Cardiovascular Journal of Africa (CVJA) lamented, like so many others, the injustice of not having an impact factor, its validity as a tool for measuring science output, and the negative effect of a low perceived impact in drawing attention from publications from developing countries.4Both the impact factor of the journal and immediate full-text availability in Pubmed Central (PMC) have featured in editorials before.Since then, after a selection process, we have been indexed by the Web of Science® (WoS) and Thomson Reuters , and have seen a growing impact factor. In the case of PMC, our acceptance to this database was announced in 2012,The impact factor is one measurement of visibility of articles in specific journals and is more appropriately called the journal impact factor (JIF). It was originally developed by Eugene Garfield as a help to librarians in selecting journals to which to subscribe.The classic JIF is defined as the ratio of the number of cites in a given year as a ratio of the number of ‘citable’ articles published in the previous two years. Information comes from the approximately 11 000 journals indexed by the WoS, which is published in the Journal Citation Report® (JCR).Factors that can be correlated with the JIF have been much researched and debated. To name but a few, the country of the journal and its socio-economic status,6New England Journal of Medicine (NEJM) with a JIF of 52.658 (JCR 2012) and then Lancet with a JIF of 39.060 (2012) are probably the world’s most read medical journals. South Africa’s general medical journal, the South Africa Medical Journal, comes in at a JIF of 1.702.The Cancer Journal for Clinicians, with a JIF of 153.459 (2012). It publishes few articles, 37 in 2010 and 11, but with 5 678 cites in 2012. It went from a JIF of 101.78 in 2011 to 153.459 in 2012, the highest jump ever recorded. This can mostly be attributed to an extraordinary number of cites, 1 787 to one article (26% of cites).Lancet, which had 21 366 cites for 547 articles, translating into its JIF of 39.060.Surprisingly, the highest JIF belongs to a journal that most readers of CVJA may not even have heard off, a clinical oncology journal, Circulation is top, with a JIF of 15.202. However, the CVJA is from Africa. Of the 46 African countries in the JCR, a non-medical journal the International Journal of Photoenergy from Egypt but domiciled in New York, has the highest JIF of 2.663. Second is the South African Medical Journal, which forms part of the medical group of 14 African journals within the JCR, with a JIF of 1.702. Of these, the CVJA with a JIF of 0.848 ranks a close third after the African Journal of Psychiatry, with a JIF of 0.871. Within the 14 titles, CVJA is the only journal from Africa in the field of cardiac and cardiovascular systems.Of course, when working in the cardiovascular field, one will not publish in a cancer journal. In the JCR field of cardiac and cardiovascular systems, where the CVJA resides, Having publications accepted in journals with a high JIF does not necessarily reflect an interest in local problems, but often current interest in developed economies. For example, in the NEJM over the eight-year period from 1997 to 2004, less than 3% of published articles addressed health issues of developing countries. Furthermore, there was a bias towards HIV/AIDS and infective disease. Of 202 articles addressing issues of developing countries, 135  were about infectious disease. Only 23 were about non-communicable disease, of which one, a book review, discussed heart disease.Then there is also the excessive emphasis on a single metric, the ‘number that’s devoured science’, the JIF.11et al. and Pendlebury.The group suggests a reduction in emphasis on the journal impact factor and to create context by using a variety of journal-based metrics, e.g. five-year impact factor, EigenFactor, SCImago, h-index, editorial and publication times, all of which are available for the CVJA. A description of these metrics, their use and citation databases other than WoS, such as Scopus and Google Scholar can be read in Bornman, http://www.ncbi.nlm.nih.gov/pmc/journals/1961/) where all the issues from 2009 to current are available in three formats: HTML, PDF and tablet friendly, the latter very user friendly. Note that only primary research and review articles are listed on PMC.With CVJA, the other important development has been listing in PMC. PMC is a free full-text archive of biomedical and life sciences journal literature at the US National Institutes of Health’s National Library of Medicine (NIH/NLM). Advantages and disadvantages have been discussed.http://www.ncbi.nlm.nih.gov/pubmed) by an article search. Here one can access full text in addition to case studies published online through SAePub (Sabinet).In a sense, one is using more than a belt and braces in using multiple repositories. This ensures that articles published in the journal will survive for a long time in cyberspace. The same articles, in addition to editorial and other content in the journal, can also be accessed through Pubmed (http://www.cvja.co.za/) where one can read articles in a number of formats, including an e-reader format or, even better, browse through a facsimile of the journal as it appears in print, with everything, adverts included. Advertising income plays an important role in sustainability of the CVJA and it is therefore important to maximise traffic through the website of the CVJA.Then there is the website of CVJA  $1 900 (graded according to the economic status of a country). In the case of CVJA, the up-front cost is $50 to have a submission reviewed and the rest of the costs are covered by advertisements, special projects and subscriptions. As indicated, however, the last modality may be under threat. For the other sources of income, using the CVJA website as a portal of entry is very important.With OA, distribution costs can be very low if a journal chooses to publish only online, but there are still high costs involved for proper peer review and editorial quality control. Production costs are not necessarily cheaper and cost falls to the author or institution.Circulation and NEJM. It is interesting that a number of high-impact journals with content perceived to be commercially of value have not embraced PMC or OA, such as the NEJM and Circulation. Other funds may be needed to carry publication costs on the authorpay principle. All research is not backed by strong institutional funding, especially not in Africa. This does provide challenges!It may well happen that institutions limit subscriptions to journals not OA but deemed very important, such as The CVJA is from Africa, but also part of the global environment. Within Africa, the journal is well placed and a portal to the world. Articles within the journal are visible, as the journal is indexed in the major databases. Content is freely available on date of publication, but the OA environment has created new challenges. A last thought: Is there not a place for an African journals database so that we can unlock synergies within Africa?


This issue marks a transition and a changing of the guard for Computational and Mathematical Methods in Medicine (CMMM). It is with some nostalgia that we look back on our long and illustrious association with Taylor and Francis; however, at the same time we look to the future with optimism and hope as Hindawi takes the helm and converts CMMM to the community-based, open access model that they have so successfully championed. The Hindawi Publishing Corporation is one of the fastest growing academic publishers worldwide with over 200 academic journals in their portfolio and a commitment to the highest levels of peer review and excellence. Reflecting on the genesis and evolution of CMMM, it is clear that Brian Sleeman, the founding Editor-in-Chief, showed great foresight in creating a journal that brought together the disparate disciplines of mathematics and medicine and that continues to play a major role in the development of mathematical medicine. He worked passionately to develop and promote the journal through some difficult times, with the insight and courage to bring together both biomedical/clinical scientists and mathematical scientists onto a single editorial board . The success that the journal has enjoyed thus far is a clear testament to his hard work, dedication, and vision. The journal has continued to provide a unique forum for the dissemination of interdisciplinary research resulting from collaborations between clinicians/experimentalists and theoreticians. CMMM has also continued to evolve rapidly, reflecting the increased focus on systems and interdisciplinary collaborative efforts across the breadth of biomedical, clinical, and translational research areas. The past year also saw the result of much hard work, with the inclusion of the journal in PubMed/Medline and the Science Citation Index Expanded. This was a great development for the journal since it not only has had an enormous impact on the general awareness and profile of the journal but has also resulted in increased submissions and downloads from the journal website over the past year. It has been exciting and rewarding to see the journal develop and evolve in this manner, and we look forward to increased success following this higher profile. The future looks extremely bright for the field of mathematical medicine as it emerges from its period of infancy and takes its place as a legitimate and central field of research and enquiry. Our sincere hope and wish is that CMMM continues from strength to strength and fulfills its role and promise as envisioned originally by its founding editor.Pamela JonesSivabal Sivaloganathan


From the time Abel was killed by his brother, Cain, in an assault action to his head as the first case of death on the earth , to the Trauma Research Center of Kashan University of Medical Sciences (KAUMS) in its own way for contribution to the advancement of trauma in all aspects of prevention, treatment and rehabilitation is going to facilitate sharing of data between the scientists and authorities of this field, and so has published its new journal and invites all national, regional and abroad specialists to submit their experiences and researches for publishing in the “Archives of Trauma Research”. We hope to arrange for a better style of life with fewer deaths due to any kind of trauma. For this we think globally, and act locally.


