce mortality significantly.

辩驳:证据和不确定性

在本期杂志中,Coker在一篇回答我们关于决定结核病规划中是否应投资二线药治疗耐多药结核病(MDR—TB)的文章中,强调了几个“需求考虑的关键问题”。我们的原有框架提出了4条概念,由此要围绕一个重点产生了几个问题:是独立选择投资于MDR—TB的控制,国际社会如何能促进对MDR—TB采取合理的方法?虽然Coker间接提出有必要积极实施对MDR—TB的管理,

Role of intestinal ultrasound in ulcerative colitis: A systematic review

BACKGROUND Intestinal ultrasound(IUS)is an emerging,non-invasive,and highly sensitive diagnostic tool in inflammatory bowel disease(IBD),including ulcerative colitis(UC).Despite its potential,its adoption in clinical practice is limited due to a lack of standardization and awareness.AIM To perform a comprehensive scoping review based on a systematic literature review on IUS in UC to inform current practice.METHODS Ninety-nine original articles about ultrasonography in UC were identified among 7608 citations searching PubMed and EMBASE databases for systematic review.RESULTS IUS can be useful as an initial diagnostic strategy in patients with suspected IBD/UC.In UC,IUS can predict endoscopic response,histologic healing,and steroid responsiveness in acute severe cases.IUS can predict response to biologics/small molecules(as early as 2 wk).IUS correlates well with ileocolonoscopy,but IUS could miss rectal,jejunal,and upper GI lesions in suspected IBD and colon polyps or extra-intestinal manifestations in known IBD.IUS is useful in special situations(children,pregnancy,and postoperative Crohn's disease).Inter-observer agreement is acceptable and trained physicians have comparable diagnostic accuracy.Point-of-care ultrasound impacted management in 40%-60%of cases.Hand-held IUS has excellent agreement with conventional IUS.CONCLUSION IUS is a non-invasive,highly sensitive tool in the diagnosis and monitoring of UC,offering excellent patient satisfaction.Point-of-care ultrasound by IBD physicians can significantly impact clinical decision-making.

Arterial pH,bicarbonate levels and base deficit at presentation as markers of predicting mortality in acute pancreatitis:a single-centre prospective study

Background.Arterial blood gas(ABG)parameters such as pH form part of multi-parameter scoring systems for predicting severe acute pancreatitis;however,literature on detailed evaluation of ABG alone in this context is scarce.Methods.Patients with acute pancreatitis presenting to our unit between January 2012 and November 2013 were prospectively studied.ABG analysis was done at admission and development of organ failure,any need for intervention,and mortality were noted.The association between various parameters of ABG analysis and the development of organ failure or local complications,need for interventions(endoscopic/radiological/surgical)and mortality were analysed.Results.Two hundred and five patients(mean age:39.33-13.85 years;61.0%males)were prospectively studied.The aetiology of acute pancreatitis was alcohol in 93 patients(45.4%)and gall stone disease in 73(35.6%).Organ failure developed in 71.2%patients and 83.9%had local complications.In 18%of patients,endoscopic/radiological/surgical interventions were needed and 14.6%died.The patients(n=35)with metabolic acidosis(pH<7.35)suffered higher frequency of organ failure,need for interventions and mortality.Patients with low arterial bicarbonate levels,as well as higher base deficit,also displayed higher frequency of organ failure,need for interventions and mortality.The receiver operating characteristic(ROC)curves for pH<7.35,bicarbonate<22 meq/L and base deficit of>4 meq/L for prediction of mortality were 0.771(95%CI:0.664–0.878),0.707(95%CI:0.622–0.791)and 0.780(95%CI:0.693–0.867),respectively.Conclusion.Arterial pH,bicarbonate levels,and base deficit at presentation are useful early markers for predicting adverse outcome in acute pancreatitis.

一处罕见的感染性胰腺坏死的肝外液体积聚区:腹股沟阴囊区

Severe acute pancreatitis often leads to pancreatic and peripancreatic collections but,rarely,it can lead to collections at sites remote from the pancreas.Three male patients presented with abdominal pain and inguinoscrotal swelling.They were initially misdiagnosed with obstructed inguinal hernia,epididymo-orchitis and hydrocele,respectively.Later,their diagnosis of acute pancreatitis was revealed on laparotomy in one patient and on computed tomography(CT)in the remaining two patients.All these cases had extensive peripancreatic necrosis and paracolic collections tracking along the psoas muscle,downwards towards the pelvis.These collections were initially managed by percutaneous drainage and saline irrigation as a part of the‘step-up’approach.Two of these patients required open necrosectomy,while all required incision and drainage of inguinoscrotal collections.All the patients were discharged in satisfactory condition.Inguinoscrotal swelling is unusual as a first presentation of acute pancreatitis.A high index of suspicion,with careful study of patient’s history and examination along with CT,may provide an accurate diagnosis.Local drainage may be required to control sepsis and also provide an egress route for intra-abdominal collections.

