Dial C for Cipher

We introduce C, a practical provably secure block cipher with a slow key schedule. C is based on the same structure as AES but uses independent random substitution boxes instead of a fixed one. Its key schedule is based on the Blum-Blum-Shub pseudo-random generator, which allows us to prove that all obtained security results are still valid when taking into account the dependencies between the round keys. C is provably secure against several general classes of attacks. Strong evidence is given that it resists an even wider variety of attacks. We also propose a variant of C with simpler substitution boxes which is suitable for most applications, and for which security proofs still hold

SUGAR-DIP trial: Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial

Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals

The use of drug-eluting stents in ST-elevation myocardial infarction

Drug-eluting stents (DES) dramatically lower rates of restenosis in patients undergoing percutaneous coronary interventions. However, their use has extended beyond the initial approved indications into off-label scenarios such as ST-elevation myocardial infarction (STEMI). Multiple retrospective case series and 10 prospective randomised controlled trials have been published on the use of DES in STEMI patients, and these generally show reduced rates of target vessel revascularisation with a neutral effect on mortality. Three meta-analyses show similar findings with the composite endpoint of death, recurrent myocardial infarction, or re-intervention significantly lower in the DES group, although this was largely driven by a decrease in target vessel revascularisation. These studies also demonstrate that DES use in the setting of STEMI is not associate

Lipid-rich Plaques Detected by Near-infrared Spectroscopy Are More Frequently Exposed to High Shear Stress

High wall shear stress (WSS) and near-infrared spectroscopy (NIRS) detected lipid-rich plaque (LRP) are both known to be associated with plaque destabilization and future adverse cardiovascular events. However, knowledge of spatial co-localization of LRP and high WSS is lacking. This study investigated the co-localization of LRP based on NIRS and high WSS. Fifty-three patients presenting acute coronary syndrome underwent NIRS-intravascular-ultrasound (NIRS-IVUS) imaging of a non-culprit coronary artery. WSS was obtained using WSS profiling in 3D-reconstructions of the coronary arteries based on fusion of IVUS-segmented lumen and CT-derived 3D-centerline. Thirty-eight vessels were available for final analysis and divided into 0.5 mm/45° sectors. LRP sectors, as identified by NIRS, were more often colocalized with high WSS than sectors without LRP. Moreover, there was a dose-dependent relationship between lipid content and high WSS exposure. This study is a first step in understanding the evolution of LRPs to vulnerable plaques. [Figure not available: see fulltext.

Evaluation of Sport Facilities in Sport Cities in Jordan

The aim of this study was to evaluate facilities in sport cities in Jordan. The sample of this study consisted of (24) employees in sport cities the researcher bilt a tool and validity and reliability was done for the research tool. The results showed that sport cities were in a good condition, however, El-Hussien city was significantly better than the other sport cities. The researcher recommended to using the research tool of this study as instrumentation to evaluate sports facilities in sport cities