Alveolar cleft reconstruction using bone marrow aspirate concentrate and iliac cancellous bone: A 12-month randomized clinical study.

OBJECTIVE: This study aimed to compare the bone density and volume in patients with alveolar cleft reconstructions utilizing bone marrow aspirate concentrate with iliac graft versus iliac graft alone. MATERIAL AND METHODS: Thirty-six patients with unilateral alveolar cleft were randomly allocated into either an intervention group receiving an iliac bone graft mixed with bone marrow concentrate or a control group receiving an iliac bone graft. Cone beam CT was obtained preoperative, 6 and 12 months postoperatively to assess the bone density of the graft and bone volume of the alveolar defect, and then, the bone loss ratio was calculated. RESULTS: Bone volume and bone density demonstrated a statistically significant increase in the intervention group at 6 and 12 months. In contrast, the bone loss ratio decreased significantly in the intervention group throughout the follow-up period. CONCLUSION: A combination of bone marrow concentrate and iliac cancellous bone in alveolar cleft reconstruction may improve bone densities and volume in addition to decreasing graft loss rate. CLINICAL SIGNIFICANCE: Using of bone marrow aspirate concentrate will decrease the amount of the graft needed and decrease the ratio of bone loss at the grafted site by the time. Trial registration ClinicalTrials.org ( NCT04414423 ) 4/6/2020.

Blockchain and COVID-19 pandemic: applications and challenges.

The year 2020 has witnessed the emergence of coronavirus (COVID-19) that has rapidly spread and adversely affected the global economy, health, and human lives. The COVID-19 pandemic has exposed the limitations of existing healthcare systems regarding their inadequacy to timely and efficiently handle public health emergencies. A large portion of today's healthcare systems are centralized and fall short in providing necessary information security and privacy, data immutability, transparency, and traceability features to detect fraud related to COVID-19 vaccination certification, and anti-body testing. Blockchain technology can assist in combating the COVID-19 pandemic by ensuring safe and reliable medical supplies, accurate identification of virus hot spots, and establishing data provenance to verify the genuineness of personal protective equipment. This paper discusses the potential blockchain applications for the COVID-19 pandemic. It presents the high-level design of three blockchain-based systems to enable governments and medical professionals to efficiently handle health emergencies caused by COVID-19. It discusses the important ongoing blockchain-based research projects, use cases, and case studies to demonstrate the adoption of blockchain technology for COVID-19. Finally, it identifies and discusses future research challenges, along with their key causes and guidelines.

Blockchain for deep learning: review and open challenges.

Deep learning has gained huge traction in recent years because of its potential to make informed decisions. A large portion of today's deep learning systems are based on centralized servers and fall short in providing operational transparency, traceability, reliability, security, and trusted data provenance features. Also, training deep learning models by utilizing centralized data is vulnerable to the single point of failure problem. In this paper, we explore the importance of integrating blockchain technology with deep learning. We review the existing literature focused on the integration of blockchain with deep learning. We classify and categorize the literature by devising a thematic taxonomy based on seven parameters; namely, blockchain type, deep learning models, deep learning specific consensus protocols, application area, services, data types, and deployment goals. We provide insightful discussions on the state-of-the-art blockchain-based deep learning frameworks by highlighting their strengths and weaknesses. Furthermore, we compare the existing blockchain-based deep learning frameworks based on four parameters such as blockchain type, consensus protocol, deep learning method, and dataset. Finally, we present important research challenges which need to be addressed to develop highly trustworthy deep learning frameworks.

Blockchain-based solution for COVID-19 vaccine waste reduction.