A successful corneal graft requires both clarity and an acceptable refraction. A clear corneal graft may be an optical failure if high astigmatism limits visual acuity. Intraoperative measures to reduce postkeratoplasty astigmatism include round and central trephination of cornea with an adequate size, appropriate sutures with evenly distributed tension, and perfect graft-host apposition. Suture manipulation has been described for minimising early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures containing relaxing incisions, compression sutures, laser refractive surgery, insertion of intrastromal corneal ring segments, wedge resection, and toric intraocular lens implantation can be performed. When astigmatism cannot be reduced using one or more abovementioned approaches, repeat penetrating keratoplasty should inevitably be considered. However, none of these techniques has emerged as an ideal one, and corneal surgeons may require combining two or more approaches to exploit the maximum advantages. Penetrating keratoplasty (PK) has emerged as a relatively safe means of restoring vision in corneal opacities and irregularities. PK is generally considered to be a successful procedure, and the graft clarity rate in keratoconic patients can be 97% . HoweverAstigmatism is the most common cause of suboptimal vision after corneal transplantation despite a clear corneal graft , 4. BaseFactors influencing the amount of astigmatism after PK include the severity of the underlying disorder , oval or eccentric trephination,  graft siCommonly practiced techniques to reduce post-PK astigmatism consist of postoperative suture manipulation including running suture tension adjustment and selective interrupted suture removal, , 19–22 oThe corneal graft-host junction typically heals by 1 year after transplantation and corneal surface stability is achieved from 3 to 4 months after complete suture removal. However, this period can significantly vary due to patient's age, general health status (diabetes mellitus and collagen vascular disorders), and use of topical and systemic immunosuppressive medications. Given that, any surgical intervention for post-PK astigmatism should be postponed at least from 3 to 4 months after complete suture removal. Previous rejection episodes should be noted and the patient should be stable on minimal immunosuppressive agents . Prior tAstigmatism should be evaluated through a combination of manifest (and sometimes cycloplegic) refraction, keratometry, corneal topography, and occasionally wavefront analysis. Central and peripheral pachymetry is required when laser or incisional refractive surgery is anticipated, respectively.Astigmatism is described with magnitude and direction. As a result, simple arithmetic calculations comparing pre- and postoperative astigmatism magnitudes ignore any change in the astigmatism orientation and can be misleading because it does not identify the separate errors of magnitude and axis. Surgically induced change in astigmatism which can be calculated by two basic methods of analyzing vectors, namely graphic and trigonometrical, take into account the vectorial change in astigmatism including its magnitude and direction. The examination of astigmatism outcomes by vector analysis has been described by a number of authors in various ways –48.During PK, attention should be paid to some critical points if a low postoperative astigmatism is to be obtained. A perfect surgical technique, including round and central trephination of recipient and donor which should be large enough to cover abnormal areas (such as thin cornea in keratoconus), is required to achieve an acceptable refractive outcome postoperatively. Additionally, appropriate sutures with evenly distributed tension and apposition make sure that patients experience a low amount of astigmatism. Suturing technique including interrupted, single or double running, and combined interrupted and running are comparable in terms of postoperative graft astigmatism as long as timely suture adjustment and/or removal are performed .After PK, sutures should be kept for at least one year unless complications such as cheese-wiring, loosening, and vascularization develop. During this period, astigmatism >4 D can be reduced by suture manipulation consisting of selective interrupted suture removal and tension adjustment of running sutures. Use of interrupted or combined running and interrupted sutures allows for the selective removal of interrupted ones, with the goal of reducing astigmatism. Successful visual rehabilitation therefore depends partially on accurate identification of the tight-interrupted sutures. Refraction and keratometry can be used to determine which sutures have to be removed. Identifying the steep and flat corneal meridians 90° apart, however, refraction and manual keratometry could be misleading in patients undergoing keratoplasty in whom nonorthogonal and irregular astigmatism is common. Computerized corneal topography has the advantage of mapping subtle corneal power changes accurately over the entire optical zone and beyond allowing identification of steep meridians that can be attributed to specific sutures , 50. In If a combined running and interrupted suturing technique is used, then many of the interrupted sutures can be safely removed as early as 1 week postoperatively with minimal risk of wound problems. Tension adjustment of running sutures should be done after 2 to 4 weeks when graft edema disappears but within 2 months when the reparative response does not completely take place at the graft-host interface. Every episode of suture removal has the added risk of infection and/or rejection, and appropriate antibiotic and steroid cover are essential.When a small amount of astigmatism is achieved through suture manipulation, the sutures are left in as long as possible, until they fray or break , 44.Spectacles and rigid gas-permeable (RGP) contact lenses are the simplest method of addressing postoperative refractive error even when sutures are still in place. However, the use of glasses may not be possible when a significant amount of astigmatic anisometropia is present. RGP contact lenses, which may be effective in 80% of cases, often provide superior visual acuity and are frequently required in eyes with moderate to severe astigmatism . The maiUnfortunately, contact lenses are often difficult to fit, strictly dependent on a patient's tolerance and lifestyle, and may induce peripheral corneal neovascularization leading to graft rejection and failure. Furthermore, many patients (the elderly in particular) are unable to handle or maintain contact lenses , 54.Relaxing incisions with or without counter-quadrant compression sutures is an effective, simple, and safe method to reduce high-post-PK astigmatism , 55–59. The site of relaxing incision can be either in the donor cornea or at the graft-host interface. Incisions in the recipient cornea are not recommended as it is believed that the scarring at the graft-host junction changes the biomechanical state of the cornea. The keratoplasty wound is supposed to form a new limbus, blocking the effect of relaxing incisions in the recipient cornea .Using subtraction or vector analysis to calculate the reduction in astigmatism, a wide range of corrections between 3.4 D and 9.7 D has been reported by this approach , 55–59. In an attempt to increase the safety and efficacy, femtosecond laser (FSL) technology has been recently introduced in the clinical practice. Nubile et al.  confirmeIn the majority of cases, relaxing incisions with or without counter-quadrant compression sutures are the only procedure performed at the time. However, it is sometimes combined with other interventions such as cataract extraction and intraocular lens (IOLs) implantation or phakic IOL implantation to simultaneously address lens opacity or high refractive error, respectively. To choose the accurate power of IOLs in such cases, it is important to know the exact effect of the intervention on graft steepness. Any possible hyperopic or myopic shift caused by such interventions should be compensated for the power of IOLs to achieve a reasonable refractive outcome after combined surgeries. Previously, a myopic shift of up to 1.5 D has been reported after relaxing incisions , 10, 27 Excimer laser photoablation techniques are capable of treating astigmatism as well as coexisting spherical refractive error after corneal transplantation. The use of LASIK after PK was first reported by Arenas and Maglione in 1997 . PRK hasAs compared to PRK, LASIK has several advantages including fast visual rehabilitation, decreased stromal scarring, minimal regression, and the ability to treat a greater amount of refractive errors , 70–72. To improve outcomes, some authors propose performing the LASIK procedure in 2 steps (flap creation first followed by laser ablation 8 to 12 weeks later) because of a hinged lamellar keratotomy effect , 83. LamIn a small group of patients with post-PK astigmatism, Kerarings were implanted which significantly reduced mean keratometry values and significantly improved corneal topography and uncorrected visual acuity . HoweverIn this procedure, a wedge of corneal tissue including the recipient and/or donor cornea is excised from the flatter corneal meridian to correct high astigmatism  after PK –40. The One surgical drawback of corneal wedge resection is the difficulty in manually excising the exact amount of tissue in width and depth, which may account for the low predictability of the technique . AdditioRecently, FSL has been used as a safe and effective alternative to the manual technique to perform a corneal wedge resection . This deIn cases of high astigmatism after penetrating keratoplasty, implantation of a toric IOL offers a promising alternative to arcuate keratotomies with or without compression sutures. These kinds of IOLs are used during cataract extraction or in phakic eyes. Cataract extraction with implantation of toric intraocular lenses (tIOL) is a new surgical option for correction of residual astigmatism following penetrating keratoplasty with only minimal direct manipulation of the graft. Viestenz et al.  reportedIn phakic eyes, Artisan toric intraocular lens was implanted to correct refractive errors after keratoplasty , 43. TheThis intervention should be considered as the last option for treating intractable high/irregular postkeratoplasty astigmatism in clear corneal grafts when other aforementioned interventions fail. Reporting a small group of patients who underwent repeat PK using the 193-nm Zeiss-Meditec MEL-60 excimer laser and employing double running sutures, Szentmáry et al.  observedNow, we have a large armamentarium of refractive surgery to correct postkeratoplasty astigmatism. However, none of them appear as a perfect option, and corneal surgeons should tailor a specific plan, on the basis of patient's needs and clinical situations, to take advantages of each intervention. For example, when the astigmatism is too high to be corrected with excimer laser alone, it can be reduced by relaxing incisions to a level which is treatable by PRK or LASIK. Similarly, a combination of relaxing incisions followed by IOL implantation or IOL implantation followed by excimer laser can be considered to achieve a refractive outcome very close to emmetropia.


