New cryptanalysis of LFSR-based stream ciphers and decoders for p-ary QC-MDPC codes

The security of modern cryptography is based on the hardness of solving certain problems. In this context, a problem is considered hard if there is no known polynomial time algorithm to solve it. Initially, the security assessment of cryptographic systems only considered adversaries with classical computational resources, i.e., digital computers. It is now known that there exist polynomial-time quantum algorithms that would render certain cryptosystems insecure if large-scale quantum computers were available. Thus, adversaries with access to such computers should also be considered. In particular, cryptosystems based on the hardness of integer factorisation or the discrete logarithm problem would be broken. For some others such as symmetric-key cryptosystems, the impact seems not to be as serious; it is recommended to at least double the key size of currently used systems to preserve their security level. The potential threat posed by sufficiently powerful quantum computers motivates the continued study and development of post-quantum cryptography, that is, cryptographic systems that are secure against adversaries with access to quantum computations. It is believed that symmetric-key cryptosystems should be secure from quantum attacks. In this manuscript, we study the security of one such family of systems; namely, stream ciphers. They are mainly used in applications where high throughput is required in software or low resource usage is required in hardware. Our focus is on the cryptanalysis of stream ciphers employing linear feedback shift registers (LFSRs). This is modelled as the problem of finding solutions to systems of linear equations with associated probability distributions on the set of right hand sides. To solve this problem, we first present a multivariate version of the correlation attack introduced by Siegenthaler. Building on the ideas of the multivariate attack, we propose a new cryptanalytic method with lower time complexity. Alongside this, we introduce the notion of relations modulo a matrix B, which may be seen as a generalisation of parity-checks used in fast correlation attacks. The latter are among the most important class of attacks against LFSR-based stream ciphers. Our new method is successfully applied to hard instances of the filter generator and requires a lower amount of keystream compared to other attacks in the literature. We also perform a theoretical attack against the Grain-v1 cipher and an experimental attack against a toy Grain-like cipher. Compared to the best previous attack, our technique requires less keystream bits but also has a higher time complexity. This is the result of joint work with Semaev. Public-key cryptosystems based on error-correcting codes are also believed to be secure against quantum attacks. To this end, we develop a new technique in code-based cryptography. Specifically, we propose new decoders for quasi-cyclic moderate density parity-check (QC-MDPC) codes. These codes were proposed by Misoczki et al.\ for use in the McEliece scheme. The use of QC-MDPC codes avoids attacks applicable when using low-density parity-check (LDPC) codes and also allows for keys with short size. Although we focus on decoding for a particular instance of the p-ary QC-MDPC scheme, our new decoding algorithm is also a general decoding method for p-ary MDPC-like schemes. This algorithm is a bit-flipping decoder, and its performance is improved by varying thresholds for the different iterations. Experimental results demonstrate that our decoders enjoy a very low decoding failure rate for the chosen p-ary QC-MDPC instance. This is the result of joint work with Guo and Johansson.Doktorgradsavhandlin

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

New cryptanalysis of LFSR-based stream ciphers and decoders for p-ary QC-MDPC codes

The security of modern cryptography is based on the hardness of solving certain problems. In this context, a problem is considered hard if there is no known polynomial time algorithm to solve it. Initially, the security assessment of cryptographic systems only considered adversaries with classical computational resources, i.e., digital computers. It is now known that there exist polynomial-time quantum algorithms that would render certain cryptosystems insecure if large-scale quantum computers were available. Thus, adversaries with access to such computers should also be considered. In particular, cryptosystems based on the hardness of integer factorisation or the discrete logarithm problem would be broken. For some others such as symmetric-key cryptosystems, the impact seems not to be as serious; it is recommended to at least double the key size of currently used systems to preserve their security level. The potential threat posed by sufficiently powerful quantum computers motivates the continued study and development of post-quantum cryptography, that is, cryptographic systems that are secure against adversaries with access to quantum computations. It is believed that symmetric-key cryptosystems should be secure from quantum attacks. In this manuscript, we study the security of one such family of systems; namely, stream ciphers. They are mainly used in applications where high throughput is required in software or low resource usage is required in hardware. Our focus is on the cryptanalysis of stream ciphers employing linear feedback shift registers (LFSRs). This is modelled as the problem of finding solutions to systems of linear equations with associated probability distributions on the set of right hand sides. To solve this problem, we first present a multivariate version of the correlation attack introduced by Siegenthaler. Building on the ideas of the multivariate attack, we propose a new cryptanalytic method with lower time complexity. Alongside this, we introduce the notion of relations modulo a matrix B, which may be seen as a generalisation of parity-checks used in fast correlation attacks. The latter are among the most important class of attacks against LFSR-based stream ciphers. Our new method is successfully applied to hard instances of the filter generator and requires a lower amount of keystream compared to other attacks in the literature. We also perform a theoretical attack against the Grain-v1 cipher and an experimental attack against a toy Grain-like cipher. Compared to the best previous attack, our technique requires less keystream bits but also has a higher time complexity. This is the result of joint work with Semaev. Public-key cryptosystems based on error-correcting codes are also believed to be secure against quantum attacks. To this end, we develop a new technique in code-based cryptography. Specifically, we propose new decoders for quasi-cyclic moderate density parity-check (QC-MDPC) codes. These codes were proposed by Misoczki et al.\ for use in the McEliece scheme. The use of QC-MDPC codes avoids attacks applicable when using low-density parity-check (LDPC) codes and also allows for keys with short size. Although we focus on decoding for a particular instance of the p-ary QC-MDPC scheme, our new decoding algorithm is also a general decoding method for p-ary MDPC-like schemes. This algorithm is a bit-flipping decoder, and its performance is improved by varying thresholds for the different iterations. Experimental results demonstrate that our decoders enjoy a very low decoding failure rate for the chosen p-ary QC-MDPC instance. This is the result of joint work with Guo and Johansson

Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery. An international, prospective cohort study

Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien-Dindo III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research