In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.

Background and Aims-Minimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. Methods-ASGE-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system and learning curves (LCs) using cumulative sum (CUSUM) analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed effects models with a random intercept for each AET were used to generate aggregate LCs allowing us to use data from all AETs to estimate the average learning experience for trainees. Results-Among 62 invited AETPs, 37 AETs from 32 AETPs participated. The majority of AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed/AET was 400 (range 200-750) and 361 (250-650), respectively. Overall, 2616 examinations were graded

The aim of this study was to compare the quality of postburn facial scars before and after injection of unfiltered nanofat. The study was performed in the Plastic Surgery Department of Mayo Hospital, Lahore, Pakistan, from January 2015 to December 2016. Forty-eight patients with postburn facial scars were included; age range was 4 to 32 years with Fitzpatrick skin types between 3 and 4. Patients with hypertrophic scars, contractures, or keloids were excluded. Scars were assessed by a senior plastic surgeon and the patient on the POSAS (Patient Observer Scar Assessment Scale). Fat was harvested from the abdomen and/or thighs with a 3-mm multiport liposuction cannula (containing several sharp side holes of 1 mm) using Coleman technique. The harvested fat was emulsified and transferred into 1-mL Luer-Lock syringes for injection into the subdermal or intradermal plane. Final follow-up was scheduled at 6 months, and scar was rated by the patient and the same surgeon on the POSAS. Preoperative and postoperative scar scores were compared, and P values were calculated. Results indicated that after nanofat grafting, there was a statistically significant improvement in scar quality. The most significant improvements on the observer scale were seen in pigmentation and pliability (P < 0.0001). Thickness and relief were the least improved variables (P = of 0.785 and 0.99, respectively). ImageJ scanning also showed pigmentation change (P = 0.076). A statistically significant improvement was seen in all parameters of the patient section of the POSAS (P < 0.0001). In conclusion, unfiltered nanofat grafting seems to be a promising and effective therapeutic approach in postburn facial scars, showing significant improvement in scar quality. The trial was registered on www.clinicaltrials.gov with following ID NCT03352297.

No abstract

Quick absorption of adipose tissue grafts makes the outcomes less satisfactory for clinical applications. In the current study, adipose tissue grafts were mixed with adipose tissue-derived stem cells (ASCs) to improve retention of adipose tissue grafts and to make the clinical outcomes of fat grafting more reliable. Adipose tissue was either injected alone (conventional group) or mixed with ASCs (stem cell group) before injection. In both groups, adipose tissue was injected at the site of contour throughout layers of tissues till visual clinical symmetry with the opposite side was achieved. The volume of injected fat graft was measured after 72 hours and 6 months using a B-mode ultrasound device connected with a 12 MH frequency probe. The percentage reduction in the volume of injected fat, physician satisfaction scores (Ph-SCs), and patient satisfaction scores (P-SCs) were also recorded. After 6 months, there was significantly lower fat absorption in the stem cell group as compared to the conventional group. Mean physician and patient satisfaction scores were significantly improved in the stem cell group. No significant adverse effects were noted in any patient. Significantly lower absorption of graft due to the use of ASCs improves the clinical outcomes of conventional fat grafting for contour deformities of the face. The current preenrichment strategy is noninvasive, safe and can be applied to other diseases that require major tissue augmentation such as breast surgery. This trial is registered with NCT02494752.

Conventional fat grafting is safe for correction of facial contour deformities. However, procedure needs to be repeated multiple times to produce satisfactory results. Beneficial effects of ex vivo expanded ASCs enriched fat grafting have a potential to alter the current treatment paradigm of fat grafting for soft tissue reconstruction.

Today IoT integrate thousands of inter networks and sensing devices e.g., vehicular networks, which are considered to be challenging due to its high speed and network dynamics. The goal of future vehicular networks is to improve road safety, promote commercial or infotainment products and to reduce the traffic accidents. All these applications are based on the information exchange among nodes, so not only reliable data delivery but also the authenticity and credibility of the data itself are prerequisite. To cope with the aforementioned problem, trust management come up as promising candidate to conduct node’s transaction and interaction management, which requires distributed mobile nodes cooperation for achieving design goals. In this paper, we propose a trust-based routing protocol i.e., 3VSR (Three Valued Secure Routing), which extends the widely used AODV (Ad hoc On-demand Distance Vector) routing protocol and employs the idea of Sensing Logic-based trust model to enhance the security solution of VANET (Vehicular Ad-Hoc Network). The existing routing protocol are mostly based on key or signature-based schemes, which off course increases computation overhead. In our proposed 3VSR, trust among entities is updated frequently by means of opinion derived from sensing logic due to vehicles random topologies. In 3VSR the theoretical capabilities are based on Dirichlet distribution by considering prior and posterior uncertainty of the said event. Also by using trust recommendation message exchange, nodes are able to reduce computation and routing overhead. The simulated results shows that the proposed scheme is secure and practical.

5G is the latest generation of cellular mobile communications. Due to its significant advantage in high data rate, reduced latency and massive device connectivity, the 5G network plays a vital role in today’s commercial telecommunications networks. However, the 5G network also faces some challenges when used in practice. This is because it consists of various diverse ingredients, termed heterogeneity. The heterogeneity of the 5G network has two consequences: first, it prevents us to use this technology in a uniform way, preventing the wide use of 5G technology; second, it complicates the structure of the 5G network, making it hard to monitor what is going on in a 5G network. To break through this limitation, researchers have worked in this field and design their own protocol, in which software-defined networking (SDN) is one key design concept. By separating control and data plane, SDN can make the 5G network functional and programmable, such that we can handle the heterogeneity in traditional 5G networks. In light of this, we say that SDN-5G network is attractive, but its advantages are not free. The intelligence centralization used in SDN has its own drawbacks when it comes to security. To break through this limitation, we propose a robust security architecture for SDN-based 5G Networks. To find the illegal request from malicious attackers, we add extra cryptographic authentication, termed synchronize secret. The basic idea of our scheme is leveraging preload secrets to differ attacks from regular network communications. The simulation results indicate that our work can completely handle the security problem from SDN with a low disconnect rate of 0.01%, which is much better than that from state of the art.