Acinetobacter bacteremia, and the results are inconsistent. We performed this study to evaluate the relationship between genospecies and the outcome of Acinetobacter bacteremia.Few clinical data are available on the relationship between genospecies and outcome of Acinetobacter bacteremia from 2003 to 2010 were reviewed retrospectively. The genospecies were identified by rpoB gene sequence analysis. The clinical features and outcomes of 90 patients with A. baumannii bacteremia were compared to those of 90 patients with non-baumannii Acinetobacter bacteremia .Clinical data from 180 patients who had A. baumannii bacteremia was associated with intensive care unit-onset, mechanical ventilation, pneumonia, carbapenem resistance, and higher APACHE II scores, compared to non-baumannii Acinetobacter bacteremia (P<0.05). In univariate analyses, age, pneumonia, multidrug resistance, carbapenem resistance, inappropriate empirical antibiotics, higher APACHE II scores, and A. baumannii genospecies were risk factors for mortality (P<0.05). Multivariate analysis revealed A. baumannii genospecies , age, pneumonia, and higher APACHE II scores to be independent risk factors for mortality (P<0.05).A. baumannii genospecies was an independent risk factor for mortality in patients with Acinetobacter bacteremia. Our results emphasize the importance of correct species identification of Acinetobacter blood isolates. Acinetobacter strains among critically ill, hospitalized patients, and subsequent epidemics, have become an increasing cause for concern The spread of multidrug-resistant (MDR) Acinetobacter species have been described Acinetobacter baumannii (genotype 2) is the most commonly found in clinical specimens. However, recently, infection caused by other Acinetobacter species belonging to the A. calcoaceticus-A. baumannii (ACB) complex, including A. nosocomialis , A. calcoaceticus (genotype 1), A. pittii (genotype 3), and Acinetobacter genomic species “close to 13 TU”, has caused concern A. baumannii by automation systems or phenotypic tests To date, more than 30 Acinetobacter bacteremia A. baumannii versus non-baumannii ACB complex strains.For these reasons, it is important to know whether or not the clinical features, risk factors, and outcomes differ according to species. To date, few studies have been published that evaluate this matter using genotypic assays in patients with This study was approved by the Institutional Review Board of Chonnam National University Hospital. A waiver of consent was granted given the retrospective nature of the project.Acinetobacter bacteremia were included.All adult patients  with bacteremia caused by ACB complex who were admitted to Chonnam National University Hospital  from January 2003 to December 2010 were included. Only patients with their first episode of Demographic and clinical data were collected by reviewing the electronic medical records of the patients and included comorbid conditions, duration of ICU and hospital stay, use of a ventilator, and use of central venous catheters at the time of bacteremia onset. The severity of patient infection was evaluated using Acute Physiology and Chronic Health Evaluation (APACHE) II scores within 24 h of bacteremia onset.Acinetobacter was identified using the automated system Vitek 2 . Acinetobacter species were determined on the basis of partial rpoB gene sequences (468 bp) detected using the primers Ac1055F (GTGATAARATGGCBGGTCGT) and Ac1598R (CGBGCRTGCATYTTGTCRT), as described by us previously In vitro susceptibility testing was conducted using Vitek 2 (bioMérieux).Acinetobacter strain was susceptible within 48 days from the onset of bacteremia. Mortality was defined as Acinetobacter-related in the absence of another definite cause of death Multidrug resistance (MDR) was defined if an isolate showed resistance to more than one of the following five antimicrobial agents: imipenem, ciprofloxacin, amikacin, cefepime, and piperacillin/tazobactam, in accordance with Paterson’s suggestion t-test or Mann-Whitney rank sum test, as appropriate. Variables with P values ≤0.10 in the univariate analysis were included in the multivariate analysis. Multivariate analyses were performed using a logistic regression model in the backward stepwise conditional manner. All tests of significance were two-tailed, and P values ≤0.05 were deemed to indicate statistical significance. Statistical analyses of the data were performed using SPSS software .Categorical variables were compared using Fisher’s exact test or the Pearson χ2 test, and continuous variables were compared using Student’s A. baumannii, 60 (33%) A. nosocomialis, 17 (9%) Acinetobacter genomic species “close to 13 TU”, 11 (6%) A. pittii, and two (1%) A. calcoaceticus.During the study period, we identified 180 isolates of the ACB complex, including 90 (50%) A. baumannii (n = 90) and non-baumannii ACB complex (n = 90) bacteria are shown in A. baumannii bacteremia, compared to non-baumannii Acinetobacter bacteremia (P<0.05). Pneumonia, MDR, and carbapenem resistance were more commonly found in A. baumannii bacteremia, while primary bacteremia was more commonly caused by non-baumannii Acinetobacter (P<0.05). No significant difference in clinical features was observed between bacteremia caused by A. nosocomialis, Acinetobacter species “close to 13 TU”, and A. pittii (data not shown).The clinical features of bacteremia caused by Acinetobacter bacteremia are shown in A. baumannii genospecies, age, pneumonia, MDR, carbapenem resistance, inappropriate empirical antibiotics, and APACHE II score were each associated with 30-day mortality (P<0.05). Multivariate analysis included the following variables: A. baumannii genospecies, APACHE II score, age, pneumonia, vascular catheter infection, inappropriate empirical antibiotics, MDR and carbapenem resistance. The independent risk factors for 30-day mortality identified in the multivariate logistic regression analysis included A. baumannii genospecies , pneumonia, age, and APACHE II score  in those with A. baumannii bacteremia . No significant difference in survival was identified between patients with A. nosocomialis bacteremia , Acinetobacter species “close to 13 TU” bacteremia , and A. pittii bacteremia .The Kaplan-Meier survival curves for A. baumannii was independently associated with poor outcome in patients with ACB complex bacteremia.In this study, we found that genospecies baumannii ACB complex are increasingly reported as a cause of bacteremia because of the introduction of genospecies identification. Recent studies showed that A. nosocomialis and A. pittii comprised 27% and 9% of ACB complex bacteremia in Taiwan A. baumannii. However, A. nosocomialis and A. pittii were sevenfold more prevalent causes of bacteremia than A. baumannii in Norway baumannii species was 50%, and Acinetobacter genomic species “close to 13 TU”, newly defined as a member of the ACB complex Non-A. baumannii bacteremia and non-baumannii ACB complex bacteremia A. baumannii bacteremia, compared to non-baumannii ACB complex bacteremia in those studies. MDR, carbapenem resistance, and pneumonia were more commonly found in A. baumannii bacteremia, while primary bacteremia itself was more commonly caused by non-baumannii ACB complex bacteria. Similar results were found in our study. MDR was more commonly found in A. baumannii than non-baumannii ACB complex blood isolates, in agreement with our previous studies A. baumannii bacteremia.Previous studies reported the differences in clinical features between Acinetobacter bacteremia was evaluated in some studies; however, the results are inconsistent. In previous studies, which did not identify ACB complex bacteria to the species level with genotyping assays and did not include genotype as a confounding factor in analysis, carbapenem resistance was revealed as an independent risk factor for mortality in ACB complex bacteremia et al. reported that A. baumannii species, and not carbapenem resistance, was an independent predictor of mortality in ICU patients with Acinetobacter bacteremia in Taiwan A.baumannii per se, appeared to be associated with a poor outcome The relationship between genospecies and outcome of A. baumannii species, rather than antibiotic resistance, mainly affected mortality, in accordance with a previous et al. suggested that in vitro and in vivo virulence characteristics differed among individual strains of the ACB complex Acinetobacter bacteremia. Our data also suggest that genotype might be a more significant predictive factor for mortality than carbapenem resistance and that genospecies should be included as a confounding factor in any analysis of risk factors for mortality in patients with Acinetobacter infections, because genospecies is significantly associated with MDR and carbapenem resistance Acinetobacter bacteremia.In the current study, we also found that Our study had several limitations. First, since it was retrospective in design, the factors influencing the physicians’ choice of antibiotics were not determined, and they may have influenced our results as unmeasured confounding factors in the analysis. Second, the current study was performed in a single center; for this reason, factors such as the rate of referrals or surgery for complex disorders could have impacted the results.A. baumannii genospecies is an independent predictor of mortality in patients with ACB complex bacteremia, emphasizing the importance of genotyping for correct species identification and prognosis prediction.In conclusion, our data showed that


Cardiovascular Journal of Africa has been evaluated for impact factor in the new Journal Citation Report of the ISI.For the first time, the What is the impact factor and what are its implications? For any journal to have an impact factor, it must be tracked by Thompson Reuters (ISI) for three years. The Journal Citation Index provides a measure of the frequency of which an average article is cited each year in the two years after publication.The journal’s impact factor does not tell us anything about how widely the journal is read or anything about the quality of any specific research article in the published journal. In fact, the impact factor was intended for librarians as a means of evaluating whether to purchase the title. The impact factor is usually placed prominently on the journal’s website or in the printed journal.Cardiovascular Journal of Africa for 2010 is 0.708 and the total number of citations was 105. The number of articles in 2008 was 47. The impact factors of other South African and African medical journals are:The impact factor for the African Journal of AIDS Research 0.425South African Medical Journal 1.676South African Journal of Surgery 0.233South African Journal of Science 0.596To increase the value of the impact factor, it is important that every effort be made to cite your articles as widely as possible.


Nutrients in 2011.It is with great appreciation that we acknowledge the following reviewers who have served our research community by reviewing manuscripts for Nutrients website to our Editorial Board and also to the guest editors of our expanding list of special issues who have devoted their time and expertise to achieving rapid growth in the quantity and quality of published manuscripts. My special thanks also to Associate Editor, Jon Buckley, and members of the editorial office for their dedication to the journal.I also wish to draw your attention on the


