Correlation between initial tumor enlargement and magnetic resonance imaging characteristics following linear accelerator-based stereotactic radiosurgery for acoustic neuromas.

BACKGROUND: Initial tumor enlargement (or pseudoprogression) instead of true tumor progression is a common phenomenon in patients with acoustic neuromas who are treated with stereotactic radiosurgery (SRS). This phenomenon can affect clinical decision-making and patient management. This study assessed the correlation between initial tumor enlargement and magnetic resonance imaging characteristics in patients with acoustic neuromas who were treated with linear accelerator (LINAC)-based SRS. The long-term tumor control outcomes were also analyzed. MATERIALS AND METHODS: In total, 330 patients with sporadic acoustic neuromas who were treated with LINAC SRS between March 2006 and March 2020 were retrospectively evaluated to assess their initial tumor enlargement. The tumors were divided into homogeneously enhanced, heterogeneously enhanced, and cystic types based on the morphological characteristics noted on magnetic resonance images. Tumor control was assessed in 275 patients with a follow-up duration of more than 2 years. RESULTS: Initial enlargement was observed in 137 of 330 (41.5%) tumors as early as 3 months after LINAC SRS. Data analysis revealed that postoperative tumors with a residual volume lower than 2.5 cm3 had a lower incidence of initial enlargement (p = 0.039). No correlation was noted between the initial enlargement and morphological characteristics of tumors. In patients with a mean follow-up duration of 82.8 ± 37.2 months, heterogeneously enhanced tumors exhibited a lower control rate than homogeneously enhanced and cystic tumors (p = 0.045). No correlation was noted between initial enlargement and tumor control. CONCLUSION: Initial enlargement can occur as early as 3 months after SRS. Postoperative residual tumors with a volume lower than 2.5 cm3 exhibit a lower incidence of initial enlargement. Heterogeneously enhanced tumors have a lower local control rate.

Focused ultrasound combined with radiotherapy for malignant brain tumor: a preclinical and clinical study.

INTRODUCTION: Blood-brain barrier (BBB) remains to be the major obstacle to conquer in treating patients with malignant brain tumors. Radiation therapy (RT), despite being the mainstay adjuvant modality regardless of BBB, the effect of radiation induced cell death is hindered by the hypoxic microenvironment. Focused ultrasound (FUS) combined with systemic microbubbles has been shown not only to open BBB but also potentially increased regional perfusion. However, no clinical study has investigated the combination of RT with FUS-BBB opening (RT-FUS). METHODS: We aimed to provide preclinical evidence of RT-FUS combination in GBM animal model, and to report an interim analysis of an ongoing single arm, prospective, pilot study (NCT01628406) of combining RT-FUS for recurrent malignant high grade glioma patients, of whom re-RT was considered for disease control. In both preclinical and clinical studies, FUS-BBB opening was conducted within 2 h before RT. Treatment responses were evaluated by objective response rate (ORR) using magnetic resonance imaging, progression free survival, and overall survival, and adverse events (AE) in clinical study. Survival analysis was performed in preclinical study and descriptive analysis was performed in clinical study. RESULTS: In mouse GBM model, the survival analysis showed RT-FUS (2 Gy) group was significantly longer than RT (2 Gy) group and control, but not RT (5 Gy) group. In the pilot clinical trial, an interim analysis of six recurrent malignant high grade glioma patients underwent a total of 24 RT-FUS treatments was presented. Three patients had rapid disease progression at a mean of 33 days after RT-FUS, while another three patients had at least stable disease (mean 323 days) after RT-FUS with or without salvage chemotherapy or target therapy. One patient had partial response after RT-FUS, making the ORR of 16.7%. There was no FUS-related AEs, but one (16.7%) re-RT-related grade three radiation necrosis. CONCLUSION: Reirradiation is becoming an option after disease recurrence for both primary and secondary malignant brain tumors since systemic therapy significantly prolongs survival in cancer patients. The mechanism behind the synergistic effect of RT-FUS in preclinical model needs further study. The clinical evidence from the interim analysis of an ongoing clinical trial (NCT01628406) showed a combination of RT-FUS was safe (no FUS-related adverse effect). A comprehensive analysis of radiation dosimetry and FUS energy distribution is expected after completing the final recruitment.

