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Interband information overlapping enhances redundancy in hyperspectral data. This makes identification of application-specific optimal bands essential for obtaining accurate information about folia...

This prospective, observational study investigated changes in sleep and the effect on energy intake, gestational weight gain, and cardiometabolic health across pregnancy in 52 healthy pregnant women with obesity. Habitual sleep was assessed by wrist-worn actigraphy (time spent in bed; TIB, total sleep time; TST, and sleep efficiency) in early (13(0)-15(6) weeks) and late (35(0)-36(6)) pregnancy. A change to habitual sleep was defined as change of one-half of the standard deviation of TIB and TST across six consecutive nights from early pregnancy. Energy intake and changes in weight, fasting glucose, insulin, and lipids across pregnancy were compared between women who changed sleep. During early pregnancy, TIB was 9:24±0:08h and varied by 1:37±0:07h across the six nights. TST and sleep efficiency significantly declined from early to late pregnancy (7:03±0:08h to 6:28±0:09h, p

Background: The most commonly received specimen in any histopathology laboratory is cholecystectomy specimen. The majority of the cholecystectomies are done for Cholelithiasis. Inflammation may be acute, chronic or acute on chronic. It almost always occurs in association with gallstones, which is responsible for carcinoma and if the diagnosed early prognosis of the carcinoma gall bladder is good. Histopathological examination is therefore a must for diagnosis of early carcinomas. Subjects and Methods: 100 cholecystectomy specimens from patients of all ages were included. All specimens were subjected to gross and microscopic assessment. Different histological findings were noted in various layers of the gall bladder. The study includes all radiologically confirmed inflammatory pathologies of including metaplastic changes of the gall bladder epithelium, irrespective of age and sex. The study excludes patients with evident gallbladder malignancy, cases with known secondaries from gall bladder, traumatic rupture of gallbladder. Results: The age of patients varied from 16 to 70 years, with a maximum number of patients (25%) belong to 31 to 40 years. Gall stones were associated with 59% cases of cholecystitis. Pigment stones were most common (74%). Histopathologically the most common diagnosis was chronic cholecystitis (69%). Conclusion: Almost all of the gallbladder lesions are inflammatory in origin, of which the most common disease being chronic cholecystitis. Chronic cholecystitis was found to be most probable diagnosis in a female of 30-40 years. Pigmented gall stones were found to be the most common etiology of chronic cholecystitis. Prompt detailed histopathological analysis will help to confirm the benign nature of the disease or to detect any precursors of malignancy.

Objectives: The objective of this study is to assess clinical characteristics, obstetric and perinatal outcome of pregnant women with H1N1 infection. Methods: A retrospective observational study was conducted at a tertiary care teaching hospital. All clinically suspected, probable as well as confirmed cases of swine flu, in pregnancy were included. We analyzed the presenting complaints, condition on admission, criteria for admission in ICU, abnormalities in laboratory reports, course of illness and perinatal outcome. Results: A total of 52 patients in pregnancy and postpartum period were admitted with fever or acute respiratory illness over the period of two years from March 2017 to February 2019. Mean age of patients was 25.88 years. 32 patients were H1N1 positive. In which, 29 were pregnant and 3 patients were postpartum. Mean gestational age was 31weeks. Out of 32 patients, 11 patients were admitted in intensive care unit. There were 4 deaths due to H1N1 illness and all were in 3rd trimester. Conclusion: Acquiring infection in late trimester, late initiation of antiviral treatment and presence of co-morbid illness were high risk factors for developing critical illness. We emphasize that high index of suspicion, early diagnosis; early antiviral therapy and immunization to pregnant women are to reduce the complications, ICU admissions and mortality in this group.

PURPOSE: This study assessed whether the newly developed PET radioligand [(11)C]PS13, which has shown excellent in vivo selectivity in previous animal studies, could be used to quantify constitutive levels of cyclooxygenase-1 (COX-1) in healthy human brain. METHODS: Brain test-retest scans with concurrent arterial blood samples were obtained in 10 healthy individuals. The one- and unconstrained two-tissue compartment models, as well as the Logan graphical analysis were compared, and test-retest reliability and time-stability of total distribution volume (V(T)) were assessed. Correlation analyses were conducted between brain regional V(T) and COX-1 transcript levels provided in the Allen Human Brain Atlas. RESULTS: In the brain, [(11)C]PS13 showed highest uptake in the hippocampus and occipital cortex. The pericentral cortex also showed relatively higher uptake compared with adjacent neocortices. The two-tissue compartment model showed the best fit in all the brain regions, and the results from the Logan graphical analysis were consistent with those from the two-tissue compartment model. V(T) values showed excellent test-retest variability (range 6.0–8.5%) and good reliability (intraclass correlation coefficient range 0.74–0.87). V(T) values also showed excellent time-stability in all brain regions, confirming that there was no radiometabolite accumulation and that shorter scans were still able to reliably measure V(T). Significant correlation was observed between V(T) and COX-1 transcript levels (r = 0.82, P = 0.007), indicating that [(11)C]PS13 binding reflects actual COX-1 density in the human brain. CONCLUSIONS: These results from the first-in-human evaluation of the ability of [(11)C]PS13 to image COX-1 in the brain justifies extending the study to disease populations with neuroinflammation. CLINICAL TRIAL REGISTRATION: NCT03324646 at https://clinicaltrials.gov/. Registered October 30, 2017. Retrospectively registered.

Introduction: Chronic suppurative otitis media (CSOM) is a common health problem in countries with low socio-economic strata because of poor nutrition, population burden, low hygienic condition, insufficient health care, and repeated upper respiratory tract infection (URTI). Untreated cases of CSOM result in complications ranging from persistent otorrhoea, mastoiditis, labyrinthitis, facial nerve palsy to intracranial abscesses or thromboses. Microbiological profile and their antibiotic sensitivity pattern are essential to enable proper treatment of this disease and preventing the development of complications. Material and Methods: The current study was designed to identify the pathogenic agents causing CSOM and to understand their antimicrobial resistance pattern who attended ENT Department of this hospital between July 2017 to June 2019. Results: Among 496 clinical samples, microbes were seen in 329 (66.3%) cases with predominant male (66.3%) distribution and age group of 11-20 years (31%). Pseudomonas spp. (50.7%) is predominantly isolated. It showed resistance to aminoglycosides and fluoroquinolones but was found sensitive to carbapenems with a resistance rate of 1.2%. ESBL (Extended-spectrum β- lactamase) detection was seen in 30.9% of GNB while MBL (Metallo β- lactamase) was detected in 2.7% of cases. S.aureus was highly resistant to first-line antibiotics with MRSA (Methicillin-resistant S.aureus) rate of 64.1%, however, all were sensitive to glycopeptides. Conclusions: There should be a minimum gap between the onset of symptoms and the treatment provided to prevent complications of CSOM and also the complicated cases should be referred to specialized centers for better management.