Coronavirus 2019 (COVID-19) vaccines have been produced on a large scale since 2020. However, large-scale vaccine production has led to two forms of waste; namely, overproduction and underutilization. Most of today's systems and technologies used to manage waste data related to COVID-19 vaccines fall short of providing transparency, traceability, accountability, trust, and security features. In this paper, we address the problem of COVID-19 vaccines waste due to their overproduction and underutilization. We propose a blockchain-based solution that is composed of five phases: registration, commitment; production and delivery; consumption; and waste assessment. These phases make up the complete life cycle of a COVID-19 vaccine, and they are governed by several smart contracts to ensure accountability of all the actions taken by the involved entities and reduce any excessive waste caused by overproduction, overordering, or underconsumption. We ensure security, traceability, and data provenance by recording all actions through smart contracts in the form of events on an immutable ledger. We utilize decentralized storage such as the InterPlanetary File System (IPFS) to reduce the costs posed by large-sized file storage when stored on-chain. We present algorithms that describe the logic behind our developed smart contracts. We test and validate the functionalities of our proposed solution. We conduct security, cost, and scalability analyses to show that our solution is affordable, scalable, and secure. We compare our solution with the existing blockchain-based solutions to show its novelty and superiority. The smart contract code is made publicly available on GitHub.

Blockchain-based Supply Chain Traceability for COVID-19 personal protective equipment.

The COVID-19 pandemic has severely impacted many industries, in particular the healthcare sector exposing systemic vulnerabilities in emergency preparedness, risk mitigation, and supply chain management. A major challenge during the pandemic was related to the increased demand for Personal Protective Equipment (PPE), resulting in critical shortages for healthcare and frontline workers. This is due to the lack of information visibility combined with the inability to precisely track product movement within the supply chain, requiring a robust traceability solution. Blockchain technology is a distributed ledger that ensures a transparent, safe, and secure exchange of data among supply chain stakeholders. The advantages of adopting blockchain technology to manage and track PPE products in the supply chain include decentralized control, security, traceability, and auditable time-stamped transactions. In this paper, we present a blockchain-based approach using smart contracts to transform PPE supply chain operations. We propose a generic framework using Ethereum smart contracts and decentralized storage systems to automate the processes and information exchange and present detailed algorithms that capture the interactions among supply chain stakeholders. The smart contract code was developed and tested in Remix environment, and the code is made publicly available on Github. We present detailed cost and security analysis incurred by the stakeholders in the supply chain. Adopting a blockchain-based solution for PPE supply chains is economically viable and provides a streamlined, secure, trusted, and transparent mode of communication among various stakeholders.

Blockchain-Based Forward Supply Chain and Waste Management for COVID-19 Medical Equipment and Supplies.

The year 2020 has witnessed unprecedented levels of demand for COVID-19 medical equipment and supplies. However, most of today's systems, methods, and technologies leveraged for handling the forward supply chain of COVID-19 medical equipment and the waste that results from them after usage are inefficient. They fall short in providing traceability, reliability, operational transparency, security, and trust features. Also, they are centralized that can cause a single point of failure problem. In this paper, we propose a decentralized blockchain-based solution to automate forward supply chain processes for the COVID-19 medical equipment and enable information exchange among all the stakeholders involved in their waste management in a manner that is fully secure, transparent, traceable, and trustworthy. We integrate the Ethereum blockchain with decentralized storage of interplanetary file systems (IPFS) to securely fetch, store, and share the data related to the forward supply chain of COVID-19 medical equipment and their waste management. We develop algorithms to define interaction rules regarding COVID-19 waste handling and penalties to be imposed on the stakeholders in case of violations. We present system design along with its full implementation details. We evaluate the performance of the proposed solution using cost analysis to show its affordability. We present the security analysis to verify the reliability of the smart contracts, and discuss our solution from the generalization and applicability point of view. Furthermore, we outline the limitations of our solution in form of open challenges that can act as future research directions. We make our smart contracts code publicly available on GitHub.

COVID-19 Contact Tracing Using Blockchain.