Long-term follow-up and comparison of programmable and non-programmable ventricular cerebrospinal fluid shunts among adult patients with different hydrocephalus etiologies: a retrospective cohort study.

BACKGROUND: Programmable valve (PV) has been shown as a solution to the high revision rate in pediatric hydrocephalus patients, but it remains controversial among adults. This study is to compare the overall revision rate, revision cause, and revision-free survival between PV and non-programmable valve (NPV) in adult patients with different hydrocephalus etiologies. METHOD: We reviewed the chart of all patients with hydrocephalus receiving index ventricular cerebrospinal fluid (CSF) shunt operations conducted at a single institution from January 2017 to December 2017. Patients included in the study were followed up for at least 5 years. Statistical tests including independent t-test, chi-square test, and Fisher's exact test were used for comparative analysis, and Kaplan-Meier curve using log-rank test was performed to compare the revision-free survival between the PV and NPV groups. RESULTS: A total of 325 patients were included in the study, of which 181 patients were receiving PVs and 144 patients receiving NPV. There were 23 patients (12.8%) with PV and 22 patients (15.3%) with NPV receiving initial revision. No significant statistical difference in the initial revision rate was observed between the two groups (p = 0.52). No survival difference was found between the PV and NPV groups. However, better revision-free survival was noted in the PV group among idiopathic normal pressure hydrocephalus (iNPH) (p = 0.0274) and post-traumatic hydrocephalus (p = 0.017). CONCLUSIONS: The combination of the different etiologies of hydrocephalus and the features of PV and NPV results in different outcomes-revision rate and revision-free survival. PV use might be superior to NPV in iNPH and post-traumatic hydrocephalus patients. Further studies are needed to clarify the indications of PV use in adult hydrocephalus patients.

LT-FS-ID: Log-Transformed Feature Learning and Feature-Scaling-Based Machine Learning Algorithms to Predict the k-Barriers for Intrusion Detection Using Wireless Sensor Network.

The dramatic increase in the computational facilities integrated with the explainable machine learning algorithms allows us to do fast intrusion detection and prevention at border areas using Wireless Sensor Networks (WSNs). This study proposed a novel approach to accurately predict the number of barriers required for fast intrusion detection and prevention. To do so, we extracted four features through Monte Carlo simulation: area of the Region of Interest (RoI), sensing range of the sensors, transmission range of the sensor, and the number of sensors. We evaluated feature importance and feature sensitivity to measure the relevancy and riskiness of the selected features. We applied log transformation and feature scaling on the feature set and trained the tuned Support Vector Regression (SVR) model (i.e., LT-FS-SVR model). We found that the model accurately predicts the number of barriers with a correlation coefficient (R) = 0.98, Root Mean Square Error (RMSE) = 6.47, and bias = 12.35. For a fair evaluation, we compared the performance of the proposed approach with the benchmark algorithms, namely, Gaussian Process Regression (GPR), Generalised Regression Neural Network (GRNN), Artificial Neural Network (ANN), and Random Forest (RF). We found that the proposed model outperforms all the benchmark algorithms.

Design and Implementation of an ML and IoT Based Adaptive Traffic-Management System for Smart Cities.