RESUMO Objetivo: Calcular as velocidades médias da dilatação de pupila para classificar a gravidade da lesão derivada da escala de coma de Glasgow, estratificada por variáveis de confusão. Métodos: Neste estudo, analisaram-se 68.813 exames das pupilas para determinar a velocidade normal de dilatação em 3.595 pacientes com lesão cerebral leve (13 - 15), moderada (9 - 12) ou grave (3 - 8), segundo a escala de coma de Glasgow. As variáveis idade, sexo, raça, tamanho da pupila, tempo de permanência na unidade de terapia intensiva, pressão intracraniana, uso de narcóticos, classificação pela escala de coma de Glasgow e diagnóstico foram consideradas confundidoras e controladas para análise estatística. Empregou-se regressão logística com base em algoritmo de classificação com aprendizado de máquina para identificar os pontos de corte da velocidade de dilatação para as categorias segundo a escala de coma de Glasgow. Resultados: As razões de chance e os intervalos de confiança desses fatores se mostraram estatisticamente significantes em sua influência sobre a velocidade de dilatação. A classificação com base na área sob a curva mostrou que, para o grau leve, na escala de coma de Glasgow, o limite da velocidade de dilatação foi de 1,2mm/s, com taxas de falsa probabilidade de 0,1602 e 0,1902 e áreas sob a curva de 0,8380 e 0,8080, respectivamente, para os olhos esquerdo e direito. Para grau moderado na escala de coma de Glasgow, a velocidade de dilatação foi de 1,1mm/s com taxas de falsa probabilidade de 0,1880 e 0,1940 e áreas sob a curva de 0,8120 e 0,8060, respectivamente, nos olhos esquerdo e direito. Mais ainda, para o grau grave na escala de coma de Glasgow, a velocidade de dilatação foi de 0,9mm/s, com taxas de falsa probabilidade de 0,1980 e 0,2060 e áreas sob a curva de 0,8020 e 0,7940, respectivamente, nos olhos esquerdo e direito. Esses valores foram diferentes dos métodos prévios de descrição subjetiva e das velocidades de dilatação previamente estimadas. Conclusão: Observaram-se velocidades mais lentas de dilatação pupilar em pacientes com escores mais baixos na escala de coma de Glasgow, indicando que diminuição da velocidade pode indicar grau mais grave de lesão neuronal. ABSTRACT Objective: To calculate mean dilation velocities for Glasgow coma scale-derived injury severity classifications stratified by multiple confounding variables. Methods: In this study, we examined 68,813 pupil readings from 3,595 patients to determine normal dilation velocity with brain injury categorized based upon a Glasgow coma scale as mild (13 - 15), moderate (9 - 12), or severe (3 - 8). The variables age, sex, race, pupil size, intensive care unit length of stay, intracranial pressure, use of narcotics, Glasgow coma scale, and diagnosis were considered as confounding and controlled for in statistical analysis. Machine learning classification algorithm-based logistic regression was employed to identify dilation velocity cutoffs for Glasgow coma scale categories. Results: The odds ratios and confidence intervals of these factors were shown to be statistically significant in their influence on dilation velocity. Classification based on the area under the curve showed that for the mild Glasgow coma scale, the dilation velocity threshold value was 1.2mm/s, with false probability rates of 0.1602 and 0.1902 and areas under the curve of 0.8380 and 0.8080 in the left and right eyes, respectively. For the moderate Glasgow coma scale, the dilation velocity was 1.1mm/s, with false probability rates of 0.1880 and 0.1940 and areas under the curve of 0.8120 and 0.8060 in the left and right eyes, respectively. Furthermore, for the severe Glasgow coma scale, the dilation velocity was 0.9mm/s, with false probability rates of 0.1980 and 0.2060 and areas under the curve of 0.8020 and 0.7940 in the left and right eyes, respectively. These values were different from the previous method of subjective description and from previously estimated normal dilation velocities. Conclusion: Slower dilation velocities were observed in patients with lower Glasgow coma scores, indicating that decreasing velocities may indicate a higher degree of neuronal injury.

Although insufficient sleep is associated with increased cardiovascular risk, evidence of a causal relationship is lacking. We investigated the effects of prolonged sleep restriction on 24-hour ambulatory blood pressure (BP) and other cardiovascular measures in 20 healthy young participants (aged 23.4±4.8 years, 9 females), who underwent a randomized, controlled, crossover, 16-day inpatient study consisting of 4 days of acclimation, 9 days of sleep restriction (4 hours of sleep/night) or control sleep (9 hours), and 3 days of recovery. Subjects consumed a weight maintenance diet with controlled nutrient composition throughout. A 24-hour BP (primary outcome) and cardiovascular biomarkers were measured repeatedly. Polysomnographic monitoring was continuous. Comparing sleep restriction versus control sleep, 24-hour mean BP was higher (adjusted mean difference, day 12: 2.1 mm Hg [95% CI, 0.6–3.6], corrected P =0.016), endothelial function was attenuated ( P P =0.011). Despite increased deep sleep, BP was elevated while asleep during sleep restriction and recovery. Post hoc analysis revealed that 24-hour BP, wakefulness, and sleep BP increased during experimental and recovery phases of sleep restriction only in women, in whom 24-hour and sleep systolic BP increased by 8.0 (5.1–10.8) and 11.3 (5.9–16.7) mm Hg, respectively (both P

