EESMR: Energy Efficient BFT-SMR for the masses

Modern Byzantine Fault-Tolerant State Machine Replication (BFT-SMR) solutions focus on reducing communication complexity, improving throughput, or lowering latency. This work explores the energy efficiency of BFT-SMR protocols. First, we propose a novel SMR protocol that optimizes for the steady state, i.e., when the leader is correct. This is done by reducing the number of required signatures per consensus unit and the communication complexity by order of the number of nodes n compared to the state-of-the-art BFT-SMR solutions. Concretely, we employ the idea that a quorum (collection) of signatures on a proposed value is avoidable during the failure-free runs. Second, we model and analyze the energy efficiency of protocols and argue why the steady-state needs to be optimized. Third, we present an application in the cyber-physical system (CPS) setting, where we consider a partially connected system by optionally leveraging wireless multicasts among neighbors. We analytically determine the parameter ranges for when our proposed protocol offers better energy efficiency than communicating with a baseline protocol utilizing an external trusted node. We present a hypergraph-based network model and generalize previous fault tolerance results to the model. Finally, we demonstrate our approach's practicality by analyzing our protocol's energy efficiency through experiments on a CPS test bed. In particular, we observe as high as 64% energy savings when compared to the state-of-the-art SMR solution for n=10 settings using BLE.Comment: Appearing in Middleware 202

Unique Chain Rule and its Applications

Most existing Byzantine fault-tolerant State Machine Replication (SMR) protocols rely explicitly on either equivocation detection or quorum certificate formations to ensure protocol safety. These mechanisms inherently require $O(n^2)$ communication overhead among $n$ participating servers. This work proposes the Unique Chain Rule (UCR), a simple rule for hash chains where extending a block by including its hash in the next block, is treated as a vote for the proposed block \textit{and its ancestors}. When a block obtains a vote from at least one correct server, we can commit the block and its ancestors. While this idea was used implicitly earlier in conjunction with equivocation detection or quorum certificate generation, this work employs it explicitly to show safety. We present three applications of UCR.\@ We design \emph{Apollo}, and \emph{Artemis}: two novel synchronous SMR protocols with linear best-case communication complexity using round-robin, and stable leaders, respectively as the first two applications. Next, we employ UCR in a black-box fashion toward making any SMR commits publicly verifiable, where clients will no longer have to wait for $2f+1$ confirmations on every block, where $\kappa$ is a security parameter and $f$ is the number of Byzantine faults tolerated by the protocol, but can instead collect a UCR proof consisting of $\min({\kappa, f)}+1$ extensions on a block. This results in faster syncing times for clients as the publicly verifiable proofs can also be gossiped with every new block extension confirming a new block

HashRand: Efficient Asynchronous Random Beacon without Threshold Cryptographic Setup

Regular access to unpredictable and bias-resistant randomness is important for applications such as blockchains, voting, and secure distributed computing. Distributed random beacon protocols address this need by distributing trust across multiple nodes, with the majority of them assumed to be honest. These protocols have found applications in blockchain technology, leading to the proposal of several distributed random beacon protocols, with some already implemented. However, many current random beacon systems rely on threshold cryptographic setups or exhibit high computational costs, while others assume partial or bounded synchronous networks. To overcome these limitations, we propose HashRand, a computation and communication-efficient asynchronous random beacon protocol that uses a secure Hash function to generate beacons and pairwise secure channels. HashRand has a per-node communication complexity of $\mathcal{O}(\lambda n \log(n))$ bits per beacon. The computational efficiency of HashRand is attributed to the two orders of magnitude lower time of a one-way Hash computation compared to discrete log exponentiation. Interestingly, besides reduced overhead, HashRand achieves Post-Quantum security by leveraging the secure Hash function against quantum adversaries, setting it apart from other random beacon protocols that use discrete log cryptography. In a geo-distributed testbed of $n=160$ nodes, HashRand produces 1 beacon every second, which is at least 4x higher than Spurt. We also demonstrate the practical utility of HashRand by implementing a Post-Quantum secure Asynchronous SMR protocol, which has a response rate of over 122k txns per second over a WAN at $n=40$ nodes

Torsion of Appendix Epiploica: A Rare Cause of Acute Right Iliac Fossa Pain

Abstract Acute appendicitis is the most common cause of right iliac fossa pain. However, if the appendix is normal at surgery, the surgeon has to search for other causes of acute abdominal pain including rare etiologies. Awareness of all causes of acute right iliac fossa pain and a high index of suspicion is essential for diagnosis of rare causes like torsion of appendix epiploica In addition, in some patients, two pathologies causing acute pain may coexist. It is to the authors' knowledge that the simultaneous occurrence of torsion of appendix epiploica and acute appendicitis in a patient has not been previously reported, and is therefore discussed in this report. From th

Endometriosis After Surgical Menopause Mimicking Pelvic Malignancy: Surgeons’ Predicament

