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Plasmablastic neoplasms comprise various haematolymphoid tumours with plasmablastic morphology which includes Plasmablastic Myeloma (PBM) and Plasmablastic Lymphoma (PBL). Distinguishing these two entities remains a major diagnostic challenge. In view of Epstein Barr Virus (EBV)-Encoded RNA (EBER) negativity, Human Immunodeficiency Virus (HIV) negativity, high Serum Free Light Chain (SFLC) assay and absence of hypermetabolic lymphadenopathy, a final diagnosis of PBM was made. This report is about a 55-year-old lady who presented with fatigue, significant loss of weight, and appetite. She had mild enlargement of the liver, spleen and no significant lymphadenopathy. There were atypical cells in peripheral blood. Bone marrow evaluation showed 51% atypical mononuclear cells. Flow cytometry was negative for acute leukaemia diagnostic markers. Immunohistochemistry (IHC) on the bone marrow biopsy revealed positivity for Cluster of Differentiation (CD) 138, Multiple Myeloma 1 (MUM1) with kappa light chain restriction and negative for EBER. The free light chain showed a kappa:lambda light chain ratio of 28,885 (0.26-1.65). The diagnosis of PBM was made and she was started on a daratumumab-based immunotherapy regimen. She achieved complete remission after induction with Measurable Residual Disease (MRD)

Extracellular matrix (ECM) products have the potential to improve cellular attachment and promote tissue-specific development by mimicking the native cellular niche. In this study, the therapeutic efficacy of an ECM substratum produced by bone marrow stem cells (BM-MSCs) to promote bone regeneration in vitro and in vivo were evaluated. Fluorescence-activated cell sorting analysis and phenotypic expression were employed to characterize the in vitro BM-MSC response to bone marrow specific ECM (BM-ECM). BM-ECM encouraged cell proliferation and stemness maintenance. The efficacy of BM-ECM as an adjuvant in promoting bone regeneration was evaluated in an orthotopic, segmental critical-sized bone defect in the rat femur over 8 weeks. The groups evaluated were either untreated (negative control); packed with calcium phosphate granules or granules+BM-ECM free protein and stabilized by collagenous membrane. Bone regeneration in vivo was analyzed using microcomputed tomography and histology. in vivo results demonstrated improvements in mineralization, osteogenesis, and tissue infiltration (114 ± 15% increase) in the BM-ECM complex group from 4 to 8 weeks compared to mineral granules only (45 ± 21% increase). Histological observations suggested direct apposition of early bone after 4 weeks and mineral consolidation after 8 weeks implantation for the group supplemented with BM-ECM. Significant osteoid formation and greater functional bone formation (polar moment of inertia was 71 ± 0.2 mm(4) with BM-ECM supplementation compared to 48 ± 0.2 mm(4) in untreated defects) validated in vivo indicated support of osteoconductivity and increased defect site cellularity. In conclusion, these results suggest that BM-ECM free protein is potentially a therapeutic supplement for stemness maintenance and sustaining osteogenesis.

McGuire et al. (2020) compellingly outline an array of complex ethical issues related to the COVID-19 pandemic. Among the most widely discussed of these is the issue of how persons with disabilitie...