Many adults receive inadequate sleep, which elevates obesity and type 2 diabetes risk and may hinder benefits of calorie restriction (CR). We hypothesized that short sleepers would experience less weight loss and diminished glycemic benefits compared to adequate sleepers during CR. We performed secondary analyses in participants randomized to 25% CR in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy- Phase 2 (CALERIE 2) trial. Body weight, dual-energy x-ray absorptiometry-measured body composition, fasting glucose, insulin, and HOMA-IR were assessed at baseline, 12, and 24 months. Self-reported sleep duration identified participants with stable sleep as short (≤7 hrs, n=45) or adequate sleepers (>7 hrs, n=65). Sex, BMI, weight, and race-adjusted linear mixed models identified differences over time and between sleepers. Short and adequate sleepers had similar body weight and composition values at all timepoints and experienced equivalent CR-induced reductions over time. Baseline HOMA-IR (1.2 vs. 1.0; P=0.047) was higher in short sleepers, with trends noted for glucose (81.7 vs. 83.5 mg/dL; P=0.093) and insulin (5.7 vs. 4.9 µU/mL; P=0.077). Both phenotypes demonstrated enhanced glycemic control relative to baseline at 12 and 24 months. While there were no 12-month differences in absolute glycemic values between sleepers, initial differences re-emerged at 24 months, with higher HOMA-IR (0.9 vs. 0.7; P=0.01) and insulin concentrations (4.3 vs. 3.4 µU/mL; P Disclosure K. K. Hoddy: None. P. Singh: None. J. L. Dorling: None. R. A. Beyl: None. J. P. Kirwan: None. K. Huffman: None. S. B. Racette: None. S. Das: None. C. K. Martin: Advisory Panel; Self; EHE Health, Board Member; Self; NaturallySlim, Other Relationship; Self; ABGIL, Academy of Nutrition and Dietetics, Research Support; Self; American Society for Nutrition, Leona M. and Harry B. Helmsley Charitable Trust, Lilly, National Institutes of Health, Patient-Centered Outcomes Research Institute, U. S. Department of Agriculture, WW. Funding National Institute on Aging (U01AG022132, U01AG020478, U01AG020487, U01AG020480, R01AG060499, U24AG047121, U24AG047121); Agricultural Research Service (1950-51000-071-01S); American Heart Association (20POST35210907); National Institute of Diabetes and Digestive and Kidney Diseases (5P30DK07247615); National Institute of General Medical Sciences (U54GM104940)

Background: The present study aimed to report occurrence of radix entomolaris in mandibular first molar. Materials and methods: The present study was conducted on 428 mandibular first molar in 280 patients. The incidence of RE and comparison of the occurrence between males and females and between the right and left sides of the mandible were recorded. Results: Out of 210 molars in males, 10 (4.76%) had and out of 218 molars in females, 8 (3.66%) had Radix Entomolaris. The difference was significant (P< 0.05). 12 Radix Entomolaris were seen in 238 left molars and 6 were seen in 190 right molars. The difference was significant (P< 0.05). Conclusion: Authors found that Radix Entomolaris was commonly seen in males. Left side exhibited more Radix Entomolaris as compared to right side.

Periodic limb movements in sleep (PLMS) are associated with adverse outcomes in patients with heart failure (HF). The aim of this study was to investigate whether PLMS change in response to adaptive servo-ventilation (ASV) for central sleep apnea (CSA) in patients with HF. We examined polysomnographic studies conducted between 2010 and 2014 at Mayo Clinic, Rochester, Minnesota (n = 14,444). In those, 314 of 579 patients with CSA completed the sleep study with a protocol that began with diagnostic polysomnography, followed by continuous positive airway pressure, and, for persistent CSA, by ASV titration. Patients with HF (n = 118) had a significantly higher median PLM index compared with those without HF (n = 196): 33.7 versus 6.1 events/h (p0.001). HF was associated with a significant PLM arousal index (PLMAI) increase from diagnostic trial to ASV (odds ratio [OR] = 1.79, p = 0.032) after adjusting for demographics, co-morbidities and medications. In patients aged68 years, HF was associated with PLMI and PLMAI increases during ASV (OR = 2.16, p = 0.016 and OR = 2.05, p = 0.024), which persisted in multivariable models (OR = 2.36, p = 0.025 and OR = 2.33, p = 0.026). In multivariable analysis, patients with ejection fraction ≤45% had higher odds of increased PLMAI during ASV than those with ejection fraction45% (OR = 1.98, p = 0.022). In conclusion, PLMS may increase in HF patients after suppression of CSA by ASV. Whereas the clinical significance of increased post-ASV PLMS in HF prognosis needs to be determined, these increases may contribute to worsening outcomes in HF patients with CSA treated with ASV.

Introduction: Midazolam is a water-soluble benzodiazepine which is frequently administered by intravenous and oral routes. Its nasal spray has become recently available. Materials and Methods: In this study, after obtaining clearance from the ethical committe, 66 patients between the age group of 4 and 10 years comparable in demographic variables were randomly allocated into two groups of 33 each. Group “O” received oral midazolam (0.5 mg/kg) 20 min before induction. Group “N” received intranasal midazolam (0.2 mg/kg) 20 min before induction. The heart rate and blood pressure (systolic, diastolic, and mean) and oxygen saturation (SPO2) were recorded. Statistical Analysis Used: The statistical analysis was done using SPSS (Statistical Package for the Social Sciences) version 15.0 software. The values were represented in number (%) and mean±sd. Results: Satisfactory sedation scores were better in nasal spray group than oral group. Satisfactory ease of induction scores, recovery times, and postanesthesia recovery scores were better in the nasal spray group than in the oral group. Conclusion: Nasal midazolam spray is acceptable and is a good alternative to oral midazolam as premedication in the pediatric population.

To provide food security with quality crops for exponentially growing population brought intense pressure on the limited land and natural resources among developing countries. Abiotic stresses such as continuously rising temperature as consequences of global warming is adding pressure to existing problems by adversely affecting crop productivity through physiological changes in plants. Hence there is need of qualitatively potential vegetable crops that can withstand changing environmental conditions such as Okra (Abelmoschus spp.) holding high level of nutrients along with economic importance. But requirement of high temperature and humidity for its cultivation make the plant prone to several phytopathogens that ultimately leads to severe qualitative and quantitative losses depending upon the plant growth stage getting affected. Due to the unenviable problems of chemical fertilizers, biocontrol agents were applied as auxiliary treatments either single or in combination that possess fewer consequences on the environment. But due to increasing environmental and soil temperature, activities of these formulations are getting hindered. Therefore, there is an urgent requirement to procure high temperature stress tolerant strains along with antagonistic and plant growth promoting abilities. In the current study, we mainly focused on isolation of high temperature tolerant Trichoderma harzianum (BHU P4) strain with antagonistic abilities against fungal pathogen Sclerotium rolfsii causing collar rot disease. The strain was also studied for plant growth promoting attributes in okra plant which resulted in increased fresh weight, dry weight, chlorophyll content and nutrient content in comparison to control and pathogen challenged plants. This study was associated with an improvement in the level of total phenol, SOD, PO and PAL enzymes in order to regulate the host defense mechanism against its confrontation with S. rolfsii.