Tensioning of anterior cruciate ligament (ACL) reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient.We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials.We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon. Rupture of the anterior cruciate ligament (ACL) is a common injury in active people. The healing response of ruptured ACL is poor, and without surgical reconstruction the ACL deficient knee limits patient activity and can lead to future degenerative changes -4. In ACThe optimum amount of force applied to the graft prior to fixation is a matter of considerable debate, with most authors recommending between 20 and 90 N of initial graft tension -18. The Cunningham et al published a study in 2002 that demonstrated that graft tensioning is highly variable among sports medicine trained orthopaedic surgeons . To our A specially designed frame was constructed using used and sterilised Ilizarov components. This frame consisted of a semi-tubular structure made of half-rings and rods, with attachments dropped from the rings to accommodate a femur Figure . The femA guide-wire was passed through the tibia at 15 degrees from the sagittal plane and 45 degrees from the axial plane as described by Asagumo et al for placement of the anteromedial bundle of an ACL graft . The guiA hand held strain tensiometer  was attached to the testing frame directly above the exit point of the femoral tunnel. A stainless steel hook projected down from the tensiometer, in order that an ACL 'graft' could be looped around the hook, to represent a double-bundle hamstring graft Figure . The LiqThe ACL graft consisted of a double-bundle porcine flexor digitorum tendon  harvesteTendons were selected that were all 120 mm in length, and when doubled could pass through an 8 mm diameter stainless steel tube. The ACL graft was then passed through the tibial and femoral tunnels (8 mm diameter) and looped over the tensiometer hook, to represent a hamstring double bundle graft. Six consultant orthopaedic & trauma surgeons agreed to participate in the study. These six surgeons had been registered specialists in orthopaedic surgery for a mean 11.5 years (Range 4-30 years). They performed on average 51 ACL reconstructions each year (Range 30-150). The testing apparatus was taken to each surgeon, and was then secured to a desk or table, with the tibia hanging freely over the edge of the table. Each surgeon was then asked to tension the ACL graft exactly as he would when performing an ACL reconstruction procedure. No other instruction was given, and each surgeon was free to move the 'leg' and tension the graft exactly as he wished. Each surgeon was blinded to the LCD. When he was satisfied with the tension within the graft, the tension on the LCD was documented. The participating surgeon was blinded to each result. This process was repeated 5 times for each surgeon at 60 second intervals.Prior to commencing this study the guidelines of the institute's Research Ethics Committee were reviewed and advice procured from the research office. The study involved professional voluntary participants. No live human or animal subjects were involved. The study did not directly affect or influence clinical care of human subjects. After consideration the authors were advised that application for Research Ethics Committee approval was not necessary under the institute's published research guidelines.All of the six participating surgeons opted to use the maximal sustained one handed pull technique. Each confirmed that this was their preferred method of tensioning an ACL graft. The results of the tensioning experiments can be seen in Table Coefficients of variation (CV) and Standard Errors of Measurement (SEM) were calculated for each participating surgeon. A CV of less than 10% was considered to represent reliable reproducibility, CV of greater than 10% representing poor reproducibility. The CV and SEM for each surgeon can be seen in Table The outcome of ACL reconstruction surgery is influenced by many variables. Graft choice ,29, tunnIt has been demonstrated that small changes in the initial tension within an ACL graft cause significant differences in stability ,35 and rIn a clinical situation there are a number of factors that will influence the initial tension placed on an ACL graft. The maximal sustained one handed pull technique relies on feedback from the graft to the surgeon, and the surgeon's interpretation of the feedback. This will in turn be influenced by the size of the patient, by the size and length of the graft material, by the size and length of the bone tunnels, and therefore the surface contact area between the graft and the bone tunnels, by the quality of the bone and the graft material being used, and by the accuracy of tunnel placement. Some of these variables are dependent upon the skill of the surgeon, but many are patient factors that cannot be controlled by the operating surgeon.This study allowed us to eliminate some of the 'patient' factors inherent in ACL reconstruction surgery. The testing jig was identical for each experiment. Each surgeon used the same sawbone and porcine tendon for their series of tests. This eliminated any difference between tests in the 'bone' quality, the tunnel alignment or placement, the length, circumference, and quality of the tendon, and the interaction between the tendon and the sawbone. Each sawbone used was prepared in exactly the same way, and the tunnels were all drilled in an identical fashion. Each tendon was the same length and circumference and was prepared in an identical fashion. There may have been minor differences in the quality of the sawbones and tendons used for each series of tests, but the main focus of the study was to determine whether or not a single surgeon could accurately reproduce a set tension within an ACL reconstruction graft under controlled conditions.The actual tensioning figures produced by each surgeon are of secondary importance, as we have already stated that the optimum initial tension that should be imparted upon the graft has not reached consensus, and that individual surgeons vary greatly in their desired initial tension. None of the surgeons were able to consistently reproduce tension in the graft under these controlled conditions. Surgeon number 3 had a very consistent series of test on all but one occasion. The other five surgeons have markedly variable results. These results were obtained under controlled experimental conditions, and we would conclude that under clinical conditions with multiple other variables introduced into the tensioning procedure, the results would be even less consistent. Even surgeon number three who had markedly similar results on all but one occasion, was unable to explain why he had one result which was markedly different from the others. The feedback that he got back from the graft was the same on all five occasions.We must acknowledge certain limitations within this study. Only six orthopaedic surgeons were included within the study. This is a small number and ideally would have been larger. We were unable to contact/include further surgeons with the necessary clinical experience for inclusion during the timescale of the experiments.We chose to use sawbones over cadaveric bones. We accept that sawbones do not simulate the mechanical properties of cadaveric bone , but theWe also accept that the hand-held tensiometer and testing frame set-up would not directly measure the tension within the graft, as the frictional effect of the graft-tunnel interface is an unknown. The purpose of the experiment however is to assess the reproducibility of the maximal sustained one handed pull technique, and so the absolute tension within the graft is being indirectly measured if the other variables, including the frictional effect of the graft-tunnel interface remain constant throughout testing.This study did not intend to assess the effect of graft fixation on the tensioning of the graft, or to assess the long term outcomes of graft tensioning on knee range of motion or joint laxity. These aspects of ACL reconstruction surgery are dealt with in other published trials, some of which have been referenced.These results demonstrate that even under closely controlled conditions, experienced ACL reconstruction surgeons are not able to consistently tension an ACL graft using the maximum sustained one-handed pull technique. This was the technique favoured by all six surgeons in this study, and is the technique favoured by the majority of ACL surgeons. There are commercially available devices that assist in graft tensioning, but to our knowledge all of these devices rely on the operating surgeon's interpretation of feedback from the graft. To our knowledge, no device yet exists that sets the tension within an ACL graft to a predetermined level.The authors declare that they have no competing interests.BJON developed the idea for testing of tensioning, designed and built the testing frame, conducted the experiments tensioning experiments with consultant surgeons, and drafted the manuscript. FJB assisted with drafting and editing of the manuscript. KMH assisted with statistical analysis and editing of the manuscript. WFB assisted with the conception of the study and the design of the testing frame. PEMcH assisted with the concept and design of the study and oversaw the technical aspects of the testing. WC assisted with the concept and design of the study, helped design the testing frame, participated in the testing protocol, assisted with editing of the manuscript, and supervised the entire study. All authors read and approved the final manuscript.


CDKN1A gene expression and the insulin signaling pathway. In addition to gene expression analyses, we completed a series of metabolomics experiments to help identify how WTp53 and ΔNp53:WTp53 differentially affect cell physiology. These data sets represent the most comprehensive analysis thus far completed for the human ΔNp53:WTp53 isoform. Collectively, the microarray and metabolomics data yielded clear predictions  about the cellular pathways disrupted by ΔNp53:WTp53 specifically. Among the most striking were links to mitochondrial function and the mTOR pathway, which influence longevity in organisms as diverse as yeast and mammals [The initial discovery that p53 could cause accelerated aging in mice was made with an artificial truncated form of p53 . The nat mammals . Numerou mammals . Mitocho mammals .mt). The Auwerx group recently established that “mitonuclear protein imbalance”  could induce UPRmt in metazoans; notably, this response appears to promote longevity [mt (longevity-promoting). Some of our findings with ΔNp53:WTp53 vs. WTp53 converge on these same processes, but in an opposite manner. For example, the mTOR pathway is activated by ΔNp53:WTp53 expression. Also, the Auwerx group linked reduced expression of mitochondrial translation factors (e.g. Mrps5) specifically, and reduced mitochondrial translation generally, to UPRmt [met synthetase) about 2.5-fold relative to WTp53 (4). The longevity-promoting effects of UPRmt were also linked to mitochondrial proteostasis (via expression of HSP-70 and HSP-60) and mitochondrial biogenesis [Another interesting question involves potential links to mitochondrial unfolded protein response (UPRongevity . Houtkooto UPRmt . By contto WTp53 . The lonogenesis , we anti


Dear Editor,Attention should be drawn to the study by colleagues Saito O et al. published in the International journal of Endocrinology and Metabolism . The stu


The choice of footwear and custom modification of footwear in fast bowling in cricket lacks biomechanical and clinical evidence. This demonstrates that despite professional advice being available, elite fast bowlers continue to wear shoes that may not be appropriate for them. The aim of this study was to investigate the biomechanical effects of three cricket shoes commonly used by fast bowlers and whether footwear modification could play a role in injury.Four male cricket fast bowlers were included in the study. A 20 camera VICON Mx system was used to collect three-dimensional kinematic data. A four segment marker set was used to track and model the lower limb. Four force platforms  were positioned at both back and front foot strike to capture kinetic data. Participants’ perceptions of footwear were measured using a VAS. Freidman two-way ANOVA with post hoc pairwise comparison was used to analyse the differences between shoes. Linear regression analysis was used to correlate predictive outcome measures.P = 0.038) and a significant decrease in front knee joint external rotation moment (P = 0.022) relative to the custom modified shoe (ASICS 490TR). Exploratory regression analysis identified that front foot peak lateral shear force was significantly correlated  to sagittal plane knee joint angle at initial contact. Sagittal plane knee joint angle at initial contact was also significantly correlated  to front foot loading rate.The custom modified cross-trainer (ASICS 490tr) demonstrated the highest participant perception footwear score (mean 9/10 VAS). The conventional cricket shoes (ASICS 170no) demonstrated a significant reduction in front foot lateral shear force (The findings of this research demonstrate that custom modified cricket shoes increase lateral shear force and knee external rotation moment at the front leg. However, the relationship between these findings and injury remain unquantified. Further research must identify the role of footwear in the mechanism of lower limb injury in fast bowlers and what characteristics of footwear correlate to improved footwear VAS scores in regards to comfort, support and performance.


A variety of complications related to endovascular procedures are being reported. We present an annoying complication implying complete migration of stent-graft of subclavian artery into the aortic lumen.A 61 years old man with abdominal endovascular aortic stent-graft inserted previously, had a saccular aneurysm of descending aorta distal to left subclavian artery and a small dissection flap with saccular aneurysm originating from left subclavian artery. Since the patient refused to have any surgical procedure for left subclavian artery revascularisation, thoracic aortic-stenting for descending aorta just below subclavian origin and a second stent-graft for left subclavian artery just above the orifice was planned. Coverage of left subclavian artery was not preferred aiming to avoid possible cerebrovascular events. During intervention, stent-graft to be inserted inside subclavian artery migrated totally into aortic arch in a perpendicular fashion.Bilateral femoral and left brachial artery accesses were done. A 16x41mm stent-graft was inserted inside left subclavian artery. While insertion with balloon dilatation, stent-graft migrated distally with the balloon forming a partial prolapse into aortic arch. We tried several endovascular maneuvers including inserting a second graft into subclavian artery to stabilize the first one or trying to press this graft with the one inserted into descending aorta, but unfortunately the stent totally migrated into aorta. We catheterized migrated stent with balloon catheter and were able to move the graft with inflated balloon fixing it. Stent-graft and inflated balloon were pulled slowly back together to proximal part of left arm of the previously inserted abdominal aortic stent-graft and stabilized it carefully. Control DSA showed settled graft without any stenosis.We present a bothering complication and an endovascular solution we performed without complication.