Contact tracing has widely been adopted to control the spread of Coronavirus-2019 (COVID-19). It enables to identify, assess, and manage people who have been exposed to COVID-19, thereby preventing from its further transmission. Today's most of the contact tracing approaches, tools, and solutions fall short in providing decentralized, transparent, traceable, immutable, auditable, secure, and trustworthy features. In this paper, we propose a decentralized blockchain-based COVID-19 contact tracing solution. Contact tracing can greatly suffice the need for a speedy response to a pandemic. We leverage the immutable and tamper-proof features of blockchain to enforce trust, accountability, and transparency. Trusted and registered oracles are used to bridge the gap between on-chain and off-chain data. With no third parties involved or centralized servers, the users' medical information is not prone to invasion, hacking, or abuse. Each user is registered using their digital medical passports. To respect the privacy of the users, their locations are updated with a time delay of 20 minutes. Using Ethereum smart contracts, transactions are executed on-chain with emitted events and immutable logs. We present details of the implemented algorithms and their testing analysis. We evaluate the proposed approach using security, cost, and privacy parameters to show its effectiveness. The smart contracts code is publicly made available on GitHub.

Blockchain-Based Solution for Distribution and Delivery of COVID-19 Vaccines.

Distribution and delivery of Coronavirus 2019 (COVID-19) vaccines have become challenging after their emergence. Today's platforms and systems leveraged for managing data related to COVID-19 vaccines' distribution and delivery fall short in providing transparency, trackability and traceability, immutability, audit, and trust features. Also, they are vulnerable to the single point of failure problem due to centralization. Such limitations hindering the safe, secure, transparent, trustworthy, and reliable distribution and delivery process of COVID-19 vaccines. In this paper, we propose an Ethereum blockchain-based solution for managing data related to COVID-19 vaccines' distribution and delivery. We develop smart contracts to automate the traceability of COVID-19 vaccines while ensuring data provenance, transparency, security, and accountability. We integrate the Ethereum blockchain with off-chain storage to manage non-critical and large-sized data. We present algorithms and discuss their full implementation, testing, and validation details. We evaluate the proposed solution by performing cost and security analysis as well as comparing it with the existing non-blockchain and blockchain-based solutions. Performance evaluation results reveal that the proposed solution is low-cost, and our smart contracts are secure enough against possible attacks and vulnerabilities. The smart contracts code along with testing scripts is made publicly available.

Blockchain-Based Decentralized Digital Manufacturing and Supply for COVID-19 Medical Devices and Supplies.

Coronavirus 2019 (COVID-19) has disclosed the deficiencies and limitations of the existing manufacturing and supply chain systems used for medical devices and supplies. It enforces the necessity to accelerate the shift towards decentralized digital manufacturing and supply chain networks. This paper proposes a blockchain-based solution for decentralized digital manufacturing of medical devices and their supply. We develop Ethereum smart contracts to govern and track transactions in a decentralized, transparent, traceable, auditable, trustworthy, and secure manner. This allows overcoming certain issues hindering the transition towards decentralized digital manufacturing and supply, including trusted traceability, attestations, certifications, and secured intellectual property (IP) rights. We incorporate the decentralized storage of the InterPlanetary file system (IPFS) into the Ethereum blockchain to store and fetch Internet of things (IoT)-based devices records and additional manufacturing and supply details. We present the system architecture and algorithms along with their full implementation and testing details. Furthermore, we present cost and security analyses to show that the proposed solution is cost-efficient and resilient against well-known vulnerabilities and security attacks. We make our smart contracts code publicly available on GitHub.

HonestChain: Consortium blockchain for protected data sharing in health information systems.

Healthcare innovations are increasingly becoming reliant on high variety and standards-compliant (e.g., HIPAA, common data model) distributed data sets that enable predictive analytics. Consequently, health information systems need to be developed using cooperation and distributed trust principles to allow protected data sharing between multiple domains or entities (e.g., health data service providers, hospitals and research labs). In this paper, we present a novel health information sharing system viz., HonestChain that uses Blockchain technology to allow organizations to have incentive-based and trustworthy cooperation to either access or provide protected healthcare records. More specifically, we use a consortium Blockchain approach coupled with chatbot guided interfaces that allow data requesters to: (a) comply with data access standards, and (b) allow them to gain reputation in a consortium. We also propose a reputation scheme for creation and sustenance of the consortium with peers using Requester Reputation and Provider Reputation metrics. We evaluate HonestChain using Hyperledger Composer in a realistic simulation testbed on a public cloud infrastructure. Our results show that our HonestChain performs better than the state-of-the-art requester reputation schemes for data request handling, while choosing the most appropriate provider peers. We particularly show that HonestChain achieves a better tradeoff in metrics such as service time and request resubmission rate. Additionally, we also demonstrate the scalability of our consortium platform in terms of the Blockchain transaction times.

