Explore the vast range of titles available.

Background and AimsEndoscopic ultrasound (EUS)-guided transmural drainage has been increasingly utilized as a first-line therapeutic modality for drainage of pancreatic fluid collections (PFC). Recently, lumen-apposing metal stents (LAMS) have been utilized for management of PFCs. We conducted a systematic review and meta-analysis to evaluate the cumulative efficacy and safety of LAMS in the management of PFC (primary outcome). We also compared the efficacy and safety of LAMS with multiple plastic stents (MPS) in the management of PFC (secondary outcome).MethodsWe searched Medline, Embase and Cochrane databases from inception to November 5, 2016, to identify studies (with ≥ 10 patients) reporting technical success, clinical success, and adverse events (AE) of EUS-guided transmural drainage of PFC using LAMS. Weighted pooled rates (WPR) were calculated for technical success, clinical success and AE. Risk ratios (RR) were calculated and pooled to compare LAMS with MPS in terms of technical success, clinical success, and AE. Pooled mean difference (MD) was calculated to compare the number of endoscopic sessions required by each type of stent to achieve clinical success. All analyses were done using random effects model.ResultsEleven studies with 688 patients were included in this meta-analysis. WPR for technical success of LAMS in PFC management was 98% (96, 99%), (I2 = 15%). WPR for clinical success was 93% (89, 96%) with moderate heterogeneity (I2 = 50%). There was no difference in clinical success for pseudocysts (PP) versus walled-off pancreatic necrosis (WON) (P = 0.51). WPR for AE was 13% (9, 20%), (I2 = 64%). AE were 10% more in WON as compared to PP (P = 0.009). Most common AE requiring intervention was stent migration (4.2%), followed by infection (3.8%), bleeding (2.4%), and stent occlusion (1.9%). Six studies with 504 patients compared the performance of LAMS with MPS. Pooled RR for technical success was 1.71 (0.38, 7.37). Pooled RR for clinical success was 0.37 (0.20, 0.67) in favor of LAMS. Pooled RR for AE was 0.39 (0.18, 0.84), (I2 = 50%). Pooled MD for number of endoscopic sessions was − 0.84 (− 1.69, 0.01).ConclusionsLAMS seem to have excellent efficacy and safety in the management of PFCs. They may be preferred over plastic stents as they are associated with better clinical success and lesser adverse events.

Background and Aims Spastic esophageal disorders (SEDs) include spastic achalasia (type III), diffuse esophageal spasm (DES), and nutcracker/jackhammer esophagus (JH). Per-oral endoscopic myotomy (POEM) has demonstrated efficacy and safety in the treatment of achalasia. Recently, POEM has been indicated for the treatment of SEDs. We conducted a systematic review and meta-analysis to determine the clinical success and safety of POEM in SEDs. Methods We searched several databases from 01/01/2007 to 01/10/2016 to identify studies (with five or more patients) on POEM for the treatment of SEDs. Weighted pooled rates (WPRs) for clinical success and adverse events (AEs) were calculated for all SEDs. Clinical success was defined as Eckardt scores of ≤3 and/or improvement in severity of dysphagia based on achalasia disease-specific health-related quality of life questionnaire. The WPRs for clinical success and AEs were analyzed using fixed- or random-effects model based on heterogeneity. The proportionate difference in clinical success and post-procedure adverse event rates among individual types of SEDs was also calculated. Results A total of eight observational studies with 179 patients were included in the final analysis. Two studies were of good quality and six were of fair quality based on the National Institutes of Health quality assessment tool. The WPR with 95% confidence interval (CI) for cumulative clinical success of POEM in all SEDs was 87% (78, 93%), I 2  = 37%. The total number of patients for individual disorders, i.e., type III achalasia, JH, and DES, was 116, 37, and 18, respectively. The WPRs for clinical success of POEM for type III achalasia, DES, and JH were 92, 88, and 72%, respectively. Proportion difference of WPR for clinical success was significantly higher for type III achalasia in comparison with JH (20%, P  = 0.01). The WPR with 95% CI for AEs of POEM in all SEDs was 14% (9, 20%), I 2  = 0%. The WPRs for post-procedure adverse events for type III achalasia, DES, and JH were 11, 14, and 16%, respectively. There was no difference in safety of POEM among individual SEDs. Conclusion POEM is an effective and safe therapeutic modality for the treatment of spastic esophageal disorders.