The rapid growth in the number of vehicles has led to traffic congestion, pollution, and delays in logistic transportation in metropolitan areas. IoT has been an emerging innovation, moving the universe towards automated processes and intelligent management systems. This is a critical contribution to automation and smart civilizations. Effective and reliable congestion management and traffic control help save many precious resources. An IoT-based ITM system set of sensors is embedded in automatic vehicles and intelligent devices to recognize, obtain, and transmit data. Machine learning (ML) is another technique to improve the transport system. The existing transport-management solutions encounter several challenges resulting in traffic congestion, delay, and a high fatality rate. This research work presents the design and implementation of an Adaptive Traffic-management system (ATM) based on ML and IoT. The design of the proposed system is based on three essential entities: vehicle, infrastructure, and events. The design utilizes various scenarios to cover all the possible issues of the transport system. The proposed ATM system also utilizes the machine-learning-based DBSCAN clustering method to detect any accidental anomaly. The proposed ATM model constantly updates traffic signal schedules depending on traffic volume and estimated movements from nearby crossings. It significantly lowers traveling time by gradually moving automobiles across green signals and decreases traffic congestion by generating a better transition. The experiment outcomes reveal that the proposed ATM system significantly outperformed the conventional traffic-management strategy and will be a frontrunner for transportation planning in smart-city-based transport systems. The proposed ATM solution minimizes vehicle waiting times and congestion, reduces road accidents, and improves the overall journey experience.

An Efficient Authenticated Key Agreement Scheme Supporting Privacy-Preservation for Internet of Drones Communications.

In recent years, due to the rapid development of Internet of things (IoTs), various physical things (objects) in IoTs are smart enough to make their own decisions without the involvement of humans. The smart devices embedded in a drone can sense, collect, and transmit real-time data back to the controller from a designated environment via wireless communication technologies. The mobility, flexibility, reliability and energy efficiency of drones makes them more widely used in IoT environments such as commercial, military, entertainment applications, traffic surveillance and aerial photography. In a generalized IoD architecture, we have communications among the drones in a flying zone, among the drones and the control server, and also among the drones and authorized user. IoD still has many critical issues that need to be addressed, such as data access being carried out through a public channel and battery operated drones. To address these concerns in IoD communications, in this paper, an efficient authentication and secure communication scheme with privacy preservation is proposed and it only uses secure one-way hash function and bitwise XOR operations when control server, drone and user mutually authenticate each other. After the successful authentication, both IoD-based participants can agree on a common session key to secure the subsequent communication messages. The widely accepted ProVerif and BAN logic analysis have been used to assure that the proposed scheme is provably secure against existing well-known security attacks and ensures privacy. Finally, a comparative analysis is presented to demonstrate the proposed scheme preserves efficiency when compared to existing competitive schemes.

Case history on Epstein-Barr Virus-associated smooth muscle tumor (EBV-SMT) of cranio-cervical junction in an immunocompetent patient.

Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare mesenchymal tumor that almost exclusively occurs in immunocompromised hosts. Here, we report a 75-year-old Taiwanese woman without definite immune-deficient history presenting with progressive occipital neuralgia, low cranial nerve deficits (CN9-12) and cervical (C1-C5) radiculopathy. Magnetic resonance imaging revealed a 4.5*4.0*6.7 cm infiltrating mass occupying posterior skull base and C1-C2 vertebra and C1-5 epidural extension with bone destruction and vertebral artery (VA) encasement. There was also a synchronous 2.7 cm tonsillar tumor. A two-stage operation for cranio-cervical tumor excision and stabilization was performed. Tumor was confirmed directly arising from VA intraoperatively. Pathology reported a spindle cell neoplasm and the diagnosis of EBV-SMT was confirmed by EBER (EBV-encoded small RNA) in situ hybridization. An immune survey and reconstruction should be conducted for patient with EBV-SMT. A near-total resection of tumor may be beneficial for local control, however, the role of surgical resection in treating CNS EBV-SMT remains to be determined.

ECS-NL: An Enhanced Cuckoo Search Algorithm for Node Localisation in Wireless Sensor Networks.