Heat pipes are passive heat transfer devices in which a working fluid is sealed inside a metal enclosure. Properly designed wick structures on the inner surface of the heat pipe are critical as the wick aids in the return of the condensed liquid from the cold end back to the hot end where the vaporization-condensation cycle begins again. Additive manufacturing techniques allow for manufacturing complex parts that are typically not feasible with conventional manufacturing methods. Thus, additive manufacturing opens the possibility to develop high performance heat pipes with complex shapes. In this study, an additive manufacturing technique called Binder Jetting is used to fabricate a fully operational compact (78 mm x 48 mm x 8 mm) flat plate heat pipe. Rectangular grooves with converging cross section along the length act as the wicking structure. A converging cross section was designed to enhance the capillary force and to demonstrate the capability of additive manufacturing to manufacture complex shapes. This work describes the challenges associated with the development of heat pipes using additive manufacturing such as de-powdering and sintering. Multiple de-powdering holes and internal support pillars to improve the structural strength of the heat pipe were provided in order to overcome the manufacturing constraints. The heat pipe was experimentally characterized for thermal performance with acetone as the working fluid for two different power inputs. The heat pipe operated successfully with a 25% increase in effective thermal conductivity when compared to solid copper. Master of Science The number of transistors in electronic packages has been on an increasing trend in recent decades. Simultaneously there has been a push to package electronics into smaller regions. This increase in transistor density has resulted in thermal management changes of increased heat flux and localization of hotspots. Heat pipes are being used to overcome these challenges. Heat pipes are passive heat transfer devices in which a working fluid is sealed inside a metal enclosure. The fluid is vaporized at one end and condensed at the other end in order to efficiently move heat through the pipe by taking advantage of the latent heats of vaporization and condensation of the fluid. Properly designed wick structures on the inner surface of the heat pipe are used to move the condensed fluid from the cold end back to the hot end, and the wick is a critical component in a heat pipe. Additive manufacturing techniques offer the opportunity to manufacture complex parts that are typically not feasible with conventional manufacturing methods. Thus, additive manufacturing opens the possibility to develop high performance heat pipes with complex shapes as well as the ability to integrate heat exchangers with the heat source. In this study, an additive manufacturing technique called Binder Jetting is used to fabricate a fully operational compact (78 mm x 48 mm x 8 mm) flat plate heat pipe. Rectangular grooves with converging cross section along the length act as the wicking structure. This work describes the challenges associated with the development of heat pipes using additive manufacturing such as depowdering and sintering. The heat pipe was experimentally characterized for thermal performance with acetone as the working fluid for two different power inputs. The heat pipe was found to operate successfully with a 25% increase in effective thermal conductivity when compared with solid copper.

Background: The impact of COVID-19 pandemic has been highly heterogeneous across the globe and different regions within the country. The differences in the outcome of these patients is related to their demographic profile, genetics, socio-economic conditions, and government health policies. Prior to the COVID-19 pandemic, the Healthcare Access and Quality (HAQ) Index for hematological malignancies (HAQ index Methods: Ten tertiary referral hospitals across India reported the demographic, clinical, laboratory, treatment, and outcomes of COVID-19 infection in patients with hematological malignancies. The registry was retrospective from March 21, 2020, and prospective from November 1, 2020, till March 20, 2021. Risk factors associated with severity and mortality were evaluated using the penalised logistic regression and Cox proportional hazards model. Findings: Data from 565 patients was included in this study. Among these, 429 (76%) patients were hospitalized, 186 (33%) patients had moderate/severe COVID-19.There were 116 (20.5%) non-survivors at a mean follow up of 147 (95% CI : 142-153) days. Age >60 years (HR 2·55, 1·23 - 5·27), diagnosis of acute myeloid leukemia (HR 2·85, 1·58 - 5·13), interruption or alteration of anticancer therapy (HR 2·78, 1·65 - 4·68), and post hematopoietic cell transplant status (HR 3·68, 1·82 - 7·45) predicted mortality. In contrast, increasing age [20-40 years (OR 2·54, 1·32 - 4·90), 41-60 years (OR 3·51, 1·84 - 6·71), >60 years (OR 6·04, 3·01 - 12·10), comorbidities such as diabetes mellitus (OR 1·89, 1·18 - 3·04), hypertension (OR 1·94, 1·17 - 3·19), diagnosis of AML (OR 3·70, 2·06 - 6·67), indolent non-hodgkin lymphoma (OR 3·20, 1·68 - 6·09), multiple myeloma (OR 2·88, 1·64 - 5·05), malignancy not being in remission (OR 1·71, 1·12 - 2·60)were significantly associated with severe COVID-19 on univariate analysis. Of these, only increasing age [20-40 years (OR 2·60 (1·31 - 5·15), 40-60 years (OR 3·44, 1.60 - 7·41), more than 60 years (OR 5·70, 2·43 - 13·35)] , AML (OR 2·73, 1·45 - 5·12), and malignancy not being in remission (OR 1·85, 1·18 - 2·89) were significantly associated with severe COVID-19 on multivariable analysis Conclusion: The overall mortality from COVID-19 infection of the entire cohort was 20.5%; the mortality was 46.2% in patients who had moderate to severe disease COVID-19 illness. Similar to previous studies, age, diagnosis of acute myeloid leukemia and a post stem cell transplant status was associated with mortality. In addition, interruption or de-escalation of anticancer therapy during Covid-19 infection was identified as an important factor associated with higher mortality on follow up in the current study. References 1. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet (London, England)2018; 391(10136): 2236-71.Lee AJX, Purshouse K. COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer 2021; 124(11): 1777-84. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is classed as group 4 in the present classification of pulmonary hypertension. The pathophysiology of CTEPH is complex, mainly is a consequence of prior acute pulmonary embolism with failure of thrombi to resolve and the recent recognition of added small vessel changes which impacts long-term outcomes even after surgical management. The role of thrombophilia testing in this condition has been debated. Hence, we here analyzed the utility of thrombophilia testing in CTEPH from a center in a developing country. Methods This is a single institution (Narayana Health City, Bangalore); retrospective study including patients ≥ 18 years of age who underwent thrombophilia workup in a diagnosis of CTEPH from January 2019 till July 2021. Tests done to evaluate thrombophilia included factor V Leiden; prothrombin F20210A mutation; MTHFR gene mutation; Protein C, S, and antithrombin deficiency; lupus anticoagulant, anti-beta2 glycoprotein I (IgM and IgG) and anticardiolipin antibody (IgM and IgG); hyperhomocysteinemia and anti-nuclear antibody testing (ANA-IF). The study was approved by the ethics committee of the institute and was carried out in accordance with the principles of the declaration of Helsinki. Results and discussion The study included 56 patients with a median age of 37 years (range 23-50), and 36 (64%) were males. Patients with recurrent venous thrombosis included 37 (66%), with the majority having thrombosis at 2 sites (53%; 22 patients with associated deep vein thrombosis). A family history of thrombosis was present in 4 patients. The majority of patients received vitamin K antagonists (76%), with the rest receiving direct oral anticoagulants (DOAC). Among the tests sent for acquired thrombophilia, ANA-IF and antiphospholipid antibody (APLA) were most frequently evaluated (94%). ANA-IF and APLA tests were positive in 5.6% and 30.1%, respectively. Among the APLA tests, Anti-beta2 glycoprotein I (IgM or IgG) was the most commonly detected antibody (13/46), followed by anticardiolipin antibody (IgG or IgM) (9/43) and lupus anticoagulant (7/40). Double and triple positive APLA were present in 3 and 4 patients, respectively. Homocysteine levels were high in 93.7% though only 16 patients were tested in this cohort. Among the tests for inherited thrombophilia, genetic tests (factor V Leiden, prothrombin F20210A mutation, and MTHFR gene mutation) were tested in only ~50%. Twenty-three percent were positive for heterozygous MTHFR followed by MTHFR compound heterozygous (10%) and heterozygous factor V Leiden heterozygous (10%). Antithrombin III, protein C, and S were tested in ~30% of patients. Antithrombin III was low in only 1 patient, with protein C and S assays being normal in all the patients. The cost analysis was calculated, showed a median of $364 (₹ 27,055) was spent per person on thrombophilia workup. The median cost incurred per patient for inherited thrombophilia workup was $232 (₹ 17,300) and for acquired thrombophilia was $132 (₹ 9814), respectively. Conclusion This single-institution study on thrombophilia workup in CTEPH patients reveals that APLA was the most commonly performed test with high positivity rates of 30.1%. Among the inherited thrombophilia, the positivity rate of MTHFR mutation was highest (33.3%), with other tests having a low positivity rate (0-10%). Hence, we would recommend APLA testing in all patients with CTEPH considering its high positivity and clinical utility. Testing for other thrombophilias should be pursued judiciously especially in economically restrictive settings. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Introduction Multiple myeloma (MM) is a malignancy involving terminally differentiated plasma cells. Its incidence in India is about 0.7/1,00,000 population amounting to about 6,800 new cases a year A number of genomic aberrations are associated with MM, most of which confer prognostic significance. Cytogenetic abnormalities are a part of R-ISS score for prognostication which stratifies presence of del(17p), t(4;14) or t(14;16) as stage 3, mSMART is another risk stratification tool which divides MM into high risk and standard risk groups based on genetic aberrations. Hence it is evident that determining the genetic abnormality in MM is important. however, due to limited resources genetic testing is not routinely done and the data in the Indian population is limited. Objective: To estimate the prevalence of molecular cytogenetic abnormalities by Fluorescent in situ hybridization (FISH) analysis in patients with MM and to assess the co-relation with response to induction chemotherapy, relapse and overall survival. Material and Methods: 64 patients were included from January 2016 to December 2019 and followed up till June 2020. Interphase FISH study was performed either at diagnosis or at relapse, on bone marrow aspirate with panel of probes consisting of CKS1B (1q21-22), CDKN2C (1p32.3), D13S319 (13q14.2/13q34), IGH (14q32.33), p53 (17p13.1) and trisomy (5p15/9q22/15q22) (trisomies are considered as hyperdiploidy in this study). Plasma cell purification techniques were not applied prior to FISH analysis. Patients were divided into 2 risk groups; 1) high risk group with presence of del17p, del13q, amplification 1q, del1p and two or more aberrations with either of these and 2) standard risk group with presence of hyperdiploidy or no genetic abnormality. There was no difference in chemotherapy regimen between the 2 groups; 46 (71.8%) received bortezomib-thalidomide-dexamethasone, 10 (15.6%) received bortezomib-cyclophosphamide-dexamethasone, 2(3.1%) received bortezomib-lenalidomide-dexamethasone, 1(1.5%) received daratumumab-bortezomib-dexamethasone and 5(7.8%) received 2 drug chemotherapy. Patients who did not complete minimum follow up of 6 months either due to death or lost to follow up were excluded from the study. Institutional Ethics Committee's approval was taken. Results: Mean age of the population was 60.33 years and male to female ratio was 1.65. 46.87%, 28.13% and 25% of the study population were in the age group of ≤ 60, 61 - 65 and ≥66 years respectively. 12.3%, 43.8% and 43.8% were in R ISS stage 1, 2 and 3 respectively. FISH analysis was done on 61 out of 64 patients (remaining 3 were excluded due to hemodilute bone marrow sample). 22 (36.1%) patients had abnormal genetic aberration on FISH analysis with 10 (16.39%) having two or more abnormalities. The frequency of genetic aberrations was as follows; amplification 1q (13/61, 21.31%), del13q (9/61, 14.75%), hyperdiploidy (7/61, 11.47%), del17p (4/61, 6.55%), IgH rearrangement (3/61, 4.91%), and del1p (1/61, 1.6%). All 3 patients with IgH rearrangement had associated one or more high-risk genetic aberration and hence were included in high risk group. 31.1% of the patients were high risk and 68.9% were standard risk. The response to induction chemotherapy, incidence of relapse, time to 1st relapse and total number of relapses are shown in (table;1) and there was no significant difference between high risk and standard risk group. Overall survival in standard risk group at 2 and 5 years was 89.6% ± 5.8% and 78.6% ± 13.9% and in high risk group was 60.7% ± 13.2% and 29.5% ± 23.1% respectively (p value: 0.762). Overall survival was significantly lower in age group ≥66 years as compared to age group ≤ 60 years and 61 - 65 years (p value 0.001) and it was also significantly lower in R ISS stage 3 as compared to R ISS stage 1 and 2 (p value 0.006). Conclusion: More than one third patients of MM (36.1%) showed genetic abnormality, amplification 1q being the most frequent. Overall survival was significantly lower in older age group and R ISS stage 3 patients. Response to induction chemotherapy and relapse rate were similar in high and standard risk groups. Although overall survival was lower in high risk group, it was statistically not significant. This study highlights the importance of FISH analysis for disease stratification and prognostication which should be routinely practiced. Disclosures No relevant conflicts of interest to declare.