Blockchain for drug traceability: Architectures and open challenges.

Pharmaceutical supply chain (PSC) consists of multiple stakeholders including raw material suppliers, manufacturers, distributors, regulatory authorities, pharmacies, hospitals, and patients. The complexity of product and transaction flows in PSC requires an effective traceability system to determine the current and all previous product ownerships. In addition, digitizing track and trace process provides significant benefit for regulatory oversight and ensures product safety. Blockchain-based drug traceability offers a potential solution to create a distributed shared data platform for an immutable, trustworthy, accountable and transparent system in the PSC. In this paper, we present an overview of product traceability issues in the PSC and envisage how blockchain technology can provide effective provenance, track and trace solution to mitigate counterfeit medications. We propose two potential blockchain based decentralized architectures, Hyperledger Fabric and Besu to meet critical requirements for drug traceability such as privacy, trust, transparency, security, authorization and authentication, and scalability. We propose, discuss, and compare two potential blockchain architectures for drug traceability. We identify and discuss several open research challenges related to the application of blockchain technology for drug traceability. The proposed blockchain architectures provide a valuable roadmap for Health Informatics researchers to build and deploy an end-to-end solution for the pharmaceutical industry.

The role of blockchain technology in telehealth and telemedicine.

OBJECTIVE: Telehealth and telemedicine systems aim to deliver remote healthcare services to mitigate the spread of COVID-9. Also, they can help to manage scarce healthcare resources to control the massive burden of COVID-19 patients in hospitals. However, a large portion of today's telehealth and telemedicine systems are centralized and fall short of providing necessary information security and privacy, operational transparency, health records immutability, and traceability to detect frauds related to patients' insurance claims and physician credentials. METHODS: The current study has explored the potential opportunities and adaptability challenges for blockchain technology in telehealth and telemedicine sector. It has explored the key role that blockchain technology can play to provide necessary information security and privacy, operational transparency, health records immutability, and traceability to detect frauds related to patients' insurance claims and physician credentials. RESULTS: Blockchain technology can improve telehealth and telemedicine services by offering remote healthcare services in a manner that is decentralized, tamper-proof, transparent, traceable, reliable, trustful, and secure. It enables health professionals to accurately identify frauds related to physician educational credentials and medical testing kits commonly used for home-based diagnosis. CONCLUSIONS: Wide deployment of blockchain in telehealth and telemedicine technology is still in its infancy. Several challenges and research problems need to be resolved to enable the widespread adoption of blockchain technology in telehealth and telemedicine systems.

Blockchain for COVID-19: Review, Opportunities, and a Trusted Tracking System.

The sudden development of the COVID-19 pandemic has exposed the limitations in modern healthcare systems to handle public health emergencies. It is evident that adopting innovative technologies such as blockchain can help in effective planning operations and resource deployments. Blockchain technology can play an important role in the healthcare sector, such as improved clinical trial data management by reducing delays in regulatory approvals, and streamline the communication between diverse stakeholders of the supply chain, etc. Moreover, the spread of misinformation has intensely increased during the outbreak, and existing platforms lack the ability to validate the authenticity of data, leading to public panic and irrational behavior. Thus, developing a blockchain-based tracking system is important to ensure that the information received by the public and government agencies is reliable and trustworthy. In this paper, we review various blockchain applications and opportunities in combating the COVID-19 pandemic and develop a tracking system for the COVID-19 data collected from various external sources. We propose, implement, and evaluate a blockchain-based system using Ethereum smart contracts and oracles to track reported data related to the number of new cases, deaths, and recovered cases obtained from trusted sources. We present detailed algorithms that capture the interactions between stakeholders in the network. We present security analysis and the cost incurred by the stakeholders, and we highlight the challenges and future directions of our work. Our work demonstrates that the proposed solution is economically feasible and ensures data integrity, security, transparency, data traceability among stakeholders.