We stress the importance of maintaining a high index of suspicion for any patient presenting with fever on the background of in situ prosthetic material. We present the difficulties in managing these extremely complicated, often life and limb threatening infections and suggest that a multidisciplinary team approach, involving specialist centre referral, may be key to success. We highlight the difficulties in diagnosing late-onset PVGI, where presentation can be subacute with subtle signs and confusing microbiology. In this case the presentation was pyrexia of unknown origin with multiple positive blood cultures isolating a variety of gut-associated organisms;  Prosthetic vascular graft infection (PVGI) is a significant complication of arterial reconstructive surgery . The incWe describe an unusual presentation of late-onset aortic graft infection which stresses the importance of maintaining a high index of suspicion in any patient with unexplained fevers and underlying in situ prosthetic material. In management of this case we demonstrate effective clinical use of Daptomycin and highlight the need for national consensus guidelines to guide the management of these complex infections.This 79-years-old gentleman was admitted from the Infectious Diseases clinic, in April 2011. He presented to the clinic with night sweats, intermittent fevers, rigors, lethargy, weight loss, poor appetite, and generalised arthralgias. He described a change in the bowel habit over the previous few months with constipation and mild abdominal discomfort. His C-reactive protein was 58. This was his fourth follow-up clinic appointment following a recent hospital discharge.Pseudomonas aeruginosa and blood cultures repeatedly isolated Pseudomonas aeruginosa and Enterobacter; July 2010 admission for probable recurrent septic arthritis, blood cultures isolated Streptococcus constellatus and Aerococcus; December 2009 admission for a primary septic arthritis, culture of synovial fluid isolated Streptococcus constellatus. In 1993 he had undergone an aortic aneurysm repair with insertion of an aorto-bi-iliac Dacron surgical graft.His past medical history included the following: August 2010 admission for relapsed septic arthritis of a right native knee, joint fluid aspirated at that time isolated On his admission in December 2009, because of the in situ aortic graft, he had undergone a CT abdomen and pelvis which showed normal appearances of the aorto-bi-iliac graft. The scan was repeated on each subsequent admission, in July 2010 and August 2010, each time showing normal appearances of the graft and no evidence of a fluid or gas collection around the abdominal aorta or iliac arteries. On admission from clinic, he underwent investigation for PUO in which he had multiple sets of blood cultures collected and 3 sets of isolated lactobacillus .He underwent a whole body scan showing a pool of activity in the right knee suggestive of chronic low-grade persistent infection. A transthoracic echocardiogram and a colonoscopy to investigate the altered bowel habit were carried out and were both negative. At this time a fourth repeat CT abdomen and pelvis was requested. This showed small extramural pockets of gas at the level of the graft bifurcation and a further possible tiny pocket of gas at the cranial aspect of the graft, appearances which would be suspicious for sepsis related to the graft.At this point, there was multidisciplinary team input from vascular surgeons, vascular radiologists, infectious diseases and microbiology and appropriate management options were discussed. The two available options were (1) explantation of the graft with extra-anatomical bypass and (2) long-term suppressive antibiotics with serial CRP and imaging. In view of his age, that the WCC was within normal limits and the CRP was falling, the equivalence of the CT finding, and the fact that the surgery to remove the graft would carry a significant mortality and morbidity risk, the decision was made to start IV antibiotics for a minimum of 6 wks. The caveat to this approach was that in the event of worsening sepsis despite antibiotics and/or CT evidence of worsening perigraft infection or development of aortoenteric fistula, then surgery would be carried out.IV Daptomycin (6 mg/kg)  was commenced after confirmatory MIC testing of the lactobacillus to Daptomycin; this was the most recently and most persistently isolated pathogen. Daptomycin was well tolerated by the patient. At 6 weeks, based on good clinical response, this was changed to oral amoxicillin plus clindamycin, and the patient was discharged home. Within 48 hrs of discharge he represented with rigors and fevers. He was readmitted and a repeat CT showed increasing air encircling the right most anterior limb of the aortic graft. At this point the decision was made to carry out surgery to remove the graft.In July 2011, the infected graft was explanted, the space washed out, and bilateral axillofemoral bypass graft inserted. Intraoperatively, a perforated duodenum was reported, which was the likely source of the multiple bacteraemias isolating the variety of gut organisms seen. This was repaired involving a retrocolic gastrojejunostomy and feeding jejunostomy, in an operation lasting more than 10 hours .To date, the patient remains well at home, the graft remains patent and perfusing the leg, and he has chosen not to continue oral suppressive antibiotics.Diagnosis of PVGI is extremely challenging. It is based on patient history and examination and parameters such as CRP, WCC, blood cultures (which often remain negative in late-onset graft infection), and 8 radiological imaging, which can be extremely difficult to interpret and in this case was repeatedly negative in the early stages. Unlike early-onset PVGI, which is often attributed to contamination of the graft at or soon after insertion  and presGold standard treatment involves complex surgery to remove the infected graft. For many patients, however, multiple comorbidities often render this an unfeasible option, leaving long courses of often empirical broad spectrum intravenous antibiotics as the only alternative. A lack of data on the effectiveness of some of the newer antimicrobial agents in prosthetic graft infection limits the treatment options available. In this case Daptomycin was used for the suppression of infection. This was an off-licence use of this newer class of antimicrobial agent, and the data to support its use is lacking. Despite the fact that management will often be on a patient-by-patient basis, there is a real and urgent need to develop national consensus treatment guidelines, providing advice on the use of newer antimicrobial agents such as Daptomycin, Linezolid, and Tigecycline in PVGI and on the optimal duration of therapy.


Low-and middle-income countries (LAMIC), with more than 80% of the global population, bear the greatest burden of mental disorders. Yet these countries are very under-represented in published psychiatric research. There are barriers to publication of mental health research from LAMIC and to the representation of research from these countries in the main literature databases worldwide. The World Psychiatric Association (WPA) aimed to help investigate the reasons for the under-representation of LAMIC in published psychiatric research and consider how to support improved research dissemination, relevant for better mental health and mental health care in all countries. As part of its work plan for the years 2008 to 2011, WPA developed a project to encourage efforts to offer support to psychiatric journals in LAMIC. A WPA publications taskforce was appointed in 2008 to promote the dissemination of research from LAMIC. The taskforce began work together with journal editors to strengthen their chances of being indexed in international databases. Among the first journals participating in the project was the IJP, which is now an inspiration and source of support for other journals. When Prof. T. S. Sathyanarayana Rao, the editor of the Journal, announced the news last year that the National Library of Medicine accepted the Indian Journal of Psychiatry (IJP) for indexation in Medline, he described it as a long cherished dream. It was a dream shared by many. Dr. Rao expressed his gratitude to all the supporters of the IPS and at the Journal. The journal he thanked the editorial team, the editorial board members, the journal committee, Indian and International Advisers, the reviewers and authors, and the publication house. He also thanked the World Psychiatric Association (WPA) and its taskforce for research dissemination for support.(www.wpanet.org). Its aims to include and increase the knowledge and skills necessary for study in the field of mental health and in the care of people with mental illnesses, as well as preserve the rights of people with mental illnesses, and promote the development and observance of the highest quality and ethical standards in psychiatric care, teaching, and research. As part of its work plan for the years 2008 to 2011, defined by the President, Prof. Mario Maj,).[The next step is to scale up the support for journal editors in the LAMIC. The work of the IJP can provide inspiration and peer support within a framework, as established by the WPA taskforce. The work can be monitored through the database and the network of editors. The work of this taskforce will continue with workshops at major WPA meetings, to include new editors as well as those who can describe their success stories. We also hope to establish editorial fellowships for junior editors in the office of high quality journals. The IJP and other journals with a record in achieving high standards, together with the funding agencies, can partner with journals from LAMIC to improve their quality and strengthen their chances of being indexed.At present, we look forward to a continued collaboration so that others can learn from the experience of the IJP and achieve indexing in Medline and eventually in ISI. The IJP’s achievement may serve as an example for other LAMIC journals to pursue indexation in major databases, as a strategy to widen the international foundation of psychiatric research. There is an important need for the inclusion of LAMIC psychiatric publications in the major indexation databases. This process will require multiple agents to partner with journals from LAMIC, to improve their quality and strengthen their chances of being indexed.