Prevalence of persistent endometriosis in women after menopause without any hormonal replacement therapy is very rare. This is a case of a woman with previous history of total hysterectomy and bilateral salpingo-oophorectomy for endometriosis who presented with hemoperitoneum, vaginal bleeding, pelvic mass, and pulmonary thromboembolism mimicking as rectovaginal septum carcinoma. This is the first case report with a unique mode of presentation wherein the patient presented with hemoperitoneum requiring emergency embolization of the vessel to stabilize the patient. She underwent en bloc resection of the tumor with high anterior resection of the rectum. Histopathology confirmed endometriosis

DECAF Score and BAP-65, the Tools for Prognosis in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Introduction: Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) result in significant morbidity and mortality. It is 3rd most common cause of death worldwide. Still, there is no proper prognostic scoring system available yet. The increasing mortality has been attributed to the smoking, epidemic and the advanced age of the world’s population. Exacerbations are uncommon in early COPD and are more common in moderate-to-severe disease. Aim: To validate and compare the Dyspnoea, Eosinopenia, Consolidation, Acidaemia, Atrial Fibrillation (DECAF) score and Blood Urea Nitrogen (BUN), Altered mental status, Pulse-age 65 (BAP-65) as tools of prognostication in AECOPD. Materials and Methods: A hospital-based prospective, observational study was conducted in the Department of General Medicine at Government Medical College Kota, Rajasthan, India. The duration of the study was two years, from December 2020 to December 2022. A total of 100 patients (84 males and 16 females), who were admitted with AECOPD were included. DECAF and BAP-65 scores, length of hospital stay, need for mechanical ventilation and mortality was recorded on a proforma and later analysed using Statistical Package for Social Sciences (SPSS) version 22.0. A Receiver Operating Characteristic (ROC) curve was drawn for comparison of the accuracy of both the scoring systems. Results: The mean age of the study participants was 64.91±11.78 years. Analysing the data statistically, the BAP65 class and DECAF score with mortality, need for mechanical ventilation, and duration of hospital stay showed a significant association. Comparing DECAF with BAP-65, DECAF showed higher predictive accuracy in mortality {Area Under Curve (AUC)- DECAF= 0.933 BAP-65-0.929) and duration of hospital stay (AUC-DECAF=0.753 BAP-65=0.929}) whereas, BAP-65 showed higher accuracy in predicting the need for mechanical ventilation (AUC-DECAF=0.851 BAP-65=0.916). Conclusion: Since, there was a good association between BAP-65 classes, as well as, the DECAF score and outcomes in AECOPD, these can be used as an assessment tool in predicting outcomes in patients presenting with AECOPD. It is better to use DECAF for predicting the length of hospital stay and mortality and BAP-65 for predicting the need for mechanical ventilation

Single-center Experience of Histopathological Spectrum and Treatment Profile in Adolescent-onset Nephrotic Syndrome in India

Introduction: Guidelines suggest a biopsy-tailored treatment rather than glucocorticoids as initial therapy for adolescent-onset nephrotic syndrome (NS) as minimal change disease is more common in younger children. There is a paucity of data regarding the clinical course and renal histopathological findings in this population. This study analyzed the clinical course and histological spectrum of adolescent-onset NS. Materials and Methods: In this retrospective study, we evaluated the medical records of patients with adolescent-onset NS who received treatment at the Department of Pediatrics, SVPPGIP & SCB Medical College, Cuttack, Orissa, India, between January 2010 and January 2017. Patients with congenital, infantile, childhood-onset, and secondary causes of NS were excluded. All children were treated as per the Indian Society of Pediatric Nephrology (ISPN) protocol.Results: The data of 48 adolescents were analyzed. The median age at onset of disease was 12 years (range: 10-14 years), and 68.75% (33/48) of the patients were males. Steroid-dependent NS (SDNS, 43.7%, 21/48) was the most common clinical course followed by frequently relapsing NS (FRNS, 29.1%, 14/48). Prednisolone with tacrolimus (37.5%, 18/48) and mycophenolatemofetil (35.4%, 17/48) were the most commonly used treatments. Biopsy results showed that minimal change disease (MCD) was the most common histopathological subtype (37.5%, 18/48) closely followed by focal segmental glomerulosclerosis (FSGS, 31.2%, 15/48). Most of the cases responded to a combination of prednisolone with either MMF, cyclophosphamide, or tacrolimus (23%).Conclusions: The most common underlying cause of adolescent-onset nephrotic syndrome as assessed histopathologically is MCD, closely followed by FSGS with most of the cases responding to a combination of prednisolone with either mycophenolatemofetil, cyclophosphamide or tacrolimus.Keywords: Adolescent-onset nephrotic syndrome; Minimal change disease; Focal segmental glomerulosclerosis; Steroid; Histopathology

Methanol extract of Pergularia daemia (Forssk.) Chiov. leaves induce apoptosis in triple-negative breast cancer through intrinsic pathway