Node localisation plays a critical role in setting up Wireless Sensor Networks (WSNs). A sensor in WSNs senses, processes and transmits the sensed information simultaneously. Along with the sensed information, it is crucial to have the positional information associated with the information source. A promising method to localise these randomly deployed sensors is to use bio-inspired meta-heuristic algorithms. In this way, a node localisation problem is converted to an optimisation problem. Afterwards, the optimisation problem is solved for an optimal solution by minimising the errors. Various bio-inspired algorithms, including the conventional Cuckoo Search (CS) and modified CS algorithm, have already been explored. However, these algorithms demand a predetermined number of iterations to reach the optimal solution, even when not required. In this way, they unnecessarily exploit the limited resources of the sensors resulting in a slow search process. This paper proposes an Enhanced Cuckoo Search (ECS) algorithm to minimise the Average Localisation Error (ALE) and the time taken to localise an unknown node. In this algorithm, we have implemented an Early Stopping (ES) mechanism, which improves the search process significantly by exiting the search loop whenever the optimal solution is reached. Further, we have evaluated the ECS algorithm and compared it with the modified CS algorithm. While doing so, note that the proposed algorithm localised all the localisable nodes in the network with an ALE of 0.5-0.8 m. In addition, the proposed algorithm also shows an 80% decrease in the average time taken to localise all the localisable nodes. Consequently, the performance of the proposed ECS algorithm makes it desirable to implement in practical scenarios for node localisation.

Performance Measurement System and Quality Management in Data-Driven Industry 4.0: A Review.

The birth of mass production started in the early 1900s. The manufacturing industries were transformed from mechanization to digitalization with the help of Information and Communication Technology (ICT). Now, the advancement of ICT and the Internet of Things has enabled smart manufacturing or Industry 4.0. Industry 4.0 refers to the various technologies that are transforming the way we work in manufacturing industries such as Internet of Things, cloud, big data, AI, robotics, blockchain, autonomous vehicles, enterprise software, etc. Additionally, the Industry 4.0 concept refers to new production patterns involving new technologies, manufacturing factors, and workforce organization. It changes the production process and creates a highly efficient production system that reduces production costs and improves product quality. The concept of Industry 4.0 is relatively new; there is high uncertainty, lack of knowledge and limited publication about the performance measurement and quality management with respect to Industry 4.0. Conversely, manufacturing companies are still struggling to understand the variety of Industry 4.0 technologies. Industrial standards are used to measure performance and manage the quality of the product and services. In order to fill this gap, our study focuses on how the manufacturing industries use different industrial standards to measure performance and manage the quality of the product and services. This paper reviews the current methods, industrial standards, key performance indicators (KPIs) used for performance measurement systems in data-driven Industry 4.0, and the case studies to understand how smart manufacturing companies are taking advantage of Industry 4.0. Furthermore, this article discusses the digitalization of quality called Quality 4.0, research challenges and opportunities in data-driven Industry 4.0 are discussed.

Circadian period 2: a missing beneficial factor in sickle cell disease by lowering pulmonary inflammation, iron overload, and mortality.

The circadian clock is important for cellular and organ function. However, its function in sickle cell disease (SCD), a life-threatening hemolytic disorder, remains unknown. Here, we performed an unbiased microarray screen, which revealed significantly altered expression of circadian rhythmic genes, inflammatory response genes, and iron metabolic genes in SCD Berkeley transgenic mouse lungs compared with controls. Given the vital role of period 2 (Per2) in the core clock and the unrecognized role of Per2 in SCD, we transplanted the bone marrow (BM) of SCD mice to Per2Luciferase mice, which revealed that Per2 expression was up-regulated in SCD mouse lung. Next, we transplanted the BM of SCD mice to period 1 (Per1)/Per2 double deficient [Per1/Per2 double knockout (dKO)] and wild-type mice, respectively. We discovered that Per1/Per2 dKO mice transplanted with SCD BM (SCD → Per1/Per2 dKO) displayed severe irradiation sensitivity and were more susceptible to an early death. Although we observed an increase of peripheral inflammatory cells, we did not detect differences in erythrocyte sickling. However, there was further lung damage due to elevated pulmonary congestion, inflammatory cell infiltration, iron overload, and secretion of IL-6 in lavage fluid. Overall, we demonstrate that Per1/Per2 is beneficial to counteract elevated systemic inflammation, lung tissue inflammation, and iron overload in SCD.-Adebiyi, M. G., Zhao, Z., Ye, Y., Manalo, J., Hong, Y., Lee, C. C., Xian, W., McKeon, F., Culp-Hill, R., D' Alessandro, A., Kellems, R. E., Yoo, S.-H., Han, L., Xia, Y. Circadian period 2: a missing beneficial factor in sickle cell disease by lowering pulmonary inflammation, iron overload, and mortality.