A real-time and accurate estimation of soil moisture content is a key factor for irrigation water management. For conventional and precision irrigation system, an irrigation demand tool is required that is economical, easy-to-use, has large-scale coverage, provides the users useful information on irrigation requirement and can be accessible on smartphone or wireless sensor platform. Owing to this, the current study aims to develop a user-friendly mobile app for monitoring and visualising irrigation water demand in terms of soil moisture deficit (or SMD). Irrigation Scheduler App is designed by using the Android Studio 3.1.4 software and Java RE 1.8.0 version. The database file of Irrigation Scheduler App contains ground measured soil moisture content and other soil physical properties such as field capacity and texture. Any android phone having code Kitkat, Lolipop, Marshmallow and Nougat support this mobile application. Future efforts will focus on expansion of this study area and updation of the application.

Automatic speaker diarization techniques typically involve a two-stage processing approach where audio segments of fixed duration are converted to vector representations in the first stage. This is followed by an unsupervised clustering of the representations in the second stage. In most of the prior approaches, these two stages are performed in an isolated manner with independent optimization steps. In this paper, we propose a representation learning and clustering algorithm that can be iteratively performed for improved speaker diarization. The representation learning is based on principles of self-supervised learning while the clustering algorithm is a graph structural method based on path integral clustering (PIC). The representation learning step uses the cluster targets from PIC and the clustering step is performed on embeddings learned from the self-supervised deep model. This iterative approach is referred to as self-supervised clustering (SSC). The diarization experiments are performed on CALLHOME and AMI meeting datasets. In these experiments, we show that the SSC algorithm improves significantly over the baseline system (relative improvements of 13% and 59% on CALLHOME and AMI datasets respectively in terms of diarization error rate (DER)). In addition, the DER results reported in this work improve over several other recent approaches for speaker diarization., Comment: 11 pages, Accepted in IEEE Transactions on Audio, Speech and Language Processing

Rapidly changes in potential evapotranspiration can provide significant information in understanding of hydrologic processes as well as for agricultural crop performance. Such information can also prove to be useful in climate related studies. However, accurate measurements and predictions of evapotranspiration are difficult especially at large spatial scales. Remote sensing provides a cost‐effective approach to determine potential evapotranspiration at both regional and global scales. In the present study, effectiveness of Hamon’s method for measuring annual variations in potential evapotranspiration based using INSAT-3D dataset was evaluated for agricultural area of Varanasi region, India. Observed potential evapotranspiration data was compared with INSAT-3D satellite data. The performances indices such as correlation (r), Bias and Root Mean Square Error (RMSE) indicate the values of 0.572, 0.524 and 0.834 for INSAT-3D data. Result indicated that INSAT-3D data further can be used for estimation of evapotranspiration.

Background: Research analyzing COVID-19 symptom screening has primarily focused on adult patients. In efforts to safely reopen schools, symptom screeners are being widely utilized. However, pediatric-specific outpatient data on which symptom combinations best identify children with COVID-19 are lacking. Such data could refine school symptom screening by improving screener sensitivity and specificity. In this study, we assessed the frequency of symptoms and symptom combinations in children tested for SARS-CoV-2 in outpatient settings. We aim to contribute to the optimization of pediatric COVID-19 screening questionnaires, to ultimately minimize both COVID-19 transmission in schools and missed school days. Methods: We conducted a retrospective analysis of outpatient symptoms screens, SARS-CoV-2 test results, and demographics of children (≤18 years) tested for SARS-CoV-2 between March 30 and November 30, 2020, at 3 UCSF-affiliated COVID-19 outpatient screening clinics in northern California. Those with incomplete symptom screens, >7 days between symptom documentation and test, and invalid test results were excluded. Results: Of 473 children tested at 1 site, 21 children had positive SARs-CoV-2 results and 452 children had negative results (4.4% positivity rate). Moreover, 85.7% of SARS-CoV-2–positive children had a known exposure to COVID-19 (Table 1). Of SARS-CoV-2–positive children, 61.9% had >1 symptom. Also, 52.4% of SARS-CoV-2–positive children had at least 1 symptom (fever, cough, or loss of taste or smell) versus 62.8% of SARS-CoV-2–negative children (Table 2). Runny nose or nasal congestion was the most frequently reported symptom in the SARS-CoV-2–positive group (47.6%) as well as the SARS-CoV-2–negative group (58.6%). Also, 14.3% of SARS-CoV-2–positive children had eye redness or discharge versus 3.1% of SARS-CoV-2–negative children. Isolated runny nose presented in 10.8% of SARS-CoV-2–negative versus 9.5% of SARS-CoV-2–positive children. All children with isolated diarrhea (n = 5), isolated headache (n = 3), and isolated rash (n = 2) tested negative. Preliminary symptom data based on 176 children from a second site showed that 9.9% of symptomatic children had a positive test result. Conclusions: Runny nose or nasal congestion was the most frequently reported symptom in all children tested for SARS-CoV-2. However, isolated runny nose or nasal congestion identified 2 cases of COVID-19 in our cohort. Eye redness or discharge may be an important symptom to screen for COVID-19 in children. Further research with a larger number of positive cases is needed to make conclusions about improving efficiency and efficacy of symptom screeners for COVID-19 in children.Funding: NoDisclosures: None

The state-of-the-art speaker diarization systems use agglomerative hierarchical clustering (AHC) which performs the clustering of previously learned neural embeddings. While the clustering approach attempts to identify speaker clusters, the AHC algorithm does not involve any further learning. In this paper, we propose a novel algorithm for hierarchical clustering which combines the speaker clustering along with a representation learning framework. The proposed approach is based on principles of self-supervised learning where the self-supervision is derived from the clustering algorithm. The representation learning network is trained with a regularized triplet loss using the clustering solution at the current step while the clustering algorithm uses the deep embeddings from the representation learning step. By combining the self-supervision based representation learning along with the clustering algorithm, we show that the proposed algorithm improves significantly 29% relative improvement) over the AHC algorithm with cosine similarity for a speaker diarization task on CALLHOME dataset. In addition, the proposed approach also improves over the state-of-the-art system with PLDA affinity matrix with 10% relative improvement in DER., 5 pages, Accepted in Interspeech 2020