329-338Most traditional anticancer medications are ineffective in treating triple negative breast cancer (TNBC), which has enhanced resistance to chemotherapeutic agents. Herbs continue to be a key element in the discovery of anticancer medications. In the present study, we assessed the cytotoxicity of methanol extract of leaves of Pergularia daemia (MLPD) in MDA-MB-231 triple-negative breast cancer (TNBC) cell line. The cytotoxicity of MLPD was assessed using MTT assay which revealed significant concentration-dependent cytotoxicity with an IC50 value of 35.95±3.57 μg/mL. Morphological evaluation of MDA-MB-231 cells treated with MLPD showed cytotoxic changes like vacuole formation, altered morphology, and reduction in the number of cells with apoptotic bodies formation. Staining techniques, such as acridine orange and ethidium bromide (AO/EB) showed early apoptosis characterized by yellow-green fluorescence and crescentshaped nucleus. Hoechst 33258 staining of MDA-MB-231 cells treated with MLPD showed nuclear marginalization indicative of nuclear apoptotic changes. To assess the mitochondrial membrane potential (MMP), we did JC-1 staining and the results revealed green fluorescence indicative of mitochondrial dependent apoptotic pathway. Comet assay confirmed significant DNA damaging property in MDA-MB-231 cells treated with MLPD. Western blotting analysis showed significant downregulation of Bcl-2 by 0.52±0.03 folds with no significant change in caspase-8 expression. Hence, the present study demonstrated that MLPD possessed potent cytotoxic effect against MDA-MB-231 TNBC cells through mitochondria mediated intrinsic pathway of apoptosis

Survival Impact of Secondary Cytoreductive Surgery for Recurrent Ovarian Cancer in an Asian Population

Objective: The aim of this study was to evaluate the role of secondary cytoreductive surgery in Asian patients with recurrent ovarian cancer and to assess prognostic variables on overall post-recurrence survival time. Methods: We conducted a retrospective review of patients with recurrent ovarian cancer who underwent secondary cytoreduction at the Gynaecological Cancer Center at the KK Women’s and Children’s Hospital, Singapore, between 1999 and 2009. Eligible patients included those who had been firstly treated by primary cytoreductive surgery and followed by adjuvant chemotherapy and had a period of clinical remission of at least six months and subsequently underwent secondary cytoreductive surgery for recurrence. Univariate analysis was performed to evaluate various variables influencing the overall survival. Results: Twenty-five patients met our eligibility criteria. The median age was 52 years (range=31–78 years). The median time from completion of primary treatment to recurrence was 25.1 months (range=6.4–83.4). Secondary cytoreduction was optimal in 20 of 25 patients (80%). The median follow-up duration was 38.9 months (range=17.8–72.4) and median overall survival time was 33.1 months (95% confidence interval, 15.3–undefined.). Ten (40.0%) patients required bowel resection, but no end colostomy was performed. One (4.0%) patient had wedge resection of the liver, one (4.0%) had a distal pancreatectomy, one (4.0%) had a unilateral nephrectomy, and one (4.0%) had adrenalectomy. There were no operative deaths. The overall survival of patients who responded to secondary cytoreductive surgery and adjuvant chemotherapy was significantly longer than those patients who did not respond to the treatment. Of those patients who responded to the surgical management, patients with clear cell carcinoma fared well compared to those with the endometrioid, mucinous adenocarcinoma, and papillary serous type (p<0.001). Complete secondary cytoreductive surgery appeared to have some relationship to overall survival but was not statistically significant. Conclusion: In carefully selected patients with recurrent ovarian cancer, optimal cytoreductive surgery is possible and in a subgroup of patients who respond to surgery and chemotherapy survival is significantly longer

Domestic animal‑related neuro‑trauma: An account, from a tertiary institute

Context: Experience of animal‑related neurotrauma at an apex institute, National Institute of Mental Health and Neurosciences, Bangalore, India. Aims: The aim of this study is to review epidemiology, clinical findings, and outcome of animal‑related traumatic brain injury (TBI) evaluated and treated at our institute. Settings and Design: A retrospective study consisting of demographic data, clinical findings, radiological details, and outcomes. Materials and Methods: The clinical and imaging records of 30 patients treated for animal‑related TBI at the emergency services, from January to July 2010. Outcome was assessed by Glasgow outcome scale (GOS). Statistical Analysis Used: SPSS 15.0 version, descriptive statistics. Results: A total of 6190 neurotrauma cases were evaluated and treated during the study period. Among them, 30 (0.48%) were animal‑inflicted injuries. Of these cases, animal‑vehicle collision and directly animal‑inflicted injuries were 15 (50%) each. The mean age of patients were 39.46 (6-71 years). Twenty‑nine (96.66%) cases were from rural areas. Twenty‑three (76.6%) had mild, 6 (20%) had moderate, and 1 (3.3%) had severe head injury (Glasgow coma scale). Four (13.3%) patients had abnormal pupillary reaction. Associated injuries were found in 25 (83.3%) patients. CT scan was abnormal in 50% (15/30), common finding was contusion in 8 (26.6%) patients, followed by edema in 6 (20%). There were 3 (10%) spine injuries, 1 (3.3%) internal carotid artery (ICA) dissection, and 2 (6.6%) brachial plexuses injuries. Three (10%) required surgery, and 1 (3.3%) patient expired. As per the GOS, good recovery was seen in 8 (80%) patients, moderate disability in 1 (10%), and vegetative state in 1 (10%) patient