Occipitocervical fusion complicated with cerebellar abscess: a case report.

BACKGROUND: Occipitocervical (OC) fusion is indicated for OC instability and other conditions. Surgical complications include infection, malunion, and instrument failure. CASE PRESENTATION: We described a patient who underwent OC fusion and subsequently developed complication of cerebellar abscess and obstructive hydrocephalus. A 63-year-old male patient had been suffering from long-term neck pain and limb numbness and weakness. Cervical spine examination revealed tight stenosis at C1 level and instability in the C1-C2 joints. A C1 laminectomy with OC fusion was performed, and the patient was discharged. Unfortunately, a few days later, he went to the emergency department and complained of persistent dizziness, vomiting, and unsteady gait. Computed tomography (CT) and magnetic resonance imaging (MRI) images revealed a suspicious cerebellar abscess formation and hydrocephalus. Furthermore, CT images indicated that the left screw was loose, and the diameter of the right screw hole was much larger than the size of the screw. Besides, inappropriate length of the screw penetrated the occipital bone and may cause the disruption of dura mater. The patient underwent external ventricular drainage first, followed by abscess drainage and C1-C2 fixation a few days later. He was discharged without any further neurological deficits or infectious problems. The patient recovered with intact consciousness, full muscle strength, and improved numbness throughout the extremities, with a Nurick grade of 1. A follow-up magnetic resonance imaging at 3 months after surgery revealed near total resolution of the abscess. Inform consent was obtained from this patient. CONCLUSIONS: Carefully conducting the procedure using the most tailored approach is essential to successful surgery, but this rare complication should always be kept in mind.

Security and Privacy in Wireless Sensor Networks: Advances and Challenges.

Wireless sensor networks (WSNs) have evolved over the last few decades due to the availability of low-cost, short-range and easy deployed sensors. WSN systems focus on sensing and transmittingthe real-time sense information of a specific monitoring environment for the back-end system to do further processing and analysis [...].

An Efficient Mobile-Healthcare Emergency Framework.

Mobile technologies are capable of offering individual level health care services to users. Mobile Healthcare (m-Healthcare) frameworks, which feature smartphone (SP) utilizations of ubiquitous computing made possible by applying wireless Body Sensor Networks (BSNs), have been introduced recently to provide SP clients with health condition monitoring and access to medical attention when necessary. However, in a vulnerable m-Healthcare framework, clients' personal info and sensitive data can easily be poached by intruders or any malicious party, causing serious security problems and confidentiality issues. In 2013, Lu et al. proposed a mobile-Healthcare emergency framework based on privacy-preserving opportunistic computing (SPOC), claiming that their splendid SPOC construction can opportunistically gather SP resources such as computing power and energy to handle computing-intensive Personal Health Information (PHI) with minimal privacy disclosure during an emergency. To balance between the risk of personal health information exposure and the essential PHI processing and transmission, Lu et al. presented a patient-centric privacy ingress control framework based on an attribute-based ingress control mechanism and a Privacy-Preserving Scalar Product Computation (PPSPC) technique. In spite of the ingenious design, however, Lu et al.'s framework still has some security flaws in such aspects as client anonymity and mutual authentication. In this article, we shall offer an improved version of Lu et al.'s framework with the security weaknesses mended and the computation efficiency further boosted. In addition, we shall also present an enhanced mobile-Healthcare emergency framework using Partial Discrete Logarithm (PDL) which does not only achieve flawless mutual authentication as well as client anonymity but also reduce the computation cost.