In the last issue, which was the first issue of JCHIMP, I discussed the origins and background of the journal .The journal was conceived in late summer 2010 and emerged with the first issue in May 2011. At the outset we were not certain of our direction beyond the fact that we wanted to be a clinically oriented, general internal medicine journal supporting the interests of community teaching hospitals and the trainees and faculty who work in them. It can be difficult to conduct scholarly work in the community setting in comparison to many university-based programs because of institutional culture, emphasis on clinical volumes, and lack of resources. Nevertheless, good scholarly work has been evident in venues like the American College of Physicians Associates Meeting each year where residents and students present clinical vignettes and other scholarly work of high quality. Too often, the scholarly effort ends there; JCHIMP provides further options. Contracting with Co-Action Publishing in Stockholm has had a major positive impact. Our 15 member editorial board and over 110 reviewers are a testimony to broad support and interest – even at this early stage. In our first issue, David Solomon, champion of open access medical journals, pointed out the glowing future of electronic open access journals as the numbers are increasing and the quality improving . With similar goals, CHERN and JCHIMP have the potential for program development and synergy.We feel that we will inevitably get more efficient with our operation. We do not believe that we have scratched the surface of the technological advances provided by this medium. We hope to formally link up with the 100 institutions that are part of the Community Hospital Education and Research Network (CHERN, Robert P. Ferguson, MDEditor


What Medicine Means To Me is a first in many ways for MSM. This is the first Theme Monograph. It is also the first Monograph which has contributions from the Asian, Australian, American and African continents.Donelson Dulany, Professor of Psychology Emeritus at the University of Illinois and Editor, American Journal of Psychology, writes on, ′What Psychology Means To Me’ (p36 ).Sunil K. Pandya, who writes on ‘Where is Medical Practice In India Heading?’ (p50) and also on ‘Turning Points In My Medical Career’ (p154 ), is a Neurosurgeon and from the Dept of Neurosurgery, Jaslok Hospital And Research Center, Mumbai, India. He is also Editor Emeritus, Indian Journal Of Medical Ethics, and on the International Advisory Board of MSM.Shaukat Ali Jawaid, who writes on ‘What Medicine And Medical Journal Editing Mean To Me’ (p62 ), is Chief Editor, Pulse International, and Managing Editor, Pakistan Journal of Medical Sciences, Karachi, Pakistan.Adamson S. Muula, who writes on ‘Medicine and Money: Friends Or Foe?’ (p78 ) is from the Department of Community Health, University of Malawi, College of Medicine, Malawi and Department of Epidemiology, University of North Carolina at Chapel Hill, United States.Vance W. Berger, from the National Cancer Institute, Bethesda, MD, USA, and J. Rosser Matthews, from the Virginia Commonwealth University, write on, ‘What Does Biostatistics Mean to Us’ (p89).Morten Hesse, who writes on ‘What Does Addiction Mean to Me’ is from Aarhus University, Centre for Alcohol and Drug Research, Købmagergade 26E, DK-1150 Copenhagen (p104).S.C. Panda, who writes on ‘Medicine: Science or Art?’ is Assistant Professor, Department of Community Medicine, V.S.S. Medical College, Burla, Orissa, and Editor, Journal of Community Medicine (p127).Roy Sugarman, Acting Director of Psychology at Royal Rehabilitation Centre in Sydney, and Conjoint Senior Lecturer in Psychiatry at the University of New South Wales, writes on, ‘What Psychology Means to Me’ (p139).J. K. Trivedi, Professor, Department of Psychiatry, and Dishanter Goel, Junior Resident, both from the King George's Medical University, Lucknow, India, write on, ‘What Psychiatry Means To Us’ (p166). JKT has also been Past Editor, Indian Journal of Psychiatry, Past President, Indian Psychiatric Society, and is a Member of the International Advisory Board of MSM.S. Malhotra and N. Shafiq, from the Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, write on, ‘What Clinical Pharmacology Means to Us’ (p184).Ajai R. Singh, Editor and Shakuntala A. Singh, Deputy Editor, MSM, write Editorials on ‘To Cure Sometimes, To Comfort Always, To Hurt The Least, To Harm Never’ (p8), ‘Psychiatrists And Clinical Psychologists’ (p10), and ‘What Is A Good Editorial?’ (p14), besides writing for the Looking Mirror, ‘A look at CMAJ: A Misty Image Indeed’ (p21). Ajai R. Singh also writes Musings (p18), and in MSM Poems (p208).Avinash De Sousa, Consulting Psychiatrist, Mumbai, writes an Obituary for his mother in, ‘Dr. Mrs. Dhanalakshmi De Sousa.1938–2005.A Tribute’ (p211).K.P. Dave, retired Head, Dept. of Psychiatry, L.T.M.G. Medical College and Hospital, Sion, Mumbai, India, also writes an obituary on ‘Dr. Mrs. Dhanalakshmi De Sousa (p213).The writings present a rich and varied fare for the serious reader.


The EPMA Journal following its transfer to BioMed Central two years after publication of the first article in the journal.Changing long-held beliefs is never easy. As a consequence of the accumulating clinical data and knowledge about the epidemiology and pathological mechanisms of the most frequent causes of morbidity and mortality, we are currently reconsidering our view of the origins and progression of cardiovascular, oncologic and neurodegenerative diseases. Optimistic versus pessimistic prognosis for healthcare sector depends much on diagnostic, preventive and treatment approaches, which healthcare systems will preferably adopt in the near future. PPPM offers great promise for the future practice of medicine. We are pleased to announce this first open access volume of  The EPMA Journal.Predictive, preventive and personalized medicine (PPPM) offers great promise for the future practice of medicine. Essential components of this approach include well-organized population screening protocols utilizing novel diagnostic biomarkers of disease states, targeted prevention of common human pathologies, optimal treatment planning and personalized medicine thereby resulting in a substantial improvement in the quality of life. This approach also offers the advantage of delivering care at potentially reduced costs to the population at large, thereby addressing social and ethical issues related to access to and affordability of healthcare. A broad distribution and a routine clinical utilization of advanced technological approaches could enable a significant portion of the population to reach and exceed 100 years of age yet remaining vibrant and in excellent physical and mental health as actively contributing members of society. One of the central issues discussed is the screening for predisposition of healthy individuals to potential pathologies later in life. The groups at risk identified within the general population can be given a fair chance of a focused diagnosis with multidisciplinary expertise and well-timed preventive measures. The reliability of the blood-tests proposed, potential application to clinical routines, enormous economic and social impacts of the new generation of molecular- and nanotechnology-based diagnostic approaches - are all discussed in As a consequence of the accumulating clinical data and knowledge about the epidemiology and pathological mechanisms of the most frequent causes of morbidity and mortality, we are currently reconsidering our view of the origins and progression of cardiovascular, oncologic and neurodegenerative diseases. The majority of these pathologies are of chronic nature: they progress from precursor lesions over one or even several decades of life until a diagnosis is made that is often too late for effective therapeutic intervention. An excellent example is the epidemic scale of diabetes mellitus type 2 witnessed in the European Union. In most industrialized countries and countries with large populations, the permanently growing cohort of people with diabetes creates a serious healthcare problem and dramatic health economic burden. Estimates for diabetes prevalence in the years 2030 is half a billion patients worldwide Figure .Furthermore, the contemporary onset of the dominant type 2 diabetes has already been observed in subpopulations of teenagers [The EPMA Journal provides highly professional multidisciplinary insights into current "disease care" versus desirable "healthcare" mechanisms to promote the paradigm change from delayed interventional "disease care" to PPPM as the medicine of the future [Our message is that new guidelines should create the robust juristic and economic platform for advanced medical services utilizing the cost-effective models of risk assessment followed by tailored treatments focused on the precursor stages of chronic disease . The EPMe future .versus pessimistic prognosis in future developments of the healthcare sector depends much on diagnostic, preventive and treatment approaches which healthcare will hopefully adopt in the near future [The EPMA Journal promotes this "three-dimensional" vision in medical approaches, namely as outlined in [Figure Optimistic r future . Withoutn Figure .The EPMA Journal that are highly appreciated by readers, namely:There are some features of a paper design specific for the articles published with • Highly informative content that provides an overview of corresponding topics, including related multi- and inter-disciplinary aspects in a reader-friendly manner that makes articles particularly useful for professionals working in allied medical fields and non-medical braches.• A reasonable combination of at least two aspects of the PPPM-concept; such as: predictive diagnostics followed by treatment design tailored to the patient; or innovative approach for population screening combined with concomitant recommendations for targeted prevention and individually created treatment algorithms.status quo (currents achievements & problems) overview followed by outlook for future trends and prognosis of developments• Discussion of the • A clear message in each publication supplied with a well-formulated PPPM-related title, a correspondingly structured abstract and conclusions including expert recommendations in the field• Smart paper-design characterized by reader-friendly subheadings of paragraphs for ease of navigationstatus quo and perspectives, text and illustrative materials• A good balance between clinical aspects and technological solutions, The EPMA Journal Award" for distinguished articles presented at the regular EPMA world congresses.• Overall excellent scientific and technological level of publications that undergo an additional evaluation by the Editorial Board (more than 50 experts from more than 30 countries worldwide) for consideration in "The EPMA Journal is for everyone: on reading the journal, readers can learn a new philosophy in medicine, novel trends in healthcare and biomedical education. The journal provides important information for individuals of various professional and scientific backgrounds. Professionals can consider the general concept of multidisciplinary approaches and learn the mindset of related medical areas and other scientific branches. A partial list of those who will especially benefit from the information provided in the journal is as follows:• professionals in conventional and molecular diagnostics, biomedicine, biotechnologies, ethics and economics, and the healthcare industry• universities, research units, private and public hospitals• patients and their family members• international associations with healthcare-oriented scientific, research and public health-related activities/responsibilities• political organizations and authorities active in the healthcare sectorThe EPMA Journal are created according to the principle of the informational pyramid turned upside-down: highly specific topics that individual professional groups work on (the pyramid-tip) are brought into more generalized scientific context and, further, correlated with concrete tasks to be performed in the healthcare sector. Consequently, PPPM-related aspects potentially interesting for corresponding border areas and giving an overview of other scientific branches. An example is provided in [Figure To reach the maximum educational impact, the review articles in n Figure . The autThe mission of the European Coordinator in this field of PPPM is performed by the European Association for Predictive, Preventive and Personalized Medicine. The concepts of innovative European and international projects, which EPMA represents for further consideration at the EU Commission, the European Parliament, NIH/NCI are elaborated upon by the consortium of the world-leading professionals (not restricted to Europe).The EPMA Mission and Objectives in the field of predictive, preventive and personalized medicine have been introduced to UNO Figure . The parThe EPMA Journal, the Association creates a professional forum to discuss most effective technologies and innovative approaches of predictive, preventive and personalized medicine.Practical application of innovative technologies in favour of predictive diagnostics, targeted preventive measures and personalized patient treatment in European healthcare and in global scale is the central idea of the Association. Through