Objective To identify markers associated with in-hospital death in patients with coronavirus disease 2019 (COVID-19)–associated pneumonia. Patients and Methods A retrospective cohort study was conducted of 140 patients with moderate to critical COVID-19–associated pneumonia requiring oxygen supplementation admitted to the hospital from January 28, 2020, through February 28, 2020, and followed up through March 13, 2020, in Union Hospital, Wuhan, China. Oxygen saturation (SpO2) and other measures were tested as predictors of in-hospital mortality in survival analysis. Results Of 140 patients with COVID-19–associated pneumonia, 72 (51.4%) were men, with a median age of 60 years. Patients with SpO2 values of 90% or less were older and were more likely to be men, to have hypertension, and to present with dyspnea than those with SpO2 values greater than 90%. Overall, 36 patients (25.7%) died during hospitalization after median 14-day follow-up. Higher SpO2 levels after oxygen supplementation were associated with reduced mortality independently of age and sex (hazard ratio per 1-U SpO2, 0.93; 95% CI, 0.91 to 0.95; P Conclusion In this cohort of patients with COVID-19, hypoxemia was independently associated with in-hospital mortality. These results may help guide the clinical management of patients with severe COVID-19, particularly in settings requiring strategic allocation of limited critical care resources. Trial Registration Chictr.org.cn Identifier: ChiCTR2000030852

OBJECTIVES: During pregnancy, altered glucose kinetics coupled with disrupted sleep increase the risk for adverse metabolic health outcomes. The aim of this prospective, observational study in pregnant women with obesity was to 1) examine sleep patterns in early and late pregnancy; and 2) identify how changes in sleep patterns impact gestational weight gain, energy intake and metabolic health. METHODS: In 52 healthy pregnant women with obesity (27.4 ± 0.6 y; BMI: 36.3 ± 0.7 kg/m,(2)), energy intake (intake-balance method), and changes in weight, fasting glucose, insulin, lipids and habitual sleep (5 consecutive nights via wrist worn accelerometer) were assessed from early (13,(0)–15,(6) weeks) to late (35,(0)–36,(6)) pregnancy. A change to habitual sleep parameters (increase or decrease) was defined as ± one-half of the standard deviation of the 5-day measurement in early pregnancy. RESULTS: Results In early pregnancy, time spent in bed (TIB) was 9.40 ± 0.13 h and varied 1.61 ± 0.11 h across the 5 nights. Total sleep time (TST) and sleep efficiency (SE) significantly declined from early to late pregnancy 7.05 ± 0.13 h to 6.46 ± 0.15 h (P

Internet of things (IOT) and Vertical Cavity Surface Emitting Laser (VCSEL) future can be seen together, since VCSEL technology-based 3D sensors are introduced for IoT applications. The improved VCSEL structure design with fixed wavelength using a thermally actuated cantilever structure is presented. This improved structure of VCSEL will help us in realizing athermal VCSEL. In athermal VCSEL the dependency of VCSEL on temperature will be much less because it will not require temperature controllers. Realizing fully temperature-independent VCSEL (i.e., athermal VCSEL) is still a challenge but we can reduce it to some extent. In this chapter, recent diversification of application of VCSEL technology from data communication to sensing has been discussed. This proposed VCSEL structure may give us an opportunity to improve the VCSEL technology. Therefore, smart 3D sensors based on VCSEL will help in making internet of things applications more reliable and will directly or indirectly serve the concept of smart homes and smart cities.

BackgroundDespite increasing neonatal antibiotic stewardship efforts, understanding of interhospital variation in neonatal antibiotic use is limited.MethodsA retrospective cohort study was conducted among primarily academically affiliated hospitals participating in the Vizient Clinical Database/Resource Manager. Neonatal discharges were identified by admission age ResultsThe 118 included hospitals represented 184 716 neonatal discharges; 22 hospitals with low NCC, 56 with medium NCC, and 40 with high NCC. Mean antibiotic DOT/1000 pd was 363 (standard deviation [SD], 94) in high NCC hospitals, 243 (SD, 88) in medium NCC hospitals, and 184 (SD, 122) in low NCC hospitals. Increasing NCC was associated with higher antibiotic use, with an incidence rate ratio (IRR) of 1.95 (95% confidence interval [CI], 1.55 to 2.47) for high vs low NCC and IRR 1.31 (95% CI, 1.05 to 1.64) for medium vs low NCC. Increasing case mix index was associated with higher antibiotic use (IRR 1.86 per unit increase; 95% CI, 1.50 to 2.31).ConclusionsAggregate antibiotic use among hospitalized neonates varies based on care complexity. Substantial variation despite stratification by complexity suggests incomplete risk adjustment and/or avoidable variation in care.

Objective To examine whether experimentally induced weight gain raises ambulatory blood pressure (BP) in healthy subjects and identify any relationship between changes in BP and changes in regional fat distribution. Patients and Methods Twenty-six normal weight subjects were randomized to 8 weeks of weight gain through overfeeding (n=16; age, 30.4±6.6 years) or to weight maintenance (controls; n=10; age, 27.1±7.7 years) between July 2004 and August 2010. Measures of body composition via dual energy X-ray absorptiometry and computed tomography, circulating biomarkers, and 24-hour ambulatory BP were obtained at baseline and after the 8-week experimental phase. Results Overfeeding resulted in 3.7 kg (95% CI, 2.9-4.5) increase in body weight in weight gainers, with increments in total (46.2 cm2; 95% CI, 27.6-64.9), visceral (13.8 cm2; 95% CI, 5.8-21.9), and subcutaneous fat (32.4 cm2; 95% CI, 13.5-51.3). No changes occurred in the maintenance group. Increases in 24-hour systolic BP (4 mm Hg; 95% CI, 1.6-6.3), mean BP (1.7 mm Hg; 95% CI, 0.3-3.3), and pulse pressure (2.8 mm Hg; 95% CI, 1.1-4.4) were evident after weight gain in the experimental group, whereas BP remained unchanged in controls. Changes in mean BP correlated only with changes in visceral fat (ρ=0.45; P=.02), but not with changes in other body composition measures. Conclusion Modest weight gain causes elevation in 24-hour BP in healthy subjects. The association between increased BP and abdominal visceral fat accumulation suggests that visceral deposition of adipose tissue may contribute specifically to the enhanced risk of hypertension associated with weight gain.