FDGPET／CT显像对初次分期胰腺癌患者的转移评估优于增强CT

【摘要】目的评价脱氧葡萄糖（FDG）PET／CT在胰腺癌初次分期中较常规多相增强cT（CECT）的增益作用。方法54例病理证实的胰腺癌患者行FDGPET／CECT显像，计算PET／CT和CECT在淋巴结分期和转移分期中的灵敏度、特异性、阳性NN值（PPV）、阴性预测值（NPV）和准确性。

Clinical outcomes and prognostic significance of early vs.late computed tomography in acute pancreatitis

Background:Guidelines recommend that contrast-enhanced computed tomography(CT)should be carried out 72 hours after onset of an attack of acute pancreatitis(AP).However,the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications,or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease,is not clear.Methods:The medical records of 214 consecutive patients with AP were analysed retrospectively and these patients were divided into two groups:the early CT group(CT done at 4–5 days after the onset of pain)and the late CT group(CT done in days 6–14 following onset of pain).The two groups were compared for differences in clinical outcomes and prognostic information obtained from CT,such as detection of pancreatic necrosis and local complications,and CT severity index.Results:Of 214 patients[143(66.8%)males;mean age 39.87613.52 years],21 patients were excluded as they did not undergo CT or CT was done more than 14 days after onset of an attack of AP.The early CT group included 114 patients,whilst the late CT group had 79.The mean CT severity index was higher in the late CT group(6.6562.27 vs.5.5262.7;P=0.005).The incidence of persistent organ failure in the early group was no different from that of the late group(38.6%vs.49.4%;P=0.143).Local complications were detected more often in the late CT group(84.8%vs.68.4%;P=0.011).There was no difference between the two groups in the need for percutaneous drainage,surgery,or mortality(all P>0.05).Conclusions:Although performing early CT does not adversely affect the outcome in AP,CT carried out more than 5 days after the onset of symptoms may detect more local complications.

肠造口的自行闭合

Intestinal loop stoma is a common surgical procedure performed for various benign and malignant abdominal problems,but it rarely undergoes spontaneous closure,without surgical intervention.Two male patients presented to our emergency surgical department with acute abdominal pain.One of them was diagnosed as having rectosigmoid perforation and underwent diversion sigmoid loop colostomy after primary closure of the perforation.The other was a known case of carcinoma of the rectum who had already undergone low anterior resection with covering loop ileostomy;the patient underwent second loop ileostomy,this time for complicated intestinal obstruction.To our surprise,both the loop colostomy and ileostomy closed spontaneously at 8 weeks and 6 weeks,respectively,without any consequences.Spontaneous stoma closure is a rare and interesting event.The exact etiology for spontaneous closure remains unknown,but it may be hypothesized to result from slow retraction of the stoma,added to the concept of a tendency towards spontaneous closure of enterocutaneous fistula.

An unusual cause of simultaneous common bile and pancreatic duct dilation

Simultaneous dilation of both the common bile duct and the pancreatic duct(double-duct sign)is usually because of ampullary or pancreatic tumours.Here we report an unusual cause of double-duct dilation;we describe the case of a 49-year-old female who developed afferent loop syndrome after pylorus-preserving pancreaticoduodenectomy:crosssectional imaging of the abdomen revealed a double-duct sign.

Nonselective beta‐blockers reduce mortality in patients with acute‐on‐chronic liver failure

Aim:Nonselective beta‐blockers(NSBBs)can reduce the incidence of complications in patients with cirrhosis and prolong survival.The safety and efficacy of NSBBs in real‐world settings in patients with acute‐on‐chronic liver failure(ACLF)identified by the Asian Pacific Association for the Study of Liver criteria are unknown.This study aimed to assess the safety and efficacy of NSBBs in patients with Asian Pacific Association for the Study of Liver(APASL)‐defined ACLF Methods:In this retrospective,multicenter study,patients with ACLF with complete 30 days follow‐up from January 2019 to December 2021 were included.The primary objective was to compare 30‐day mortality among standard of care(SOC)and NSBB(+SOC)groups.The secondary objectives were to compare the incidence of infection,variceal bleed,and recompensation among both the groups.Results:A total of 346 patients were included.Only 26%(n=89)of them received NSBBs,while 74%(n=257)received only SOC.On Kaplan-Meier analysis,the incidence of mortality was 21%(95%confidence interval[CI]:16.20-26.50)in SOC group compared to only 8%(95%CI:3.22-15.53)in NSBB group at Day 30(p=0.005).Similarly,mortality in SOC group was 63%(95%CI:56.81-69.00)compared to 46%(95%CI:35.44-57.00)in NSBB group at 1 year(p=0.001).NSBB therapy could not reduce the incidence of infections or variceal bleed.Forty‐seven percent of patients in the SOC group and 73%of patients in the NSBB group(p<0.001)recompensated.Carvedilol was prescribed in 77.5%and propranolol in 22.5%of patients.Conclusions:NSBBs reduce mortality without any effect on infection or variceal bleed in patients with ACLF.However,only one in four ACLF patients are suitable for NSBB therapy.