Ensuring protocol compliance and data transparency in clinical trials using Blockchain smart contracts.

BACKGROUND: Clinical Trials (CTs) help in testing and validating the safety and efficacy of newly discovered drugs on specific patient population cohorts. However, these trials usually experience many challenges, such as extensive time frames, high financial cost, regulatory and administrative barriers, and insufficient workforce. In addition, CTs face several data management challenges pertaining to protocol compliance, patient enrollment, transparency, traceability, data integrity, and selective reporting. Blockchain can potentially address such challenges because of its intrinsic features and properties. Although existing literature broadly discusses the applicability of blockchain-based solutions for CTs, only a few studies present their working proof-of-concept. METHODS: We propose a blockchain-based framework for CT data management, using Ethereum smart contracts, which employs IPFS as the file storage system to automate processes and information exchange among CT stakeholders. CT documents stored in the IPFS are difficult to tamper with as they are given unique cryptographic hashes. We present algorithms that capture various stages of CT data management. We develop the Ethereum smart contract using Remix IDE that is validated under different scenarios. RESULTS: The proposed framework results are advantageous to all stakeholders ensuring transparency, data integrity, and protocol compliance. Although the proposed solution is tested on the Ethereum blockchain platform, it can be deployed in private blockchain networks using their native smart contract technologies. We make our smart contract code publicly available on Github. CONCLUSIONS: We conclude that the proposed framework can be highly effective in ensuring that the trial abides by the protocol and the functions are executed only by the stakeholders who are given permission. It also assures data integrity and promotes transparency and traceability of information among stakeholders.

iRhom2 in the pathogenesis of oral squamous cell carcinoma.

iRhom2 is an inactive rhomboid protease involved in diverse signalling events. It has been implicated in the pathogenesis of a number of cancer types, including oesophageal and ovarian cancer, while its closely associated family member, iRhom1, is implicated in head and neck cancer. However, a role for iRhom2 in head and neck cancer has not been investigated. Immunoblotting for iRhom2 in 54 oral squamous cell carcinoma (OSCC) and 24 paired normal tissues demonstrated higher levels of iRhom2 protein in tumour compared with normal samples (P < 0.05). iRhom2 over-expression correlated with poor patient survival (P < 0.0005) but with no other clinicopathological variable. Increased cell migration was observed in stably over-expressing iRhom2 clones of OSCC cell lines in the absence of increased cell proliferation, but not in the normal oral keratinocyte cell line, NOK-hTERT, and this was abrogated by knock-down of iRhom2. iRhom2 protein expression is increased in a proportion of OSCC and this up-regulation is associated with faster cell migration and decreased patient survival. These data implicate iRhom2-controlled signalling events in the pathogenesis of this cancer.

Blockchain-Based Solution for COVID-19 Digital Medical Passports and Immunity Certificates.

COVID-19 has emerged as a highly contagious disease which has caused a devastating impact across the world with a very large number of infections and deaths. Timely and accurate testing is paramount to an effective response to this pandemic as it helps identify infections and therefore mitigate (isolate/cure) them. In this paper, we investigate this challenge and contribute by presenting a blockchain-based solution that incorporates self-sovereign identity, re-encryption proxies, and decentralized storage, such as the interplanetary file systems (IPFS). Our solution implements digital medical passports (DMP) and immunity certificates for COVID-19 test-takers. We present smart contracts based on the Ethereum blockchain written and tested successfully to maintain a digital medical identity for test-takers that help in a prompt trusted response directly by the relevant medical authorities. We reduce the response time of the medical facilities, alleviate the spread of false information by using immutable trusted blockchain, and curb the spread of the disease through DMP. We present a detailed description of the system design, development, and evaluation (cost and security analysis) for the proposed solution. Since our code leverages the use of the on-chain events, the cost of our design is almost negligible. We have made our smart contract codes publicly available on Github.