Diabetic Retinopathy is an eye disease caused in patients with diabetic which leads to blindness. So, detection of Diabetic retinopathy at early stage prevents loss of vision. In this paper, we proposed an effective segmentation method that combines modified Fuzzy C Means (FCM) clustering with spatial features and Inertia Weight Particle Swarm optimization (IWPSO) for detection of Diabetic Retinopathy. The input human retinal fundus images are filtered by a median filter to reduce speckle noise and then contrast enhancement is done by Adaptive Histogram Equalization. Then segmented by various methods like Chaotic Particle Swarm optimization (CPSO), Inertia Weight Particle Swarm optimization (IWPSO) and our proposed method. The performance of these methods is analyzed using the metrics Accuracy, True Positive Rate (Sensitivity), True Negative Rate (Specificity), False Positive Rate and False Negative Rate. A comparative analysis has been made for the above said segmentation algorithms and the results proved that our proposed method achieved the best than the other methods.

INTRODUCTION Acute Graft-versus-host disease (aGVHD) is a common complication of allogeneic hematopoietic cell transplantation (HCT), affecting about 50% of transplants. Grading of aGVHD can serve a variety of purposes, including retrospective assessment of peak severity, real-time assessment of severity at prespecified time points, and determination of the need for treatment. But several problems hamper the application of grading systems to predict outcomes among patients with aGVHD: (1) Assignment of a peak GVHD score is done retrospectively; clinicians cannot use the current grading system for peak score in real-time1. (2) The systems do not account for the time to the response after treatment1. (3) Assignment of grade IV GVHD is often used to indicate that GVHD caused a death, irrespective of the severity. In this situation, the grading reflects the outcome and cannot be used to predict the outcome1. Recently serum biomarkers have emerged as an additional potential measurement of acute GVHD severity. The Mount Sinai Acute GVHD International Consortium (MAGIC) Group, has validated MAGIC algorithm probability (MAP) that combines two GI biomarkers (ST2 and REG3α) into a single value. The MAP predicts response to treatment, GVHD severity. But in resource-limited settings, like transplant centers in India lack testing features. In this study we have developed a risk scoring based on clinical and easily available biochemical parameters to predict the severity of aGVHD. AIMS AND OBJECTIVES To predict the aGVHD severity at the onset based on risk factor score. To assess the steroid response in different risk groups MATERIAL AND METHODS The study included patients who underwent allogeneic HCT at Narayana hrudayalaya hospital, between January 2015 and April 2020 and developed acute GVHD within 100 days of transplant. After taking institutional ethics committee approval, data were collected from medical records. Baseline patient characteristics are mentioned in table 1. The following parameters were analyzed as risk factors for the development of severe GVHD (MAGIC grade 3 and 4): 1. Age >18 yrs, 2. MDR organisms in baseline stool culture, 3. HCT comorbidity index >1, 4. Peripheral blood as a source of stem cells, 5. Female to male transplants, 6. Myeloablative regimens, 7. Suboptimal GVHD prophylaxis, 8. CD34 dose > 6 x 106/kg, 9. Grade 3/4 mucositis 10. Early-onset GVHD (within 28 days), 11. Albumin level at the onset of GVHD, 12. Albumin drop from baseline3, and 13. Bloodstream infection. Risk factors with a p-value of 8). The following outcomes were assessed in each group; severity of GVHD (Grade I/II vs Grade III/IV) and response to steroids. RESULTS Out of 148 patients, 35.5% of Group 1, 56.5% of Group 2 patients and 85.5% of Group 3 patients developed Grade 3 or 4 GVHD respectively (P-value 8 to predict Grade 3/4 GVHD is 85.4%, negative predictive value is 50.6%, sensitivity is 50.5%, and specificity is 85.5%. From Group 1 and 2, only 30% of patients were steroid non responders, while 55.3% of Group 3 patients are steroid non responders (P-value - 0.04). CONCLUSION Traditional GVHD scoring systems reflect the outcome and cannot be used to predict the outcome. Various biomarker-based scoring systems are helpful in this situation, but in resource-limited settings, it might not be easily feasible. Clinical scoring systems like risk factor-based scoring systems are very helpful, which can predict the severe GVHD at early time points leading to management decisions such as upfront initiation of aggressive treatments and earlier introduction of second-line agents. References Leisenring WM, et al. An acute graft-versus-host disease activity index to predict survival after hematopoietic cell transplantation with myeloablative conditioning regimens. Blood. 2006;108(2):749-55. 2.Rashidi A, et al. Peritransplant Serum Albumin Decline Predicts Subsequent Severe Acute Graft-versus-Host Disease after Mucotoxic Myeloablative Conditioning. Biol Blood Marrow Transplant. 2016;22(6):1137-41. Disclosures No relevant conflicts of interest to declare.