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.Funding: NoDisclosures: None

Growing evidence indicates that periodic limb movements of sleep (PLMS) may be related to increased risk of developing cardiovascular disease. However, the association of PLMS with atrial fibrillation (AF) is unclear, especially in patients with sleep-disordered breathing (SDB). This study sought to investigate whether PLMS were associated with increased AF prevalence, independent of established risk factors.We performed a cross-sectional study of patients who underwent attended polysomnography at Mayo Clinic from 2011 to 2014. The association of PLMS with AF prevalence was estimated by using logistic regression models.15,414 patients were studied, 76.3% of individuals with SDB defined by apnea-hypopnea index (AHI) ≥5/h, and 15.3% with a diagnosis of AF. In univariate logistic modelling, individuals with periodic limb movement index (PLMI) ≥30/h had higher odds of AF (odds ratio [OR] 1.96, 95% confidence interval [CI]1.79-2.16, p0.001) when compared to patients with PLMI15/h. After multivariate adjustment (for age, race, sex, history of smoking, hypertension, diabetes, coronary artery disease, heart failure, cerebrovascular disease, renal disease, iron deficiency anemia, chronic obstructive pulmonary disease, AHI, arousal index), in mild SDB patients, a PLMI ≥30/h or periodic limb movement arousal index (PLMAI) ≥5/h had significantly higher odds of AF than those with PLMI15/h (OR 1.21, 95% CI 1.00-1.47, p=0.048) or PLMAI1/h (OR 1.27, 95% CI 1.03-1.56, p=0.024).Frequent PLMS are independently associated with AF prevalence in patients with mild SDB. Further studies are needed to better understand the relationship with incident AF.

Summary Low leptin concentration has been shown to be associated with central sleep apnea in heart failure patients. We hypothesized that low leptin concentration predicts central sleep apnea. Consecutive ambulatory New York Heart Association (NYHA) classes I–IV heart failure patients were studied prospectively, including measurement of serum leptin, echocardiography and polysomnography. Sleep apnea was defined by type (central/mixed/obstructive) and by apnea–hypopnea index ≥5 by polysomnography. Subjects were divided into four groups by polysomnography: (1) central sleep apnea, (2) mixed apnea, (3) no apnea and (4) obstructive sleep apnea. Fifty-six subjects were included. Eighteen subjects were diagnosed with central sleep apnea, 15 with mixed apnea, 12 with obstructive apnea and 11 with no sleep apnea. Leptin concentration was significantly lower in central sleep apnea compared to obstructive apnea (8 ± 10.7 ng mL−1 versus 19.7 ± 14.7 ng mL−1, P ˂ 0.01) or no sleep apnea (8 ± 10.7 ng mL−1 versus 17.1 ± 8.4 ng mL−1, P ˂ 0.01). Logistic regression showed leptin to be associated independently with central sleep apnea [odds ratio (OR): 0.19; 95% confidence interval (CI): 0.06–0.62; area under the curve (AUC): 0.80, P

15O-H2O PET imaging is an accurate method to measure cerebral blood flow (CBF) but it requires an arterial input function (AIF). Historically, image-derived AIF estimation suffers from low temporal resolution, spill-in, and spill-over problems. Here, we optimized tracer dose on a time-of-flight PET/MR according to the acquisition-specific noise-equivalent count rate curve. An optimized dose of 850 MBq of 15O-H2O was determined, which allowed sufficient counts to reconstruct a short time-frame PET angiogram (PETA) during the arterial phase. This PETA enabled the measurement of the extent of spill-over, while an MR angiogram was used to measure the true arterial volume for AIF estimation. A segment of the high cervical arteries outside the brain was chosen, where the measured spill-in effects were minimal. CBF studies were performed twice with separate [15O]-H2O injections in 10 healthy subjects, yielding values of 88 ± 16, 44 ± 9, and 58 ± 11 mL/min/100 g for gray matter, white matter, and whole brain, with intra-subject CBF differences of 5.0 ± 4.0%, 4.1 ± 3.3%, and 4.5 ± 3.7%, respectively. A third CBF measurement after the administration of 1 g of acetazolamide showed 35 ± 23%, 29 ± 20%, and 33 ± 22% increase in gray matter, white matter, and whole brain, respectively. Based on these findings, the proposed noninvasive AIF method provides robust CBF measurement with 15O-H2O PET.

Introduction African Americans are at a greater risk for cardiovascular disease and inadequate sleep than are corresponding whites. Age-associated declines in sleep duration, cardiovascular health, and physical activity highlight the need to understand the relationship among these variables in this population. While physical activity is thought to be beneficial for promoting sleep quality, it remains unknown how habitual short sleep during a physical activity intervention influences the intervention response in this population. Methods Sedentary older African Americans (n=27; 65-85 years old; 74% female) participating in the intervention arm of a 12-week randomized controlled physical activity trial (NCT03474302) were categorized as short (n= 15) or adequate (n=12) sleepers, defined as sleeping 6 hours/night on average during the intervention. Participants wore validated activity monitors at baseline and 12 weeks, and commercially available sleep monitors were worn daily. Differences in cardiovascular outcomes at baseline and 12 weeks were assessed between sleep categories using sex-adjusted linear mixed models. Results The intervention increased accelerometer derived steps (p=0.04) with no between group differences (p=0.78). Moderate to vigorous activity (MVA) duration increased (p0.05). Significant differences or trends between adequate and poor sleepers were observed (-10.5 mmHg; p=0.096; -30 mg/dL p=0.044; -21 mg/dL; p=0.095, respectively). Conclusion Adequate sleep during a physical activity intervention may be important to elicit cardiovascular benefits. Thus, research evaluating sleep extension complementary to increased physical activity is warranted in short sleepers. Support BrightFocus (A20175472); National Institute of General Medical Sciences of the National Institutes of Health (U54-GM104940)

In this paper, we have performed the theoretical study of single and dual gate MoS 2 based TMD Field Effect Transistor (TMDFET). The different performance characteristics of TMDFET such as ON state current (ION), leakage current (IoFF), and IoN/IoFF ratio can be done by using different gate oxide thickness and channel length. The Molybdenum disulphide (MoS 2 ) is used as channel material for both single and dual gate TMDFET device. For the calculation of ION and IoFF characteristics, the Non Equilibrium Greens Function (NEGF) has been used by solving the Poisson's equation. The IoFF (leakage) current is calculated at gate-source voltage (VGS) =0 by keeping drain-source voltage (VDS) fixed at 0. 5V and also calculated the on state current (ION) at different values of VGS for oxide thickness varying from 1nm to 3nm in step of 0.5nm and channel length from 5nm to 11nm in step of 2nm range. Other performance characteristics with reduced short channel effect like subthreshold slope are also calculated for both single and dual gate TMDFET. It has been observed that the performance of dual gate TMDFET is better in case of ON state current (ION), and reduced leakage current (IoFF) than single gate TMDFET. The effect of short channel is also minimum in dual gate device over single gate device.