A Multidisciplinary Team Approach to Brain and Spine Stereotactic Radiosurgery Conferences: A Unique Institutional Model.

OBJECTIVE: The use of multidisciplinary teams (MDTs) comprised of all members of the patient care team is becoming increasingly popular in the field of oncology. We present a single-center experience exploring the utility and uniqueness of an MDT in the care of patients undergoing brain and spine stereotactic radiosurgery (SRS). METHODS: The weekly SRS conference brought together neurosurgeons, radiation oncologists, neuroradiologists, physicists, dosimetrists, therapists, advanced practice providers, and trainees in these fields as well as researchers from a variety of disciplines with a goal of optimizing patient care. A survey of 20 conference attendees from 7 different facets of the MDT was conducted for feedback. RESULTS: The survey results revealed that most respondents believed the SRS conference increased educational opportunities, provided opportunities for research and collaborations, helped streamline patient care, and was beneficial to their practice. CONCLUSIONS: We present our institutional MDT model, a framework and workflow that can be incorporated at other large academic centers. We believe that the SRS conference has educational, academic, and patient care value.

Tumor necrosis factor alpha gene polymorphisms and haplotypes in Egyptian children with nephrotic syndrome.

BACKGROUND: Nephrotic syndrome (NS) characterized by complex pathogenesis and clinical course with relapses; and needs novel breakthroughs for decades. Polymorphisms of cytokines genes including tumor necrosis factor alpha (TNF-α)may influence susceptibility to NS as well as different patients' steroid responses. In the current study, we demonstrated the potential roles of TNF-α promoter gene polymorphisms [-238, -308, -863] and haplotypes in susceptibility to childhood NS. Also, elucidating their possible influence on patients' steroid response and serum TNF-α level. METHODS: This case-control study included 150 children suffering from NS and 150 healthy children. Polymerase chain reaction- restriction-fragment length polymorphism (PCR-RFLP) was performed to evaluate different TNF-α gene polymorphism. TNF-α serum levels were assessed by ELISA. RESULTS: Serum TNF-α levels were significantly higher in NS patients than in controls and in steroid resistant NS (SRNS) than in steroid sensitive NS (SSNS) (P<0.001 for each). The risk of NS in patients carrying TNF-α-238GA genotype, and TNF-α-308GA or AA genotypes and allele A was significantly increased compared to healthy children. While no significant association was detected between TNF-α-863 and NS. The risk of resistance to steroid therapy was significantly high in NS carrying TNF-α-238GA genotype and A allele, TNF-α-308, AA genotypes and A allele, and TNF-α-863CA, AA genotypes and A allele. The TNF-α GCG (-308/-863/-238) haplotype has protective roles against NS and steroid resistance. However, the risk of NS was significantly high in TNF-α AAG and AAA haplotype's carriers compared to healthy children. Additionally the risk of steroid resistance was significantly high in TNF-α AAA haplotype's NS carrier (OR (95%CI): 2.2 (1.19-4.36), P=0.01). Moreover, we found significant higher serum TNF-α levels NS patients including SSNS and SRNS carrying mutant allele TNF-α-238GA genotype, -308GA and AA and -863CA and AA wild genotype's carriers than in those GG, GG and CC respectively. Interstingely, TNF-α levels were significantly higher in healthy children carrying TNF-α(-308/-863/-238) [AAG and AAA haplotypes], NS cases carrying [ACA, AAG, AAA haplotypes], and in SSNS carrying [ACA and AAA haplotypes] than in those carrying GCG, haplotype of wild alleles. CONCLUSION: This study reported, for the first time, that TNF-α promoter gene polymorphisms and/or haplotypes are risk factors of NS and resistance to steroid among Egyptian children.