In the last years, the internet and multimedia technologies are widely used to exchange medical images and practicing telemedicine; which exposes this data to various illegitimate attacks due to their sensitivity. For this reason, many researchers work to afford a proper security and an efficient protection during the transmission. In this context, we propose a blind multi-watermarking approach for medical images using Lifting Wavelet Transform and Fast Walsh–Hadamard Transform. This approach proves the ability to embed a binary image ([Formula: see text]), used for integrity purposes, in addition to the patient information (EPR) associated with the medical cover image. Moreover, an error correcting code was used to improve the security of the EPR. We tested the proposed approach on different imaging modalities, and the obtained results show a good imperceptibility and robustness against several common attacks.

No abstract

Results: 49 patients with obstructive jaundice had 76 PTC procedures during the review period. Median patient age was 66 years (range 42 e 90 years). 18 patients (36%) were male and 31 patients (63 %) were female. 20 patients (40 %) had gallbladder and cholangiocarcinoma, 11 patients (22 %) had pancreatic cancer, 8 patients (16 %) had colorectal cancer, 2 had melanoma, 2 had ovarian cancer, 1 had hepatocellular carcinoma, 1 had small bowel cancer, 1 had duodenal cancer, 1 had RCC and 1 had a neuroendocrine tumour. Median time from admission with obstructive jaundice to PTC was 7 days (range 1-42 days). The median duration of hospital stay was 20 days (range 1-65 days). Post PTC 26.5 % patient had further systemic treatment with a median survival of 99 days while 73.5 % of patients had no further treatment, median survival in this sub-group was 44 days. Reasons for no further treatment included frailty in 61 % patients, a decline in performance status post-PTC in 11 %, unsuccessful PTC in 8%, no further treatment available in 5 %, further treatment declined in 3%, stable disease and surveillance in 3% and deaths during the admission in 11% patients. Post PTC, 24% of patients died within 30 days, 32% died between 31-90 days while 44 % of patients survived beyond 90 days. We noticed a 10% complication risk post-PTC with sepsis being the commonest. Re-procedure bilirubin levels did not have any impact on overall survival. Median overall survival post-PTC was 52 days. Conclusion:Obstructive jaundice is a debilitating oncological complication leading to increased patient morbidity and mortality. Fit patients with potential for further treatment should be considered for urgent intervention to improve jaundice, but terminally ill patients with poor performance status and no therapeutic option could be considered for best supportive care.Legal entity responsible for the study: The author.

The overall recurrence rate was 33.9% in the CROSS group and 44.1% in the CROSS group. The patterns of recurrence were similar in both groups and distant failure predominated in this R0 cohort (23.7% in CROSS and 30.5% in PFRT). Conclusion:While the jury is still out for the best NACRT regimens for ESCC, our results suggest similar efficacy of both CROSS and PFRT regimens in those who achieved R0 resection. The pattern of recurrence was similar to those reported in the landmark CROSS study but the survival outcomes could not be reproduced in the Asian community-setting with ESCC. Further studies to optimize patient selection and treatment intensification are unmet needs for this aggressive disease.

No abstract