Background and Aims Variable success and adverse event rates have been reported for endoscopic ultrasound-guided biliary drainage (EUS-BD) utilizing either extrahepatic or intrahepatic approach. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of EUS-BD and to compare the two approaches and transluminal methods of EUS-BD. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus from January 2001 through January 5, 2015, to identify studies reporting technical success and adverse events of EUS-BD. A sample size of more than 20 patients was a further criterion. Weighted pooled rate (WPR) for technical success and post-procedure complications was calculated for overall studies and predefined subgroups. Pooled odds ratios were calculated for technical success and adverse events for two approaches and transluminal methods of EUS-BD for distal common bile duct (CBD) strictures. Results The WPR with 95 % confidence interval (CI) for technical success and post-procedure adverse events was 90 % (86, 93 %) and 17 % (13, 22 %), respectively, with considerable heterogeneity ( I 2  = 77 %). For high-quality studies, the WPR for technical success was 94 % (91, 96 %), I 2  = 0 % and WPR for post-procedure adverse event was 16 % (12, 19 %), I 2  = 39 %. In meta-regression model, distal CBD stricture and transpapillary drainage were associated with higher technical success and intrahepatic access route was associated with higher adverse event rate. There was no difference in technical success using either approach OR 1.27 (0.52, 3.13), I 2  = 0 % or transluminal method OR 1.32 (0.51, 3.38), I 2  = 0 %. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I 2  = 27 %. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I 2  = 0 %. Conclusion In cases of failure of traditional ERC to achieve biliary drainage, EUS-BD appears to be an emerging therapeutic modality with a cumulative success rate of 90 % and cumulative adverse events rate of 17 %. Randomized controlled trials are required to further evaluate the efficacy and safety of the procedure along with the comparison to traditional modalities like percutaneous transhepatic biliary drainage.

Substitution boxes are the key factor in symmetric-key cryptosystems that determines their ability to resist various cryptanalytic attacks. Creating strong substitution boxes that have multiple strong cryptographic properties at the same time is a challenging task for cryptographers. A significant amount of research has been conducted on S-boxes in the past few decades, but the resulting S-boxes have been found to be vulnerable to various cyberattacks. This paper proposes a new method for creating robust S-boxes that exhibit superior performance and possess high scores in multiple cryptographic properties. The hybrid S-box method presented in this paper is based on Chua’s circuit chaotic map, two-dimensional cellular automata, and an algebraic permutation group structure. The proposed 16×16 S-box has an excellent performance in terms of security parameters, including a minimum nonlinearity of 102, the absence of fixed points, the satisfaction of bit independence and strict avalanche criteria, a low differential uniformity of 5, a low linear approximation probability of 0.0603, and an auto-correlation function of 28. The analysis of the performance comparison indicates that the proposed S-box outperforms other state-of-the-art S-box techniques in several aspects. It possesses better attributes, such as a higher degree of inherent security and resilience, which make it more secure and less vulnerable to potential attacks.

This conceptual paper after thorough review of literature developed model for outsourcing success which is creating value for business. Through propelling effect as how much and which activity / function to outsource, degree of outsourcing identified one of the predominant factors for developing a robust vendor management system. Framework proposed in this paper providing a balanced robust system for the success of outsourcing from the realm of strategic management. It is contributing to body of knowledge from new dimension. By harnessing the concepts of vendor management capability, partnership quality, trust, degree of outsourcing organization can achieve outsourcing success. In this stratum efficient propensity involvement of focal and vendor organization create value for business which is the underlying objective to develop this model of outsourcing success.