Awake craniotomies for epileptic gliomas: intraoperative and postoperative seizure control and prognostic factors.

PURPOSE: Awake craniotomy is well-established for tumors resected in eloquent brain areas. Whether awake craniotomy provides improved seizure control in patients with epileptic gliomas has not been well evaluated. This study analyzed the incidence, risk factors and outcome of seizures during and following awake craniotomies for patients presenting with epilepsy and glioma. METHODS: Forty-one patients undergoing awake craniotomies for epileptic gliomas were retrospectively analyzed. Postoperative seizure was defined as either early (postoperative day 7 + before) or late onset (after postoperative day 7). Neurologic function was assessed with modified Rankin Scales (mRS) and seizure outcome was assessed using International League Against Epilepsy (ILAE) classification. Multivariable logistic regression was used for clinical variables associated with postoperative seizures. RESULTS: Three patients (7.3%) had intraoperative seizures however did not fail the awake craniotomies. Mean mRS before and after the awake craniotomies were 2.4 and 2.1, respectively (P = 0.032). Fourteen (34.1%) patients had early seizures, which caused longer hospitalization than those without early seizures (P = 0.03). Surgical resection to isocitrate dehydrogenase 1 (IDH1) mutation tumors, comparing to IDH1 wild type tumors, caused better postoperative seizure control. 6-month late seizure freedom was achieved in 33 patients (80.5%). Early seizure recurrence (odds ratio = 30.75; P = 0.039) and postoperative mRS ≥ 3 (odds ratio = 7.00; P = 0.047) were independent risk factors for late seizures. CONCLUSIONS: Intraoperative seizures could be well-controlled during awake craniotomies. Early postoperative seizures extended hospitalization and strongly predicted late seizure recurrence. Awake craniotomies benefited long-term seizure control in patients with epileptic gliomas.

Tumefactive Sludge Mimicking Gallbladder Neoplasm: A Case Report and Review of the Literature.

Biliary sludge (or very thick bile) is mainly comprised of calcium bilirubinate granules and lesser amounts of cholesterol crystals, and it can produce a layer of low amplitude of echoes in the most dependent part of the gallbladder (GB). In tumefactive biliary sludge, low-amplitude echoes do not form a fluid-fluid level but instead tend to give the appearance of a polypoid mass that is bounded by a smooth margin, round, and lobulated. Differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. In this case report, we describe a rare case in which biliary sludge did not form a fluid-fluid level but tended to accumulate and appear as a polypoid mass within the lumen of the GB. The lesion was finally identified as being tumefactive sludge mimicking neoplasm of the GB.

An Efficient User Authentication and User Anonymity Scheme with Provably Security for IoT-Based Medical Care System.

In recent years, with the increase in degenerative diseases and the aging population in advanced countries, demands for medical care of older or solitary people have increased continually in hospitals and healthcare institutions. Applying wireless sensor networks for the IoT-based telemedicine system enables doctors, caregivers or families to monitor patients' physiological conditions at anytime and anyplace according to the acquired information. However, transmitting physiological data through the Internet concerns the personal privacy of patients. Therefore, before users can access medical care services in IoT-based medical care system, they must be authenticated. Typically, user authentication and data encryption are most critical for securing network communications over a public channel between two or more participants. In 2016, Liu and Chung proposed a bilinear pairing-based password authentication scheme for wireless healthcare sensor networks. They claimed their authentication scheme cannot only secure sensor data transmission, but also resist various well-known security attacks. In this paper, we demonstrate that Liu-Chung's scheme has some security weaknesses, and we further present an improved secure authentication and data encryption scheme for the IoT-based medical care system, which can provide user anonymity and prevent the security threats of replay and password/sensed data disclosure attacks. Moreover, we modify the authentication process to reduce redundancy in protocol design, and the proposed scheme is more efficient in performance compared with previous related schemes. Finally, the proposed scheme is provably secure in the random oracle model under ECDHP.

