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Objectives To evaluate the left ventricular energy loss (EL), energy loss reserve (EL‐r), and energy loss reserve rate in patients with mild coronary artery stenosis by using vector flow mapping (VFM) combined with exercise stress echocardiography. Methods A total of 34 patients (case group) with mild coronary artery stenosis and 36 sex and age matched patients (control group) without coronary artery stenosis according to coronary angiogram were prospectively enrolled. The total energy loss (ELt), basal segment energy loss (ELb), middle segment energy loss (ELm), apical segment energy loss (ELa), energy loss reserve (EL‐r), and energy loss reserve rate were recorded in the isovolumic systolic period (S1), rapid ejection period (S2), slow ejection period (S3), isovolumic diastolic period (D1), rapid filling period (D2), slow filling period (D3), and atrial contraction period (D4). Results Compared with the control group, some of the EL in the resting case group were higher; some of the EL in the case group were lower after exercise, and those during D1 ELb and D3 ELb were higher. Compared with the resting state, the total EL and the EL within the time segment in the control group were higher after exercise, except during D2 ELb. In the case group, except for during D1 ELt, ELb and D2 ELb, the total and segmental EL of each phase was mostly higher after exercise (p < .05). Compared with the control group, most of the EL‐r and EL reserve rates in the case group were lower (p < .05). Conclusion The EL, EL‐r, and energy loss reserve rate have a certain value in the evaluation of cardiac function in patients with mild coronary artery stenosis.

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Background: Lower limb dysplasia is a rare complication after interventional closure of patent ductus arteriosus (PDA) in childhood. The most common treatment of PDA is interventional closure via femoral artery. Compared with traditional surgery, its advantages include less trauma and faster postoperative recovery, but the complications after interventional occlusion should not be ignored. Case presentation: A 10-year-old girl had redness and swelling of the toes of the right lower limb with skin ulceration on the medial side of the right foot for more than 4 months. She accepted interventional closure of PDA 7 years ago. Physical examination showed that the right foot was about 2 cm shorter than the left foot. We present a rare case of a young girl with lower limb dysplasia after interventional closure of PDA in childhood, Combined findings of Color Doppler ultrasound, Intravenous Ultrasound (IVUS), Computed tomography angiography (CTA) and Angiography, we found right foot developmental delay most likely was due to vascular injury after interventional closure of PDA in childhood. Conclusion: It is critical to understand not only the acute but also the long-term complications that may occur after interventional procedure. To avoid the development of vascular injury, it is advised that patients who underwent femoral artery catheterization for interventional treatment in their early years undergo strict clinical and imaging surveillance.

A considerable and growing fraction of servers, especially of web servers, is hosted in compute clouds. In this paper we opportunistically leverage this trend to improve privacy of clients from network attackers residing between the clients and the cloud: We design a system that can be deployed by the cloud operator to prevent a network adversary from determining which of the cloud's tenant servers a client is accessing. The core innovation in our design is a PoPSiCl (pronounced "popsicle"), a persistent pseudonym for a tenant server that can be used by a single client to access the server, whose real identity is protected by the cloud from both passive and active network attackers. When instantiated for TLS-based access to web servers, our design works with all major browsers and requires no additional client-side software and minimal changes to the client user experience. Moreover, changes to tenant servers can be hidden in supporting software (operating systems and web-programming frameworks) without imposing on web-content development. Perhaps most notably, our system boosts privacy with minimal impact to web-browsing performance, after some initial setup during a user's first access to each web server.