A simple prognostic index in acute heart failure

Background Rapid effective triage is integral to emergency care in patients hospitalized for heart failure, to guide the type and intensity of therapy. Several indexes and scores have been proposed to predict outcome; most of the them are complex and unfit to use at the bedside. Methods We propose a new prognostic index for in hospital mortality in acute heart failure. The index was built according to the formula; 220 – age – heart rate + systolic blood pressure – ( creatinine X 10). The index was tested in 1628 patients admitted for acute heart failure and enrolled, from November 2007 to December 2009, in the Italian Registry on Heart Failure Outcome ( IN-HF); a prospective, multicentre, observational study. Results The prognostic index was an independent predictor for in hospital mortality risk ( c statistic= 0.74) (p<0.0001), together with left ventricular ejection fraction (p= 0.001), Glycemia ( p= 0.019) and hemoglobin concentration (p = 0.002). Conclusion A simple prognostic index based on variables easily assessed can be useful to predict mortality in acute heart failure at the first arrival in hospital

Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis

Objective: First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality. Methods: We searched MEDLINE and EMBASE for studies that evaluated clinical outcomes associated with prolonged and normal PR intervals. Relevant studies were pooled using random effects meta-analysis for risk of mortality, cardiovascular mortality, heart failure, coronary heart disease, atrial fibrillation and stroke or transient ischaemic attack (TIA). Sensitivity analyses were performed considering the population type and the use of adjustments. Results: Our search yielded 14 studies that were undertaken between 1972 and 2011 with 400 750 participants. Among the studies that adjusted for potential confounders, the pooled results suggest an increased risk of mortality with prolonged PR interval risk ratio (RR) 1.24 95% CI 1.02 to 1.51, five studies. Prolonged PR interval was associated with significant risk of heart failure or left ventricular dysfunction (RR 1.39 95% CI 1.18 to 1.65, three studies) and atrial fibrillation (RR 1.45 95% CI 1.23 to 1.71, eight studies) but not cardiovascular mortality, coronary heart disease or myocardial infarction or stroke or TIA. Similar observations were recorded when limited to studies of first-degree heart block. Conclusions: Data from observational studies suggests a possible association between prolonged PR interval and significant increases in atrial fibrillation, heart failure and mortality. Future prospective studies are needed to confirm the relationships reported, consider possible mechanisms and define the optimal monitoring strategy for such patients

Some Results on Distinguishing Attacks on Stream Ciphers

Stream ciphers are cryptographic primitives that are used to ensure the privacy of a message that is sent over a digital communication channel. In this thesis we will present new cryptanalytic results for several stream ciphers. The thesis provides a general introduction to cryptology, explains the basic concepts, gives an overview of various cryptographic primitives and discusses a number of different attack models. The first new attack given is a linear correlation attack in the form of a distinguishing attack. In this attack a specific class of weak feedback polynomials for LFSRs is identified. If the feedback polynomial is of a particular form the attack will be efficient. Two new distinguishing attacks are given on classical stream cipher constructions, namely the filter generator and the irregularly clocked filter generator. It is also demonstrated how these attacks can be applied to modern constructions. A key recovery attack is described for LILI-128 and a distinguishing attack for LILI-II is given. The European network of excellence, called eSTREAM, is an effort to find new efficient and secure stream ciphers. We analyze a number of the eSTREAM candidates. Firstly, distinguishing attacks are described for the candidate Dragon and a family of candidates called Pomaranch. Secondly, we describe resynchronization attacks on eSTREAM candidates. A general square root resynchronization attack which can be used to recover parts of a message is given. The attack is demonstrated on the candidates LEX and Pomaranch. A chosen IV distinguishing attack is then presented which can be used to evaluate the initialization procedure of stream ciphers. The technique is demonstrated on four candidates: Grain, Trivium, Decim and LEX

Attack-Tolerant Time-Synchronization in Wireless Sensor Networks

Abstract—Achieving secure time-synchronization in wireless sensor networks (WSNs) is a challenging, but very important problem that has not yet been addressed effectively. This pa-per proposes an Attack-tolerant Time-Synchronization Protocol (ATSP) in which sensor nodes cooperate to safeguard the time-synchronization service against malicious attacks. ATSP exploits the high temporal correlation existing among adjacent nodes in a WSN to achieve (1) adaptive management of the profile of each sensor’s normal behavior, (2) distributed, cooperative detection of falsified clock values advertised by attackers or compromised nodes, and (3) significant improvement of syn-chronization accuracy and stability by effectively compensating the clock drifts with the calibrated clock. To reduce the risk of losing time-synchronization due to attacks on the reference node, ATSP utilizes distributed, mutual synchronization and confines the impact of attacks to a local area (where attacks took place). Furthermore, by maintaining an accurate profile of sensors’ normal synchronization behaviors, ATSP detects various critical attacks while incurring only reasonable communication and computation overheads, making ATSP attack-tolerant and ideal for resource-constrained WSNs. I

Block and Stream Ciphers and the Creatures in Between

In this paper we define a notion of leak extraction from a block cipher. We demonstrate this new concept on an example of AES. A result is LEX: a simple AES-based stream cipher which is at least 2.5 times faster than AES both in software and in hardware

Long-term cerebral thromboembolic complications of transapical endocardial resynchronization therapy

Purpose: Cardiac resynchronization therapy (CRT) is an established therapeutic option in selected heart failure patients (pts). However, the transvenous left ventricular (LV) lead implantation remains ineffectual in a considerable number of pts. Transapical LV (TALV) lead implantation is an alternative minimally invasive, surgical, endocardial implantation technique. The aim of the present prospective study is to determine the long-term outcome, including the cerebral thromboembolic complications, of pts

The Conditional Correlation Attack: A Practical Attack on Bluetooth Encryption

Abstract. Motivated by the security of the nonlinear filter generator, the concept of correlation was previously extended to the conditional correlation, that studied the linear correlation of the inputs conditioned on a given (short) output pattern of some specific nonlinear function. Based on the conditional correlations, conditional correlation attacks were shown to be successful and efficient against the nonlinear filter generator. In this paper, we further generalize the concept of conditional correlations by assigning it with a different meaning, i.e. the correlation of the output of an arbitrary function conditioned on the unknown (partial) input which is uniformly distributed. Based on this generalized conditional correlation, a general statistical model is studied for dedicated key-recovery distinguishers. It is shown that the generalized conditional correlation is no smaller than the unconditional correlation. Consequently, our distinguisher improves on the traditional one (in the worst case it degrades into the traditional one). In particular, the distinguisher may be successful even if no ordinary correlation exists. As an application, a conditional correlation attack is developed and optimized against Bluetooth two-level E0. The attack is based on a recently detected flaw in the resynchronization of E0, as well as the investigation of conditional correlations in the Finite State Machine (FSM) governing the keystream output of E0. Our best attack finds the original encryption key for two-level E0 using the first 24 bits of 2 23.8 frames and with 2 38 computations. This is clearly the fastest and only practical known-plaintext attack on Bluetooth encryption compared with all existing attacks. Current experiments confirm our analysis