PML regulates PER2 nuclear localization and circadian function.

Studies have suggested that the clock regulator PER2 is a tumour suppressor. A cancer network involving PER2 raises the possibility that some tumour suppressors are directly involved in the mammalian clock. Here, we show that the tumour suppressor promyelocytic leukaemia (PML) protein is a circadian clock regulator and can physically interact with PER2. In the suprachiasmatic nucleus (SCN), PML expression and PML-PER2 interaction are under clock control. Loss of PML disrupts and dampens the expression of clock regulators Per2, Per1, Cry1, Bmal1 and Npas2. In the presence of PML and PER2, BMAL1/CLOCK-mediated transcription is enhanced. In Pml(-/-) SCN and mouse embryo fibroblast cells, the cellular distribution of PER2 is primarily perinuclear/cytoplasmic. PML is acetylated at K487 and its deacetylation by SIRT1 promotes PML control of PER2 nuclear localization. The circadian period of Pml(-/-) mice displays reduced precision and stability consistent with PML having a role in the mammalian clock mechanism.

A Secure Cloud-Assisted Wireless Body Area Network in Mobile Emergency Medical Care System.

Recent advances in medical treatment and emergency applications, the need of integrating wireless body area network (WBAN) with cloud computing can be motivated by providing useful and real time information about patients' health state to the doctors and emergency staffs. WBAN is a set of body sensors carried by the patient to collect and transmit numerous health items to medical clouds via wireless and public communication channels. Therefore, a cloud-assisted WBAN facilitates response in case of emergency which can save patients' lives. Since the patient's data is sensitive and private, it is important to provide strong security and protection on the patient's medical data over public and insecure communication channels. In this paper, we address the challenge of participant authentication in mobile emergency medical care systems for patients supervision and propose a secure cloud-assisted architecture for accessing and monitoring health items collected by WBAN. For ensuring a high level of security and providing a mutual authentication property, chaotic maps based authentication and key agreement mechanisms are designed according to the concept of Diffie-Hellman key exchange, which depends on the CMBDLP and CMBDHP problems. Security and performance analyses show how the proposed system guaranteed the patient privacy and the system confidentiality of sensitive medical data while preserving the low computation property in medical treatment and remote medical monitoring.

A Secure Dynamic Identity and Chaotic Maps Based User Authentication and Key Agreement Scheme for e-Healthcare Systems.

Secure user authentication schemes in many e-Healthcare applications try to prevent unauthorized users from intruding the e-Healthcare systems and a remote user and a medical server can establish session keys for securing the subsequent communications. However, many schemes does not mask the users' identity information while constructing a login session between two or more parties, even though personal privacy of users is a significant topic for e-Healthcare systems. In order to preserve personal privacy of users, dynamic identity based authentication schemes are hiding user's real identity during the process of network communications and only the medical server knows login user's identity. In addition, most of the existing dynamic identity based authentication schemes ignore the inputs verification during login condition and this flaw may subject to inefficiency in the case of incorrect inputs in the login phase. Regarding the use of secure authentication mechanisms for e-Healthcare systems, this paper presents a new dynamic identity and chaotic maps based authentication scheme and a secure data protection approach is employed in every session to prevent illegal intrusions. The proposed scheme can not only quickly detect incorrect inputs during the phases of login and password change but also can invalidate the future use of a lost/stolen smart card. Compared the functionality and efficiency with other authentication schemes recently, the proposed scheme satisfies desirable security attributes and maintains acceptable efficiency in terms of the computational overheads for e-Healthcare systems.