Background Despite strenuous public health efforts, obesity rates continue to rise globally, and contribute importantly to increased cardiometabolic morbidity and mortality. Dietary habits play a k...

Background Osteoporosis, a condition associated with decreased bone density, contributes significantly to morbidity and mortality. Importantly, the incidence and economic burden of osteoporosis is ...

Obstructive sleep apnea (OSA) is a common sleep disorder associated with obesity. Emerging evidence suggest that OSA increases the risk of cardiovascular morbidity and mortality partly via accelerating the process of cellular aging. Thus, we sought to examine the effects of intermittent hypoxia (IH), a hallmark of OSA, on senescence in human white preadipocytes. We demonstrate that chronic IH is associated with an increased generation of mitochondrial reactive oxygen species along with increased prevalence of cells with nuclear localization of γH2AX & p16. A higher prevalence of cells positive for senescence-associated β-galactosidase activity was also evident with chronic IH exposure. Intervention with aspirin, atorvastatin or renin-angiotensin system (RAS) inhibitors effectively attenuated IH-mediated senescence-like phenotype. Importantly, the validity of in vitro findings was confirmed by examination of the subcutaneous abdominal adipose tissue which showed that OSA patients had a significantly higher percentage of cells with nuclear localization of γH2AX & p16 than non-OSA individuals (20.1 ± 10.8% vs. 10.3 ± 2.7%, Padjusted

Background and Purpose— Noninvasive imaging of brain perfusion has the potential to elucidate pathophysiological mechanisms underlying Moyamoya disease and enable clinical imaging of cerebral blood flow (CBF) to select revascularization therapies for patients. We used hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) technology to characterize the distribution of hypoperfusion in Moyamoya disease and its relationship to vessel stenosis severity, through comparisons with a normative perfusion database of healthy controls. Methods— To image CBF, we acquired [ 15 O]-water PET as a reference and simultaneously acquired arterial spin labeling (ASL) MRI scans in 20 Moyamoya patients and 15 age-matched, healthy controls on a PET/MRI scanner. The ASL MRI scans included a standard single-delay ASL scan with postlabel delay of 2.0 s and a multidelay scan with 5 postlabel delays (0.7–3.0s) to estimate and account for arterial transit time in CBF quantification. The percent volume of hypoperfusion in patients (determined as the fifth percentile of CBF values in the healthy control database) was the outcome measure in a logistic regression model that included stenosis grade and location. Results— Logistic regression showed that anterior ( P P =0.003) in Moyamoya patients were susceptible to hypoperfusion, whereas posterior regions were not. Cortical regions supplied by arteries with stenosis on MR angiography showed more hypoperfusion than normal arteries ( P =0.001), but the extent of hypoperfusion was not different between mild-moderate versus severe stenosis. Multidelay ASL did not perform differently from [ 15 O]-water PET in detecting perfusion abnormalities, but standard ASL overestimated the extent of hypoperfusion in patients ( P =0.003). Conclusions— This simultaneous PET/MRI study supports the use of multidelay ASL MRI in clinical evaluation of Moyamoya disease in settings where nuclear medicine imaging is not available and application of a normative perfusion database to automatically identify abnormal CBF in patients.

An incessant increase in global population along with a continuous augmentation in abiotic stress conditions, such as temperature, pH, salinity, etc., and limitation of natural resources has posed a serious threat to developing nations in terms of food security and enhanced nutritional value of the yield. Substantial crop losses in both qualitative and quantitative aspects due to the several prevalent phytopathogens are adding severity to the existing trouble. Confrontation with this ongoing problem initially led to the application of chemical fertilizers. However, hazardous aftereffects of the chemical fertilizers on the ecosystem have instigated a demand for a promising eco-friendly substitute that deals with both biotic and abiotic stresses. Rhizospheric microorganisms can be utilized as an effective alternative because they reside in soil and have the intrinsic property of upholding balanced ecosystem. These plant growth-promoting rhizobacteria (PGPRs) enhance plant growth even in poor and stressed environmental conditions by the formation of beneficial associations with the host through biological nitrogen fixation, phosphate solubilization, siderophore and hormone production, etc. They can also trigger host defense mechanism through induced systemic resistance (ISR). These PGPRs are also helpful for phytoremediation by various processes such as direct absorption, accumulation, etc. PGPRs are utilized in the fields of phytostimulation, biofertilization, and biocontrol activities. In the current chapter, we would aim to uphold the mechanisms opted by PGPR for effective plant growth promotion and defense under various abiotic as well as biotic stress conditions. In this context, we would also aim to delve in detail about the host-PGPR cross talk during the onset of stress conditions.

Background: Clonidine is a commonly used agent for premedication through oral, intravenous, and intramuscular route. Very few studies mentioned intramuscular clonidine as premedication. Aims and Objectives: The aim of the present study is to compare oral and intramuscular clonidine as predication agent in bupivacaine spinal anesthesia patients. Materials and Methods: In our study, recruited patients were randomly allocated in three groups of 32 each. All patients received intrathecal bupivacaine heavy 3 mL with oral 150 μg clonidine in Group 1, intramuscular 150 μg clonidine in Group 2, and oral placebo tablet in Group 3 1 h before taking the patient in operation theater. We have assessed for duration of sensory block, duration of motor block, duration of analgesia, sedation score, and hemodynamic changes in groups. Statistical Analysis: The parametric data were expressed as mean ± standard deviation. Primary analysis of parametric data between the two groups was done by student's t-test, and among three groups, analysis of variance was used. Results: Duration of motor block was found significantly high in Group 2 than Group 1 (208.06 ± 9.48 vs. 200.25 ± 9.42; P < 0.05). Duration of sensory block was also found significantly high in Group 2 than Group 1 (219.69 ± 9.44 vs. 210.25 ± 9.68; P < 0.05). Time to give first dose of analgesia was also found greater in Group 2 than Group 1 (234.66 ± 11.76 vs. 217.75 ± 10.09; P < 0.05). Sedation score and other side effects were found statistically nonsignificant between Group 1 and 2. Conclusion: We can conclude that preoperative intramuscular clonidine is a better alternate of oral clonidine for bupivacaine spinal anesthesia in terms of long duration of motor and sensory block and less requirement of analgesic with clinically insignificant side effects.