That is to say, there are few schemes that can achieve complete anonymity for both the signer and the recipient. However, in many practical applications, such as network conference, both the signer’s and the recipient’s anonymity should be considered carefully. Motivated by these concerns, we propose a novel multi-recipient signcryption scheme with complete anonymity. The new scheme can achieve both the signer’s and the recipient’s anonymity at the same time. Each recipient can easily judge whether the received ciphertext is from an authorized source, but cannot determine the real identity of the sender, and at the same time, each participant can easily check decryption permission, but cannot determine the identity of any other recipient. The scheme also provides a public verification method which enables anyone to publicly verify the validity of the ciphertext. Analyses show that the proposed scheme is more efficient in terms of computation complexity and ciphertext length and possesses more advantages than existing schemes, which makes it suitable for practical applications. The proposed scheme could be used for network conferences, paid-TV or DVD broadcasting applications to solve the secure communication problem without violating the privacy of each participant.Most of the existing multi-recipient signcryption schemes do not take the anonymity of recipients into consideration because the list of the identities of all recipients must be included in the ciphertext as a necessary element for decryption. Although the signer’s anonymity has been taken into account in several alternative schemes, these schemes often suffer from the Key words: Multi-recipient signcryption; Signcryption; Complete Anonymity; Public verification. In general, multi-recipient signcryption can be used in many important applications, such as paid-TV or DVD broadcasting systems With development of network technology and its applications, a lot of group-oriented network services such as network multicasting or broadcasting have been proposed. Usually, in these services, a message sender is required to securely send the same messages to a group of recipients, such that only a certain number of recipients can read the messages while unauthorized recipients can extract nothing useful from these messages et al. et al. et al. cross-comparison attackjoint conspiracy attackNevertheless, today, more and more people are concerned regarding personal privacy, thus participant anonymity should be taken into account when designing multi-recipient signcryption Generally speaking, anonymity of participants includes both the sender’s and the recipient’s anonymity. Besides the anonymity of the sender, the anonymity of the recipient is often equally important so that designers of multi-recipient signcryption schemes should pay attention. For example, in paid-TV and DVD broadcasting application systems, no user should accept that his/her subscription of these services is publicly viewable to others especially when the service is quite sensitive. However, unfortunately, almost none of the existing schemes take the anonymity of recipients into consideration because the identity of each recipient must be included in the ciphertext as a necessary element for decryption. The list of the authorized recipients’ identities in the ciphertext is used to show who are the authorized recipients and how each authorized recipient gets his/her person-specific data for encryption from the ciphertext during the decryption process. Thus, schemes cross-comparison attack and the joint conspiracy attack. Therefore, existing schemes cannot deal with the anonymity of the sender or the recipient properly. Furthermore, these schemes are not suitable for applications that need complete anonymity for the sender and the recipient. For example, in a network conference application, every conference participant often wants to be kept anonymous when he/she is taking part in the conference discussion. Furthermore, if a participant (i.e. sender) wants to publish criticism or objections, he/she hopes that others (i.e. recipients) do not know his/her identity. At the same time, the recipient cannot want the other recipients to reveal that he/she is an authorized recipient. In fact, today, anonymity is one of the most important prerequisites for people to talk freely and make objective decisions.Following the arguments above, it is known that almost none of the existing multi-recipient signcryption schemes take the full anonymity of recipients and senders into account. Although there are several schemes that provide a solution for anonymity of the signer, they are not perfect, that is, they suffer from the Motivated by the above, this paper proposes a completely anonymous multi-recipient signcryption scheme which meets: (1) The identity of the sender is kept secret; (2) The identities of all the recipients are kept secret; (3) Each recipient can easily judge whether the received message is from an authorized source, but he/she cannot determine the real identity of the sender; (4) Each recipient can easily judge whether he/she is an authorized recipient, but he/she cannot determine the identity of any other authorized recipient; (5) The validity of ciphertext can be verified publicly. Speaking of practical applications, the proposed scheme can be in principle used for network conference, paid-TV or DVD broadcasting application systems to assure secure communication among authorized participants, while at the same time, providing complete anonymity for all participants.To facilitate the description of our scheme, notations used throughout the document are summarized in The security of the proposed scheme is based on the following problems and security assumptions.G1 and G2 be two cyclic groups of prime order q and let P be a generator of G1. Let e: G1×G1→G2 be a bilinear mapping. The DBDH, CDH and DBDH-M problems can thus be defined as:Let Decisional Bilinear Diffie-Hellman (DBDH) Problem: Given Definition 1:The advantage of any probabilistic polynomial time (PPT) algorithm B in solving the DBDH Problem is defined as: DBDH assumption: For any PPT algorithm B, Computational Diffie-Hellman (CDH) Problem: Given abP.Definition 2: The advantage of any PPT algorithm B in solving the CDH Problem is defined as: CDH assumption: For any PPT algorithm B, Modified Decisional Bilinear Diffie-Hellman (DBDH-M) Problem: Given Definition 3:The advantage of any PPT algorithm B in solving the DBDH-M Problem is defined as: DBDH-M assumption: For any PPT algorithm B, Our identity(ID)-based multi-recipient signcryption scheme with complete anonymity consists of four algorithms, namely: Setup, Extract, Anony-signcrypt and De-signcrypt, shown as follows:s and public parameters params. Note that the public parameters are publicly known while the master key must be kept secret.Private Key Generator (PKG) runs this algorithm to generate a master key s and the public parameter params as input, it outputs the private key D associated with ID, namely D = Extract. The private key D must be kept secret.This algorithm is run by PKG to extract the private key of the user. With a user’s identity ID, PKG’s master key S. With PKG’s public parameter params, a plaintext message M, a list of recipients’ identity L = {ID1,ID2,…,IDn} as input, the signer IDS runs this algorithm to generate a ciphertext C associated with M, namely C = Anony-signcrypt , which satisfies L and IDSC.This algorithm is run by the signer IDC, PKG’s public parameter params, the recipient’s identity IDi.With the ciphertext et al. et al. The security model of ciphertext indistinguishability under chosen ciphertext attack was first proposed by Canetti IND-sMIBSC-CCA: Let A be a polynomial-time attacker and s and public parameters params, sends params to A, and keeps the master key s secret. Upon receiving public parameters, A outputs n target identities Challenger B runs this algorithm to generate master key A performs a number of queries to B:s, params).Extraction query: Upon receiving private key extraction query about an identity ID, ion query: A chooses a target plaintext M, a list of recipients’ identity information 1,ID2,…,IDn}L = {ID and gives them to B. B randomly chooses an identity SID, computes the private key SD, and generates the ciphertext C = Anony-signcrypt  and returns it to A.Anony-signcryption query: A generates the list of target identitiesj. If C is a valid ciphertext, B decrypts it to obtain the corresponding plaintext M = De-signcrypt  and returns it to A; otherwise, B outputs an error message De-signcrypt0, M1) and an arbitrary identity SID with its private key SD. Upon receiving  and SD, B picks up a random bit* to A.A outputs a target plaintext pair . Upon receiving , the Challenger B randomly chooses A outputs a target identity pair . The constraint here is that A issues private key extraction queries. Upon receiving a private key extraction query, denoted by ID*, IDi*), i = 1,2, Challenger B returns M* = De-signcrypt  to A, where Di*is the private key of IDi*.A issues de-signcryption queries for the target identities. Upon receiving a de-signcryption query about . Let P be a generator of G1. Choose a bilinear mapping e: G1×G1→G2.Let H1:{0,1}*→G1; H2: G2→{0,1}M||; H3:{0,1}*→qZ*; H4:{0,1}M||×G1×…×G1→qZ*, where |M| is the length of the plaintext message.Define four one-way hash functions: params = <G1,G2,q,e,P,pubP,H1,H2,H3,H4> and keep the master key s secret.Choose a random number Practically speaking, PKG is acted by some authority. For example, in a network conference application, the organizer of a conference should deal with the PKG, which is responsible for developing the system parameters as the steps mentioned above.params, s, and an identity With QID = H1(ID).Compute ID’s public key DID = sH1(ID) = sQID.Compute ID’s private key Each participant, the sender or the recipient, should register himself/herself at PKG and obtain his/her private key from PKG by this algorithm. For example, in a network conference application, if someone wants to attend a conference and talk with other participants, he/she must firstly send his/her ID information to the organizer PKG to get his/her own private key computed by PKG.params, a plaintext M and his/her private key SD as input, the signer IDS chooses a list of recipients’ identity L = {ID1,ID2,…,IDn} and performs this algorithm to generate the ciphertext C of the plaintext M:With SQ is the public key of IDS.Randomly choose two secret integers i = 1,2,…,n, compute i = H3x(IDi) and i is the public key of IDi.For i = 1,2, …,n, compute For i = 1, 2, …, n, compute T = {1,T2,…,TnT}.For S is the private key of IDS.Compute Generate the ciphertext: After obtaining the private key, each participant can securely and anonymously send messages to other participants that he/she selects. For example, in a network conference application, any participant can freely select some participants as expected recipients to receive his/her messages. What he/she needs to do is to encrypt the messages by this algorithm and then broadcast the ciphertext.params, the recipient’s identity IDi and his/her private key iD as input, the recipient IDi decrypts C as follows:The algorithm is carried out by the recipient. With The one, who has not registered himself/herself with PKG to get his/her private key, can use the following steps to check the integrity or validity of the ciphertext. The registered participant can skip this process and directly jump to the following judgement algorithm:Compute e = e holds. If yes, the ciphertext is valid. Otherwise, the ciphertext is invalid or has been damaged during transmission.Verify whether the equation The one, who has registered himself/herself with PKG to get his/her private key, can use the following steps to check whether the ciphertext is valid and whether he/she is an authorized recipient before the following encryption process:Compute e = e holds. If yes, it means that IDi is one of the recipients designated by the signer and the ciphertext is valid. Otherwise, the recipient quits the decryption process.Check whether the equation The authorized user can recover the plaintext by the following steps:ix = H4(IDi) and then compute Compute Compute The one who receives the broadcasting ciphertext can verify the validity of the message and judge whether he/she is authorized by the public verification or judgement algorithm. If necessary, he/she can use the de-signcrypt algorithm to decrypt the ciphertext. In a network conference application, due to the nature of the broadcast communication, anyone, authorized recipients or unauthorized ones, can easily receive the ciphertext and check the validity of the message and the authorization of the decryption. But, only the authorized recipients can decrypt it correctly.The public verification algorithm in the De-signcrypt algorithm is correct.The judgement algorithm in the De-signcrypt algorithm is correct.i where For each authorized IDThe decryption algorithm in the De-signcrypt algorithm is correct.i, The authorized IDThus, we can get Then, we can get the plaintext through the computations We shall give security proof of the proposed scheme on confidentiality, unforgeability and anonymity under the random oracle model.In the IND-sMIBSC-CCA security model, if an adversary A has an advantageagainst the game defined in Definition 4 within running time t , then there is a algorithm B in solving the DBDH problem in the timewith an advantageB is challenged with an instance A who is capable of breaking the IND-sMIBSC-CCA security with a non-negligible advantage B makes use of A to solve the DBDH instance. B simulates the system with various oracles H1, H2, H3 and H4 and allows A to make polynomially bounded number of queries, adaptive to these oracles. The game between A and B is demonstrated below:The challenger B sets P1 = cP, pub = bPP, and gives <G1,G2,q,e,P,pubP,H1,H2,H3,H4> to the attacker A as the public parameters. Upon receiving the system parameters, A outputs n target identities A performs a number of queries to B:H1, H2, H3 and H4 be random oracles controlled by B as follows. The results of querying H1, H2, H3 and H4 are stored in H1-list, H2-list, H3-list and H4-list, respectively.Let H1. If there exists  in H1-list, B returns jQ; othzerwise, does as follows:Input an identity Choose an integer jQ = jPl; otherwise, compute jQ = jPl-P1;If j, jl, jQ) into H1-list;Put . If the corresponding answer has existed already, B returns the answer to A. Otherwise, B randomly chooses an element in proper scope as the result and returns it to A, and at the same time, B adds the inquiry and the result into the corresponding list.jB searches for  in H1-list. B recovers triple  in H1-query and computes his private key D = jPpubl = jbPl, and returns it to A. If B aborts and outputs “failure”.Upon receiving private key extraction query on identity IDA’s anony-signcryption query , B checks if B shall get the private key of IDS through the Extraction query. After that, B can run the Anony-signcryption query to generate the ciphertext M. An alternative to this is:Upon receiving B randomly chooses two secret integers Y = sPrl, i = 1, 2, …,n, compute ix = H3(IDi) and iQ is the public key of IDi.For i = 1,2,…,n, compute: For i = 1,2,…,n, compute T = {T1,T2,…,nT}.For B randomly chooses an integer B). Then, B computes B gets the ciphertext A.C together with an identity IDj, B proceeds as follows:On receiving the De-signcryption query of the ciphertext B shall return that the ciphertext C is invalid because B does not know the private key of ID.If B computes e = e holds. If it does not hold, the ciphertext is not valid and then B outputs B does the following steps:If D corresponding to ID from the H1-list.Find the secret key T.Compute Compute B outputs the message B outputs If all the above verifications are true, then A outputs a target plaintext pair  and a private key SD. Upon receiving  and SD, B picks up a random bit B searches H1-list to get B finally creates the target ciphertext C* to A.A performs a number of queries as Phase 1. Note that A cannot query the identity information of C* in de-signcryption query.A outputs its guess B wins this game and outputs 1 as the answer of DBDH problem because B outputs 0.Finally, B in the following. For dq de-signcryption queries, the probability to reject a valid ciphertext is not greater than A wins the IND-sMIBSC-CCA game, the advantage of B isFrom the above discussion, we shall analyze the advantages of In the SUF-sMIBSC-CMA security model, if there is an adversary F who can win the game in the time t with a non-negligible advantage e extraction queries, qs anony-signcryption queries and 1, H2, H3, H4, respectively.B is given  as an instance of the CDH problem. Assume that there is an adversary F who has a non-negligible advantage B uses F to solve the CDH problem. Firstly, B simulates the system with the various oracles H1, H2, H3 and H4, and then allows F to adaptively ask polynomially bounded number of queries to these oracles. The game between B and F is demonstrated below:The challenge B sets pub = bPP, and gives <G1, G2, q, e, P, pubP, H1, H2, H3, H4> to the attacker F as the public parameters. Upon receiving the system parameters, F outputs n target identities F adaptively performs polynomially bounded number of queries to the various oracles in this phase, which are similar to those in Theorem 4.F generates a target ciphertext S*Q = S*Pl = aP, and then we have F’s success here. As in the anony-signcryption query, the probability for B to answer a failure signcryption query is not greater than sq/2k, and then the advantage is We consider the advantage of In the ANON-sID-CCA security model, if an adversary A has advantageagainst the game defined in Definition 6 within running time t , then there is an algorithm B in solving the DBDH-M problem with an advantage B is challenged with an instance A who is capable of breaking the ANON-sID-CCA security with a non-negligible advantage B makes use of A to solve the DBDH-M instance. B simulates the system with hash functions H1, H2, H3 and H4, and allows A to make polynomially bounded number of queries. The game between B and A is demonstrated below:The challenger A outputs a target identity pair .Suppose that B sets the public key aP and bP are given from the instance of the DBDH-M problem. Here, B does not know a and b. A performs polynomially bounded number of queries to H1, H2, H3 and H4, which are similar to those in Theorem 4.j such that jQ = jPl = aP, B computes jD = jPpubl.Upon receiving the private key extraction query of an identity IDC*, IDi*) i = 1,2 and B performs the following steps:Upon receiving a decryption query about |G1|+|M|. The specific comparison results are shown in First, we talk about the signcryption process. In the proposed scheme, the operation about Lagrange interpolation can also be pre-processed, so these operations can be excluded when considering computational complexity. In order to signcrypt a message pT, the most time-consuming operation in the existing schemes and our scheme) in our decryption algorithm is smaller than those of the existing schemes, which makes our scheme more attractive in terms of computation performance. Regarding the de-signcryption in our scheme, some calculations of the de-signcryption algorithm are used to judge the validity of ciphertext and the authorization of the recipient, which is important for broadcast-based communications to avoid receiving unwanted information (e.g. SPAM). Note that although the schemes Compared to existing schemes, our scheme has some advantages. To achieve the signer’s anonymity, the identity of the signer is no longer included in the ciphertext, although the private key of the signer is necessary for signcryption. The recipients can therefore only judge if the ciphertext received is from a trusted signer, but they cannot determine the real identity of the signer. To achieve the recipient’s anonymity, the ID information of all authorized recipients is mixed by the Lagrange interpolation polynomial during the signcryption process, which prevents the recipient’s ID from being exposed. This method also ensures that only the recipient, who has got the entire ciphertext, can decrypt the ciphertext, thus achieving the decryption fairness. The ID-based cryptography enables one user to confidentially send messages to other users, despite of whether the latter is a registered user, and the public verification property of our scheme enables unregistered users to judge the validity of the received ciphertext before having to register himself/herself with PKG. The merit/demerit comparison between the existing schemes and our scheme is summarized in cross-comparison attack and joint conspiracy attack. In these schemes, in order to protect the privacy of the sender, the sender randomly chooses some legitimate participants to hide the true identity. But in practice, these schemes are vulnerable to the cross-comparison attack and joint conspiracy attack mentioned above. (2) The schemes From To summarize, the ciphertext in our scheme no longer contains the real identity information of all participants, thus our scheme meets anonymity of the sender and recipients at the same time, and efficiently protects the privacy of all involved participants. Even more important, this scheme possesses fair decryption and public verification properties. Furthermore, our scheme is easy to implement in exsiting applications. Here, we also take a network conference application as an example. In such a case, a message sender needs only to transform the plaintext message to a ciphertext message using our encryption algorithm and then broadcasts it through the broadcast communication channel, while a message recipient simply needs to decrypt the ciphertext using our decryption algorithm. Our scheme requires only extra encryption or decryption operations for each participant and leaves the original implementation untouched, which in fact should represent an easy implementation of our scheme. While our scheme has the advantages mentioned above, it also has some disadvantages, namely its application, which increases the costs for the implementation. For example, it probably takes a great deal to establish PKG and maintain it, which may affect routine application of our scheme to some extent.Due to the nature of broadcasting communications, the anonymity of both the sender and the recipient is of upmost importance in multi-recipient signcryption. However, almost none of the existing multi-recipient signcryption schemes take the anonymity of recipients into account. Although there are several schemes that provide a solution to the anonymity of the signer, they have known limitations. Owing to practical application requirements, a completely anonymous multi-recipient signcryption becomes more and more important. Aiming at the participants’ anonymity, a completely anonymous multi-recipient signcryption is proposed in this paper. The new scheme ensures anonymity of all participants, the sender and all recipients. Furthermore, each recipient can easily judge whether the received message is from an authorized source, but he/she cannot determine the true identity of the sender. Each recipient can easily judge whether he/she is an authorized recipient, but he/she cannot determine the identity of any other authorized recipient. At the same time, the validity of the ciphertext can be verified publicly. The confidentiality, unforgeablity and anonymity of our scheme are formally proven using the random oracles model. Compared to existing schemes, our scheme is more efficient in computation and ciphertext length, and possesses more merits, which makes our scheme suitable for practical applications. Our scheme is important in group-oriented network applications, such as the network conference, paid-TV or DVD broadcasting. The proposed scheme solves the secure communication problem among authorized participants, while at the same time, it provides complete anonymity for all involved participants.