Curiosity to know the unknown and desire to behold what we need are important reasons for advancement in technology. Humans had the ability of vision to know what the world is like and through which we were able to explore and visualize the unknown and the needed respectively. As its result, computer vision was introduced to the world at late 1970's which was a field which consists of various discipline. This was developed to automate the process of what human visual system can perform. It concentrates on the theory of artificial intelligence which uses images as source of information. There are multiple forms to represent image data such as video sequence, views from multiple camera or multi-dimensional data from the medical scanner etc. In this article, the video which has been used for surveillance and entertainment has been studied in various perspective of its application. Thus, under computer vision the video could be explicitly used for newer implementation and experiments where they could be enhanced to a lot more than just a visual source.

In automotive domain, CAD models and its assemblies are validated for conformance to certain design requirements. Most of these design requirements can be modeled as geometric queries, such as distance to edge, planarity, gap, interference and parallelism. Traditionally these queries are made in discrete domain, such as a faceted model, inducing approximation. Thus, there is a need for modeling and solving these queries in the continuous domain without discretizing the original geometry. In particular, this work presents an approach for distance queries of curves and surfaces, typically represented using NURBS. Typical distance problems that have been solved for curves/surfaces are the minimum distance and the Hausdorff distance. However, the focus in the current work is on computing corresponding portions (patches) between surfaces (or between a curve and a set of surfaces) that satisfy a distance query. Initially, it was shown that the footpoint of the bisector function between two curves can be used as a distance measure between them, establishing points of correspondence. Curve portions that are in correspondence are identified using the antipodal points. It is also identified that the minimum distance in a corresponding pair is bound by the respective antipodal points. Using the established footpoint distance function, the distance between two surfaces was approached. For a query distance, sets of points satisfying the distance measure are identified. The boundary of the surface patch that satisfies the distance is computed using the ?-shape in the parametric space of the surface. Islands contributing to the distance query are also then computed. A similar approach is then employed for the distance between a curve and a set of surfaces. Initially, the minimum footpoint distance function for a curve to a surface is computed and repeated for all other surfaces. A lower envelope then gives the portions of the curves where the distance is more than the query. � 2013 Elsevier Ltd. All rights reserved.

GPS receivers have a major drawback: they don't work properly under multi-storey concrete structures, for e.g. in underground car parks, University buildings, shopping malls, factory complexes etc. A navigation system for such huge enclosed spaces, which does not rely on a GPS is very desirable for visitors to such places who do not know the layout of the place. This paper presents the design and development of a low-cost GPS-less navigation system based on TI Stellaris-LM3S3748, which could help visitors find their way around such places.

Given two distinct points S and E on a closed parametric curve forming the boundary of a simply-connected domain (without holes), this paper provides an algorithm to find the shortest interior path (SIP) between the two points in the domain. The SIP consists of portions of curves along with straight line segments that are tangential to the curve. The algorithm initially computes point-curve tangents and bitangents using their respective constraints. They are then analyzed further to identify potential tangents. A region check is performed to determine the tangent that will form part of the SIP. Portions of the curve that belong to the SIP are also identified during the process. The SIP is identified without explicitly computing the length of the curves/tangents. The curve is represented using non-uniform rational B-splines (NURBS). Results of the implementation are provided. � 2011 Elsevier Ltd. All rights reserved.