Inadequate sleep is increasingly pervasive, and the impact on health remains to be fully understood. The cardiovascular consequences alone appear to be substantial. This review summarizes epidemiologic evidence regarding the association between extremes of sleep duration and the prevalence and incidence of cardiovascular diseases. The adverse effects of experimental sleep loss on physiological functions are discussed, along with cardiovascular risk factors that may underlie the association with increased morbidity and mortality. Current data support the concept that inadequate sleep duration confers heightened cardiovascular risk. Thus implementation of preventative strategies may reduce the potential disease burden associated with this high-risk behavior.

Introduction: Endothelial cell migration and proliferation play an important role in the growth and development of new blood vessels and endothelium healing. This process occurs in response to injury, inflammation and immune reactions. Dysfunction of the endothelium may play a significant role in development and progression of cardiovascular disease related to sleep-disordered breathing. The aim of our study was to evaluate the chemo-attractant activity of serum from obstructive sleep apnea (OSA) and normal subjects on coronary artery endothelial cell migration. Material and methods: We studied 12 severe OSA patients, free of other co-morbidities and on no treatment, along with 12 age-, body mass index, and gender matched healthy controls. Blood was collected at three time points: at 21:00 before sleep, at 6:00 after waking from sleep, and at 11.00 (after 5 h of normal daytime activity). Serum chemo-attractant activity for human coronary endothelial cells was assessed using a colorimetric cell migration assay kit. Results : In healthy subjects, serum chemo-attractant activity peaked in the morning after waking from sleep (p = 0.02). This early morning increase was blunted in severe OSA subjects, in whom chemo-attractant activity was weaker than in normal controls (p = 0.02), and did not change significantly at the different time-points (p < 0.001 vs. controls). Conclusions : Chemo-attractant activity of the serum from OSA patients is lower compared to serum from healthy subjects, especially in the morning. Altered chemo-attractant serum activity may conceivably contribute to the impairment of endothelial function in obstructive sleep apnea patients.

Whether measures of central obesity, such as waist-to-hip ratio (WHR), provide additional information beyond body mass index (BMI) in defining mortality risks is unclear. This study examined data f...

Background Levofloxacin prophylaxis in pediatric oncology patients with chemotherapy-induced severe prolonged neutropenia has been shown to reduce risk for febrile neutropenia and systemic infections. With increased use of prophylaxis there is concern for development of antibiotic-resistant infections. We analyzed bloodstream infections (BSI) in pediatric oncology patients exposed to levofloxacin prophylaxis during prolonged severe neutropenic episodes to determine the rate of antibiotic resistance Methods We performed a retrospective chart review of pediatric oncology patients who received levofloxacin prophylaxis between January 2015 – December 2019. Patients were placed on levofloxacin prophylaxis based on institutional guidelines for patients at risk for severe prolonged neutropenia (i.e., absolute neutrophil count [ANC] < 500 cells/µL for >7 days). Demographic information, start and end dates for levofloxacin prophylaxis, and all BSI episodes within 2 months after exposure to the fluoroquinolone were collected Results Thirty-five patients were identified who received levofloxacin prophylaxis. There were 32 BSI in 12 patients. Twenty-five BSI involved gram-positive organisms (GP), including nine (36%) due to coagulase negative Staphylococcus and seven (28%) due to viridans Streptococcus. Seven BSI episodes involved gram-negative (GN) organisms with 4 (57%) from E.coli. Resistance to fluroquinolones was noted in 42% and 48% of BSI from GN and GP organisms respectively. The vast majority (85%) of viridans Streptococcus isolates were resistant to levofloxacin. In contrast, 8% of viridans Streptococcus isolates were resistant to fluoroquinolones from the same time frame per our hospital antibiogram. Conclusion In this recent cohort of pediatric oncology patients with BSI after exposure to levofloxacin prophylaxis, there was a high percentage infected with fluoroquinolone-resistant organisms.This contrasts with some of the earlier published data from adults which reported low rate of fluoroquinolone resistance. This case series highlights the need for close monitoring for development of antibiotic resistance as utilization of prophylactic levofloxacin increases in pediatric oncology patients. Disclosures All Authors: No reported disclosures

Body fat distribution contributes to obesity-related metabolic and cardiovascular disorders. Visceral fat is more detrimental than subcutaneous fat. However, the mechanisms underlying visceral fat-mediated cardiometabolic dysregulation are not completely understood. Localized increases in expression of the renin angiotensin system (RAS) in adipose tissue (AT) may be implicated. We therefore investigated mRNA and protein expression of RAS components in visceral versus subcutaneous AT using paired samples from individuals undergoing surgery (N = 20, body mass index: 45.6 ± 6.2 kg/m2, and age: 44.6 ± 9.1 years). We also examined RAS-related proteins in AT obtained from individuals on renin angiotensin aldosterone system (RAAS) targeted drugs (N = 10, body mass index: 47.2 ± 9.3 kg/m2, and age: 53.3 ± 10.1 years). Comparison of protein expression between subcutaneous and visceral AT samples showed an increase in renin (p = 0.004) and no change in angiotensinogen (p = 0.987) expression in visceral AT. Among proteins involved in angiotensin peptide generation, angiotensin converting enzyme (p = 0.02) was increased in subcutaneous AT while chymase (p = 0.001) and angiotensin converting enzyme-2 (p = 0.001) were elevated in visceral fat. Furthermore, visceral fat expression of angiotensin II type-2 receptor (p = 0.007) and angiotensin II type-1 receptor (p = 0.031) was higher, and MAS receptor (p < 0.001) was lower. Phosphorylated-p53 (p = 0.147), AT fibrosis (p = 0.138) and average adipocyte size (p = 0.846) were similar in the two depots. Nonetheless, visceral AT showed increased mRNA expression of inflammatory (TNFα, p < 0.001; IL-6, p = 0.001) and oxidative stress markers (NOX2, p = 0.038; NOX4, p < 0.001). Of note, mRNA and protein expression of RAS components did not differ between subjects taking or not taking RAAS related drugs. In summary, several RAS related proteins are differentially expressed in subcutaneous versus visceral AT. This differential expression may not alter AngII but likely increases Ang1-7 generation in visceral fat. These potential differences in active angiotensin peptides and receptor expression in the two depots suggest that localized RAS may not be involved in differences in visceral vs subcutaneous AT function in obese individuals. Our findings do not support a role for localized RAS differences in visceral fat-mediated development of cardiovascular and metabolic pathology.

Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement.