bluuebunny/crossref_metadata_2025 huggingface dataset:
New approach to expedite the delivery of the final crowns for teeth requiring crown lengthening surgery: a pilot study
Authors: Oh Se-Lim , Abrera-Crum Luz , Yang Ji Seung , Choi Seung Kee
Published: November 2022

Background

The healing period from crown lengthening procedures (CLPs) often delays the final crown delivery. This study aimed to explore the feasibility of a new approach expediting the delivery of the final crowns for teeth requiring CLPs.

Methods

Teeth requiring CLPs and single-crown restorations between the canine and the second molar were included. After the initial tooth preparation, a CLP was performed. In the experimental group, the final tooth preparation and final impression were made during the CLP; the final crown was then delivered at the suture-removal appointment. In the control group, the final impression was made 8 weeks after the CLP. The level of gingival margin (GM), pocket depth (PD), and crestal bone levels (CBLs) were compared between the two groups before CLPs (T0), at delivery of the crowns (T1), and at 12 months in function (T2).

Results

Twenty-one lithium-disilicate crowns were delivered to 20 subjects and followed up. The mean interval between the CLPs and the delivery of crowns was 2.5 weeks for the experimental group and 12 weeks for the control group. No significant differences were observed between the two groups in the level of GM, PD, and CBLs at each time point. No significant treatment difference in crestal bone loss was observed between the two groups at T2 (Experimental = -0.11 mm, Control = -0.03 mm; p = 0.67).

Conclusion

Making the final tooth preparation and the final impression at the CLP significantly reduced the time between the CLP and the delivery of the final crown and showed comparable clinical outcomes.
Specialised Paediatric PAlliativE CaRe: Assessing family, healthcare professionals and health system outcomes in a multi-site context of various care settings: SPhAERA study protocol
Authors: Zimmermann Karin , Simon Michael , Scheinemann Katrin , Tinner Oehler Eva Maria , Widler Michèle , Keller Simone , Fink Günther , Mitterer Stefan , Gerber Anne-Kathrin , von Felten Stefanie , Bergstraesser Eva
Published: November 2022

Background

The number of children and adolescents living with life-limiting conditions and potentially in need for specialised paediatric palliative care (SPPC) is rising. Ideally, a specialised multiprofessional team responds to the complex healthcare needs of children and their families. The questions of, how SPPC is beneficial, for whom, and under what circumstances, remain largely unanswered in the current literature. This study’s overall target is to evaluate the effectiveness of a SPPC programme in Switzerland with respect to its potential to improve patient-, family-, health professional-, and healthcare-related outcomes.

Methods

This comparative effectiveness study applies a quasi-experimental design exploring the effectiveness of SPPC as a complex intervention at one treatment site in comparison with routine care provided in a generalised PPC environment at three comparison sites. As the key goal of palliative care, quality of life - assessed at the level of the patient-, the family- and the healthcare professional - will be the main outcome of this comparative effectiveness research. Other clinical, service, and economic outcomes will include patient symptom severity and distress, parental grief processes, healthcare resource utilisation and costs, direct and indirect health-related expenditure, place of death, and introduction of SPPC. Data will be mainly collected through questionnaire surveys and chart analysis.

Discussion

The need for SPPC has been demonstrated through numerous epidemiological and observational studies. However, in a healthcare environment focused on curative treatment and struggling with limited resources, the lack of evidence contributes to a lack of acceptance and financing of SPPC which is a major barrier against its sustainability. This study will contribute to current knowledge by reporting individual and child level outcomes at the family level and by collecting detailed contextual information on healthcare provision. We hope that the results of this study can help guiding the expansion and sustainability of SPPC and improve the quality of care for children with life-limiting conditions and their families internationally.

Trial registration

Registered prospectively on ClinicalTrials.gov on January 22, 2020. NCT04236180

Protocol version

Amendment 2, March 01, 2021.
Primiparous women’s knowledge of diastasis recti abdominis, concerns about abdominal appearance, treatments, and perceived abdominal muscle strength 6–8 months postpartum. A cross sectional comparison study
Authors: Gluppe Sandra , Ellström Engh Marie , Bø Kari
Published: November 2022

Background

Diastasis recti abdominis (DRA) is a prevalent condition in the postpartum period. To date, there is scant knowledge on how DRA influences physical, mental, and emotional health. This study investigates primiparous women`s knowledge about DRA, concerns about abdominal appearance, and perceived abdominal muscle strength, comparing women with and without reported DRA.

Methods

This was a cross-sectional comparison study. Data were collected by a web-based questionnaire, mainly through social media in Norway. To be included in the study women had to be primiparous 6–8 months postpartum. The questionnaire contained questions regarding women`s knowledge about DRA, perceived protrusion, received treatment, concerns with abdominal appearance and muscle strength. Abdominal body image was measured through the shape concern questions from The Eating Disorder Examination questionnaire (EDE-Q 6.0). Demographic and other descriptive variables are presented as means with standard deviations (SD) or as frequencies with percentages. Chi-square test of independence and independent sample t-tests were used to compare differences between women with and without abdominal protrusion for categorical and continuous variables, respectively.

Results

Our sample consisted of 460 women. Knowledge about DRA was reported by 415/440 (94.3%) women. A total of 73.3% reported to have been worried during pregnancy about abdominal appearance postpartum. Mean degree of concern about present abdominal appearance was 5.5/10 (SD 2.4). Almost 80% experienced weaker abdominal muscles than pre-pregnancy. Ninety-six women (20.9%) reported a protrusion along the midline of their abdomen. Significantly more women with protrusion reported weaker abdominal muscles than women without protrusion. The most frequent treatment women with protrusion reported were exercises for the abdominal muscles (92.6%). Mean score on the EDE-Q, shape concern questions, was higher in women with reported protrusion (mean score: 2.37 (SD 1.6) than women without protrusion (mean score: 2.14 (SD 1.4), p = 0.175.

Conclusion

Primiparous women are concerned about abdominal appearance both during pregnancy and after birth. Those reporting abdominal protrusion are less satisfied with their abdominal appearance and they report weaker abdominal muscles than women without protrusion. This study may contribute to improved knowledge about women`s health concerns, and assessment of DRA should be part of routine follow-up of postpartum women.
A novel deep learning-based method for COVID-19 pneumonia detection from CT images
Authors: Luo Ju , Sun Yuhao , Chi Jingshu , Liao Xin , Xu Canxia
Published: November 2022

Background

The sensitivity of RT-PCR in diagnosing COVID-19 is only 60–70%, and chest CT plays an indispensable role in the auxiliary diagnosis of COVID-19 pneumonia, but the results of CT imaging are highly dependent on professional radiologists.

Aims

This study aimed to develop a deep learning model to assist radiologists in detecting COVID-19 pneumonia.

Methods

The total study population was 437. The training dataset contained 26,477, 2468, and 8104 CT images of normal, CAP, and COVID-19, respectively. The validation dataset contained 14,076, 1028, and 3376 CT images of normal, CAP, and COVID-19 patients, respectively. The test set included 51 normal cases, 28 CAP patients, and 51 COVID-19 patients. We designed and trained a deep learning model to recognize normal, CAP, and COVID-19 patients based on U-Net and ResNet-50. Moreover, the diagnoses of the deep learning model were compared with different levels of radiologists.

Results

In the test set, the sensitivity of the deep learning model in diagnosing normal cases, CAP, and COVID-19 patients was 98.03%, 89.28%, and 92.15%, respectively. The diagnostic accuracy of the deep learning model was 93.84%. In the validation set, the accuracy was 92.86%, which was better than that of two novice doctors (86.73% and 87.75%) and almost equal to that of two experts (94.90% and 93.88%). The AI model performed significantly better than all four radiologists in terms of time consumption (35 min vs. 75 min, 93 min, 79 min, and 82 min).

Conclusion

The AI model we obtained had strong decision-making ability, which could potentially assist doctors in detecting COVID-19 pneumonia.
Nurses’ duty to care during the COVID-19 pandemic: a cross-sectional survey
Authors: Shin Hyerine , Kim Kyung hee , Kim Ji-su , Kwak Yeun-hee
Published: November 2022

Background

Despite the increased demand for nurses worldwide, discussion of nurses’ duty to care is lacking. This study aimed to examine nurses’ duty to care during the coronavirus disease 2019 (COVID-19) pandemic and to identify the influencing factors.

Methods

This was a cross-sectional descriptive research study that used a structured online questionnaire. Registered Korean nurses answered a demographic questionnaire and the Nash Duty to Care Scale.

Results

Age and employment at tertiary hospitals increased nurses’ duty to care. Male sex, a highly educated status, and employment at tertiary hospitals increased the perceived risk. Male sex and employment at tertiary or general hospitals increased confidence in the employer, while a high level of education and a longer total clinical career decreased the same. Age and a higher monthly wage increased perceived obligation. Age, lack of religious beliefs, and clinical experience of 3–7 years increased professional preparedness.

Conclusion

Without enough nursing manpower, the disaster response system could prove to be inefficient. Considering that adequate nurse staffing is essential in disaster management, it is crucial to ensure that nurses have a will to provide care in the case of disaster. In the future, a more active discussion on nurses’ duty to care and additional research on factors that may hinder and facilitate the same are needed.
Remnant cholesterol and the risk of cardiovascular disease in type 2 diabetes: a nationwide longitudinal cohort study
Authors: Huh Ji Hye , Han Kyung-do , Cho Yun Kyung , Roh Eun , Kang Jun Goo , Lee Seong Jin , Ihm Sung-Hee
Published: November 2022

Background

Elevated remnant cholesterol (remnant-C) is considered a risk factor for cardiovascular disease (CVD); however, whether this notion applies to the East Asian population with type 2 diabetes (T2D) has not been established. This study investigated the association between remnant-C concentrations and the risk of CVD in Korean patients with T2D.

Methods

By using the Korean National Health Insurance Service database, 1,956,452 patients with T2D and without atherosclerotic CVD who underwent regular health checks between 2009 and 2012 were included. Cox regression analyses were conducted to assess the association between remnant-C concentrations and incident CVD comprising myocardial infarction (MI) and ischemic stroke.

Results

In total, 50,120 (2.56%) cases of MI and 73,231 (3.74%) cases of ischemic strokes occurred during a median follow-up of 8.1 years. The adjusted hazard ratios for MI and stroke in the highest remnant-C quartile were 1.281 (95% confidence interval [CIs], 1.249–1.314) for MI and 1.22 (1.195–1.247) for ischemic stroke, compared to those in the lowest quartiles. The results were similar, based on stratified analysis by age, sex, use of statin or fibrate, and levels of other cholesterol. The increased risk of CVD in the highest remnant-C quartile was profound in patients who had a longer T2D duration. A remnant-C concentration ≥ 30 mg/dL differentiated patients who were at a higher risk of CVD, compared to patients with a lower concentrations, regardless of whether LDL-C levels were or were not on target at ≤ 100 mg/dL.

Conclusion

In Korean patients with T2D, remnant-C was associated with CVD, independent of the LDL-C level or other conventional CVD risk factors. Our finding confirmed evidence of the causal role of remnant-C on CVD, as a residual risk of CVD, in East Asian patients with T2D.
The effects of probiotic administration on patients with prediabetes: a meta-analysis and systematic review
Authors: Li Ya , Wu You , Wu Lili , Qin Lingling , Liu Tonghua
Published: November 2022

Background

This paper aimed to examine the effects of probiotics on eight factors in the prediabetic population by meta-analysis, namely, fasting blood glucose (FBG), glycated haemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), and the mechanisms of action are summarized from the existing studies.

Methods

Seven databases (PubMed, Web of Science, Embase, Cochrane Library, SinoMed, CNKI, and Wanfang Med) were searched until March 2022. Review Manager 5.4 was used for meta-analysis. The data were analysed using weighted mean differences (WMDs) or standardized mean differences (SMDs) under a fixed effect model to observe the efficacy of probiotic supplementation on the included indicators.

Results

Seven publications with a total of 460 patients were included. According to the meta-analysis, probiotics were able to significantly decrease the levels of HbA1c (WMD, -0.07; 95% CI -0.11, -0.03; P = 0.001), QUICKI (WMD, 0.01; 95% CI 0.00, 0.02; P = 0.04), TC (SMD, -0.28; 95% CI -0.53, -0.22; P = 0.03), TG (SMD, -0.26; 95% CI -0.52, -0.01; P = 0.04), and LDL-C (WMD, -8.94; 95% CI -14.91, -2.97; P = 0.003) compared to levels in the placebo group. The effects on FBG (WMD, -0.53; 95% CI -2.31, 1.25; P = 0.56), HOMA-IR (WMD, -0.21; 95% CI -0.45, 0.04; P = 0.10), and HDL-C (WMD, 2.05; 95% CI -0.28, 4.38; P = 0.08) were not different from those of the placebo group.

Conclusion

The present study clearly indicated that probiotics may fulfil an important role in the regulation of HbA1c, QUICKI, TC, TG and LDL-C in patients with prediabetes. In addition, based on existing studies, we concluded that probiotics may regulate blood glucose homeostasis in a variety of ways.

Trial Registration

This meta-analysis has been registered at PROSPERO with ID: CRD42022321995.
Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review
Authors: Gavriilidis Paschalis , Catena Fausto , de’Angelis Gianluigi , de’Angelis Nicola
Published: November 2022

Introduction

Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years.

Methods

Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature.

Results

Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported.

Conclusions

Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.
Spectroscopic details on the molecular structure of pyrimidine‑2‑thiones heterocyclic compounds: computational and antiviral activity against the main protease enzyme of SARS-CoV-2
Authors: Sayed Doaa S. El , Abdelrehim El-Sayed M.
Published: November 2022

Computational tools in investigating of spectral heterocyclic compounds ranges based on pyrimidine‑2‑thiones, take some importance in identifying their molecular and electronic behavior. Some charcoal heterocyclic compounds were previously synthesized in our laboratory and their experimental results were compared with the computational evaluation. Computational spectroscopic analytical items (IR, NMR and UV–Vis) were calculated using the more popular DFT methods and the predicted results were compared with the reported experimental ones. Quantum and chemical parameters were calculated and molecular electrostatic surface potential (MEP) was studied which predicted the highly electronic sites around the compounds. Some molecular properties (ionization energy, electron affinity, energy gap, hardness, electronegativity, electrophilicity index, static dipole moment and average linear polarizability) of these Schiff bases which were computed at B3LYP/6-31G(d,p) level in aqueous phase. Benchmark analysis was performed for three ab initio functionals such B3LYP, BPV86 and B3PW91 methods to explain the data resulted from NMR spectra. The docking study of some selected previously synthesized compounds was performed using the viral Mpro enzyme protein in compared to a k36 reference ligand inhibitor. The study indicated the ability of the synthesized compounds to form H-bond and hydrophobic (VDW, π-alkyl and π-sulfur) interactions with Mpro enzyme receptor with high inhibition effect of compound L2.
Late relapse of ulcerative colitis presenting as tracheobronchitis: a case report
Authors: Okamoto Shouichi , Koike Kengo , Sekiya Mitsuaki , Nishino Koichi , Mimori Tomoyasu , Takahashi Kazuhisa
Published: November 2022

Background

Lung involvement in inflammatory bowel diseases usually follows colitis. However, the time to lung involvement onset varies depending on the case, and pulmonary lesions are usually not parallel to exacerbations of the colitis.

Case presentation

A 67-year-old Asian woman with a 38-year history of ulcerative colitis presented to our hospital with a complaint of prolonged dry cough for 2 months. The colitis had remained quiescent for > 35 years with low-dose salazosulfapyridine treatment. Chest computed tomography indicated circumferential thickening of the tracheal wall, while bronchoscopy examination revealed widespread erythematous edema and diffuse narrowing of the bronchial lumen. Biopsy of the bronchial mucosa showed submucosal lymphocytic infiltration. She was diagnosed with ulcerative-colitis-related tracheobronchitis and successfully treated with corticosteroids.

Conclusions

Tracheobronchitis, in our case, occurred despite the longest remission period previously reported. Careful follow-up is necessary for the early recognition and treatment of pulmonary disease in patients with ulcerative colitis, regardless of the disease duration and long-term remission of colitis.
Longitudinal correlates of fruit and vegetable consumption with depressive symptoms among middle-aged and older adults in South Africa
Authors: Pengpid Supa , Peltzer Karl
Published: November 2022

Background

Fruit and vegetable intake may influence mental well-being. The aim of this study was to assess longitudinal associations between fruit and vegetable intake and depressive symptoms among rural South Africans.

Methods

This longitudinal community study enrolled 3,891 adults (≥ 40 years) from the “Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)”. Fruit and vegetable intake was assessed by self-report at wave 1, and depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale at wave 1 and 2. Outcomes were incident and persistent depressive symptoms at wave 2. Logistic regression was used to assess the associations between fruit and vegetable intake at wave 1 and incident, and persistent depressive symptoms.

Results

Results indicate that in the fully adjusted model for individuals with no depressive symptoms at baseline, we found no significant association between frequency of fruit or vegetables intake and incident depressive symptoms. We also found no significant association between frequency of fruit or vegetable intake and persistent depressive symptoms.

Conclusion

Fruit and vegetable intake was not significantly associated with incident and persistent depressive symptoms.
Damage characterization and resilience optimization of reinforced concrete bridge piers under vehicle impact
Authors: Roy Suman , Unobe Ikwulono D. , Sorensen Andrew
Published: November 2022

Vehicle impact creates a dynamic loading condition at high strain rate exhibiting a unique interaction with the resisting structural members’ material properties. This interaction results in an increase in the material’s strength properties, a behavior captured in analysis via the computation of a strength factor known as the dynamic increase factor (DIF). In reinforced concrete (RC) bridge piers, the concrete cover receives the initial impact from the vehicle, causing damage to this exterior surface. This makes the DIF related to the concrete material (i.e., the compressive DIF) particularly important in this initial phase of the crash scenario; thus, requiring an in-depth analysis into its effect on the performance of the pier during and after the impact event. This study initiates an investigation into the influence of the compressive DIF on the performance of RC piers under impact from vehicles classes. Of particular interest is estimating a post impact residual capacity for the pier, while also determining concrete strength parameters (compressive strength) that offers a good tradeoff between the shear capacity which primarily resists the impact loads, and the axial capacity which controls the principal serviceability of the pier. The resulting analyses, using a representative test pier, show that an optimal compressive strength of concrete will minimize loss in the residual capacity of the pier. The effect of the compressive DIF on other important design parameters, i.e., bond strength and development length is also scrutinized. This study will aid forensic structural engineers in scrutinizing the post impact concrete behavior and serviceability.
A statistical mechanics approach to cultural evolution of structured behavior in non-human primates: From disorder to tetris-like structures
Authors: Vera Javier , Fuentealba Diego , Lopez Mario , Ponce Hector
Published: November 2022

This paper explores a statistical mechanics approach to cultural evolution of structured behavior in non-human primates. Previous works on cultural evolution have proposed Iterated Learning procedures, in which the behavioral output of one individual becomes the target behavior for the next individual in the chain. Within this line of research, previous work has suggested that even in non-human primates this paradigm shows that cultural transmission can lead to the progressive emergence of tetris-like structures. Our simulations are based on several interrelated statistical mechanics measurements, which quantify the way structures become closer to each other and the tendency to put activated cells together (understood by means of a number of measures and an energy-like function). With these tools, we suggested the hypothesis that the appearance of tetris-like structures might be an indirect consequence of the energy-like minimization. From this, it is plausible to think that the preference of the participants for tetris-like structures is strongly related to some kind of minimization towards simplicity in cognition.
Genotype-phenotype Description of Vitamin D–dependent Rickets 1A: CYP27B1 p.(Ala129Thr) Variant Induces a Milder Disease
Authors: Méaux Marie-Noëlle , Harambat Jérôme , Rothenbuhler Anya , Léger Juliane , Kamenicky Peter , Soskin Sylvie , Boyer Olivia , Boros Emese , D’Anella Pascal , Mignot Brigitte , Gebhart Maite , Vic Philippe , Richard Nicolas , Thivichon-Prince Béatrice , Francou Bruno , Linglart Agnès , Bacchetta Justine , Molin Arnaud
Published: November 2022

Introduction

Vitamin D–dependent rickets type 1A (VDDR1A) is a rare genetic disease associated with loss-of-function variations in the gene encoding the vitamin D–activating enzyme 1α-hydroxylase (CYP27B1). Phenotype-genotype correlation is unclear. Long-term outcome data are lacking. The objective of this study was to describe characteristics and outcomes to search for a phenotype-genotype correlation.

Methods

We retrospectively collected clinical data, genetic features, and outcomes from 24 genetically confirmed cases from 10 French centers; results are presented as median (min–max).

Results

Clinical symptoms at diagnosis (age, 1.5 [0.5-8.7] years) were mainly bone and neurological abnormalities, and laboratory data showed hypocalcemia (1.97 [1.40-2.40] mmol/L), hypophosphatemia (−3.4 [−13.4 to (−)0.2] SD score for age), low 25OHD and low 1,25(OH)2D3, secondary hyperparathyroidism with PTH at 6.6 (1.3-13.7) times the upper limit for normal (ULN; PTH expressed as ULN to homogenize data presentation), and increased alkaline phosphatase (1968 [521-7000] IU/L). Bone radiographs were abnormal in 83% of patients. We identified 17 variations (11 missense, 3 frameshift, 2 truncating, and 1 acceptor splice site variations) in 19 families (homozygous state in 58% [11/19]). The partial loss-of-function variation p.(Ala129Thr) was associated with a milder phenotype: older age at diagnosis, higher serum calcium (2.26 vs 1.85 mmol/L), lower PTH (4.7 vs 7.5 ULN), and lower alkaline phosphatase (759 vs 2082 IU/L). Patients were treated with alfacalcidol. Clinical (skeletal, neurological), biochemical, and radiological outcomes were satisfactory, and complications occurred if there was bad adherence.

Conclusion

Overall, our findings highlight good outcomes under substitutive treatment and the need of a closer follow-up of eyes, teeth, kidneys, and blood pressure in VDDR1A.
ODP611 Combination Of Seated Saline Suppression Test And Computed Tomography In Predicting Subtype Diagnosis Of Primary Aldosteronism In Chinese Population
Authors: Zhang Dan , Zhang Tingting , Chen Tao , Li Yuanmel , Mo Dan , Tian Haoming , Ren Yan
Published: November 2022

Objective

The study aimed to evaluate the accuracy of the seated saline suppression test (SSST) combined with adrenal computed tomography (CT) in determining the primary aldosteronism (PA) subtypes.

Methods

Each patient underwent a SSST and adrenal CT. Logistic diagnostic model (CT finding + post-SSST plasma aldosterone concentration (PAC)) were built, which evaluated the accuracy of the SSST combined with adrenal CT for a subtype classification of PA. Subtype diagnosis of PA was determined by adrenal venous sampling (AVS), pathology and clinical outcomes (primary aldosteronism surgical outcome(PASO)).

Results

A total of 72 patients with PA were classified into two groups, including 45 aldosterone-producing adenoma (APA) and 27 idiopathic hyperaldosteronism (IHA) patients. By binary logistic regression analysis, adrenal CT (odds ratio (OR)=16.28, 95% confidence interval (CI) 4.18-63.42, P<0. 05) and 4-hours PAC after SSST (OR =1.13, 95% CI 1. 03 to 1.23, P<0. 05) were significantly independent predictors of APA patients. We have successfully developed a diagnostic model based on logistic regression that is able to predict the probability of APA. The area under the receiver operating characteristic (ROC) curve of logistic diagnostic models(AUC=0.907, 95% CI 0.815 to 0.963) was significantly greater either than that for the adrenal CT (AUC=0.807,95% CI 0.696 to 0.890,respectively,P<0. 05) or SSST (AUC=0.799,95% CI 0.688 to 0.884,respectively,P<0. 05). Positive CT finding combined with a post-SSST PAC≥18.2 ng/dL provided sensitivity of 88.89%,specificity of 74. 07%,and positive predictive value (PPV) of 93.9%(31/33) for predicting APA, that determined patients who required AVS prior to surgery.

Conclusion

The model combining CT finding with post-SSST PAC has superior accuracy in subtype diagnosis of PA compared with SSST or adrenal CT alone. The current study was the first study to investigate the accuracy of the new method on the subtype classification of PA. We are fortunate to find it may be a safe, convenient, sensitive and noninvasive approach in predicting subtype diagnosis of PA in Chinese individuals, especially in primary care where AVS may be unavailable. The results require further confirmation by RCT clinical trials.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
LBSAT61 Pure Aldosterone-secreting Adrenocortical Carcinoma Causing Resistant Hypertension In A Patient With Previously Controlled Longstanding Hypertension: A Case Report
Authors: Alnahas Zeinab , Horani Mohamed
Published: November 2022

Introduction

Adrenocortical carcinoma is a rare endocrine malignancy that could be classified into functioning or non-functioning, depending on the tumor's ability to secret adrenocortical hormones. Pure aldosterone-secreting adrenocortical carcinoma is extremely rare, accounting for <7% of all functioning tumors that could present with primary aldosteronism and secondary hypertension.

Case Presentation

A 48-year-old man had a past medical history of longstanding hypertension that recently became resistant to multiple antihypertensive medications (thiazide, angiotensin receptor inhibitor, calcium channel blocker, hydralazine) despite medications compliance. He presented to the ER with left flank pain that was not associated with dysuria, nausea, or vomiting. On admission, his blood pressure was 223/135 mmHg. CT scan of the abdomen and pelvis showed mild left-sided hydronephrosis, hydroureter with a 2mm stone at the left ureterovesical junction, and a 7. 0×7. 0×6.4 cm left heterogeneous adrenal mass that was highly suspicious for malignancy. His laboratory workup revealed low serum potassium of 2.9 mmol/L (reference value 3.5-5.1 mmol/L), serum creatinine of 1.38 mg/dL (reference value 0.7-1.3 mg/dL), random cortisol of 21.8 mcg/dL (reference value 5-25 mcg/dL), ACTH of 5 pmol/L (reference value 10-60 pmol/L), serum levels of normetanephrine of 0.67 nmol/L (reference range 0-0.89 nmol/L), metanephrines of <0.10 nmol/L (reference range 0-0.49 nmol/L), and chromogranin A of 45 ng/mL (reference range 0-95 ng/mL). Further investigations showed high serum aldosterone of 28 ng/dL (reference range 2-9 ng/dL) and low plasma renin activity of 0.1 ng/mL per h (reference range 0.5-2.5 ng/mL per h) supported the diagnosis of primary aldosteronism. The patient underwent left adrenalectomy, and the diagnosis of pure aldosterone-secreting adrenocortical carcinoma was confirmed by histological examination.

Conclusion

Pure aldosterone-secreting adrenocortical carcinoma is an extremely rare adrenal tumor that could cause resistant hypertension. Re-evaluation of secondary causes of hypertension is essential in patients with a previously controlled longstanding hypertension, developing uncontrolled or resistant hypertension.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
ODP019 A Case Study of the Association of Autoimmune Polyglandular Syndrome and Pulmonary Artery Hypertension
Authors: Lambert Peter , Baker Mary
Published: November 2022

We report a patient with combined pulmonary arterial hypertension (PAH) and autoimmune polyglandular syndrome (APS) type 2. A 41 y/o woman with hypothyroidism presented for right heart (RHC) in the work up of PAH. Pt had a medical history of PAH diagnosed by transthoracic echocardiogram (TTE) and hypothyroidism. She reported symptoms of fatigue, shortness of breath with increased pigmentation of her skin progressive for several years. Preadmission lab found hyponatremia of 126 and potassium of 6.6. She was admitted and treated with IV insulin with D50, kayexalate, IV fluids. A random 11 AM cortisol was 0.57 mcg/dl N: AM: 6. 0–30. 0 mcg/dl; PM: 3. 0–16. 0 mcg/dl. Acosyntropin test was ordered. Pt failed the stimulation test (baseline 0.39, 30 min 0.49, 60 min 0.50, with an ACTH at baseline of 1423 pg/ml N: 7.2-63.3). Pt was started on hydrocortisone 20 mg AM/10 mg PM with fludrocortisone 0.1mg. On follow up at 2 weeks, her energy, mood, appetite and breathing tolerance had improved. Follow up RHC in 4 weeks found normalization of right heart pressures. APS is a collection of autoimmune diseases. Type I APS, caused by a defect in the autoimmune regulator (AIRE) gene, is diagnosed with two of three conditions, chronic mucocutaneous candidiasis, hypoparathyroidism, and adrenal cortical insufficiency. Type II APS (formally "Schmidt's Syndrome"), associated with HLA haplotypes DR3 (DQB*0201) and DR4 (DQB1*0302), is diagnosed with chronic autoimmune adrenal insufficiency with either Type 1 DM or chronic autoimmune thyroid disease (commonly Hashimotos but can be Graves). It typically presents later in life compared to APS I, age 30-40s. The association between PAH is rare but has been noted in several case studies. It has been associated with APS I in Korniszewski et al. and Bhansali et al. For APS II, the first association was reported by Barrou et al. of a patient with hypothyroidism, hypogonadism, and adrenal insufficiency who later developed PAH. Two cases reported by García-Hernández et al found PAH with positive adrenal antibodies without adrenal insufficiency. In 2009 Walid R. et al. reported a case of severe adrenal insufficiency (hypotension, hypokalemia) with PAH. She improved with steroids, but her PAH was present on TTE four years after treatment started. Pt in that case declined RHC. The patient in this case study proceeded with a RHC which did show normalization of right heart pressures, the first reported case to document normalization of PAH with replacement steroid treatment.

Presentation: No date and time listed
ODP624 A case of Cushing disease demonstrated rapid deterioration of clinical findings and marked hypercortisolemia
Authors: Hashimoto Makiko , Kajio Hiroshi , Uchihara Masaki , Tanabe Akiyo
Published: November 2022

Introduction

In cases of ACTH-dependent Cushing syndrome, the differentiation between Cushing disease and the ectopic ACTH syndrome (EAS) can sometimes be challenging. Herein we report on a case of Cushing disease who showed clinical features resembled EAS caused by malignant neoplasms and required a detour for the diagnosis.

Clinical case

A 49-year-old Japanese woman presented a rapid exacerbation of muscle weakness of her limbs, leg edema and moon face from two months ago. She did not have any past medical history, hypertension, diabetes mellitus, or osteoporosis. Her serum K was 2.6 mEq/L, ACTH level was 151 pg/mL, serum cortisol level was 36.6 μg/dL, and urinary free cortisol (UFC) level was 4250 μg/day. Serum cortisol after 1 mg dexamethasone suppression test (DST) showed 41.9 μg/dL and that after 8 mg DST was 14.1 μg/dL. A pituitary MRI demonstrated a poor enhancement area with a clear margin of 10 mm in diameter in her dorsal side of the pituitary gland. She was diagnosed with ACTH-dependent Cushing syndrome and metyrapone was initiated. Soon she developed severe cough with infiltrative shadows on her lungs two days later. Her respiratory condition deteriorated rapidly, and she was urgently transferred to our hospital and intubated one week later. She had complicated pneumocystis carinii, nocardia pneumonia, and severe respiratory failure based on immunodeficiency due to hypercortisolemia. She was treated with systemic management in the intensive care unit, infection treatment and dose adjustment of metyrapone. Her condition improved and she was extubated on the 8th day. Although she had the pituitary tumor, EAS caused by a malignant neoplasm was suspected because of a combination of rapid clinical deterioration, marked hypercortisolemia and hypokalemia. However gastrointestinal tract survey, 18F-PET/CT and somatostatin receptor scintigraphy did not show any significant lesions. Finally, selective inferior petrosal sinus sampling (IPSS) demonstrated over secretion of ACTH from the pituitary gland. ACTH decreased to an undetectable level and hydrocortisone was supplemented after transsphenoidal surgery. No recurrence was observed in 1 year of follow-up. Pathological findings showed a densely granulated type of ACTH-producing adenoma without Crooke's change. KI-67 index were 4.7%, which was higher than that in general ACTH producing pituitary adenomas.

Conclusion

We experienced Cushing disease with the rare clinical course. This case suggests that although a step-by-step approach is often adopted to make a differential diagnosis of patients with ACTH-dependent Cushing's syndrome, ultimately IPSS is required. Because her KI-67 index showed 3 or higher despite the gentle tumor behavior, careful follow-up is required.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON101 Fluctuating Insulin Requirements in Untreated Acromegaly: From 200-to-0
Authors: Bellavia Lauren , Goldstein Michael , Klek Stanislaw
Published: November 2022

Introduction

Acromegaly is a clinical disorder that occurs from autonomous production of growth hormone (GH). Diabetic ketoacidosis (DKA) is an uncommon and late complication of acromegaly. Acromegaly presenting in DKA prognosticates glycemic management with insulin-based regimens. Cessation of insulin therapy, however, can be achieved in patients with acromegaly after proper medical and/or surgical interventions. Our case highlights a unique outcome in a patient with newly-diagnosed acromegaly that initially presented in DKA with very high insulin requirements and was ultimately de-escalated off all anti-hyperglycemic therapy with significant glycemic improvement prior to any treatment for acromegaly.

Clinical Case

A 32 year-old male with a past medical history of colorectal cancer and no known history of diabetes presented to the emergency department for evaluation of generalized weakness, epigastric pain, nausea, and vomiting and was admitted for DKA. Hemoglobin A1c was 11.6% (reference range < 5.7%), confirming the diagnosis of newly-diagnosed diabetes. C-peptide was 1.4 ng/mL (reference range 0.5-3.3 ng/mL) and anti-glutamic acid decarboxylase, anti-islet cell, and anti-zinc transporter 8 antibodies were all negative. He was initiated on intravenous insulin infusion, with rates achieving > 200 units of insulin per day. Given severe insulin resistance in conjunction with acromegalic features on physical exam and a unique history of colorectal cancer at a young age without any family history, evaluation for acromegaly was initiated. Human GH level was 68.60 ng/mL (reference range 0.05-3.00 ng/mL) and insulin-like growth factor-1 (IGF-1) level was 1,036 ng/mL (reference range 82-242 ng/mL). MRI brain revealed a hypoenhancing 1.3 cm lesion enlarging the left lateral pituitary gland. Diagnosis of acromegaly due to a GH-secreting macroadenoma was established. The patient was discharged on a high-dose insulin regimen in addition to metformin therapy with de-escalation off of all anti-glycemic therapy within a few weeks of diagnosis; at his 3 month follow-up visit, his repeat hemoglobin A1c was 6.1 with repeat GH level of 28.8 ng/mL and IGF-1 level of 1602 ng/mL, despite not yet undergoing any treatment for the underlying condition.

Conclusion

DKA as an initial presentation of acromegaly has been previously reported in literature, however, not with a concomitant history of colon cancer. Moreover, no previous cases of acromegaly have reported glycemic normalization off of anti-hyperglycemic therapy prior to any treatment for acromegaly. Our case highlights that evaluation for secondary causes, including acromegaly, should be considered in patients with severe insulin resistance and emphasizes the dramatic range of insulin requirements that patients with acromegaly may have.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON116 Central Diabetes Insipidus in a patient with Pituitary Macroadenoma status post Trans-sphenoidal Resection, complicated by Nephrogenic Diabetes Insipidus due to Chronic Lithium use
Authors: Akula Monika , Chalasani Krishna , Cheng Jennifer , Figueroa Jonathan , Hu Katherine , Ong Raquel , Zin Khin , Patel Nikunjkumar , Holland Soemiwati
Published: November 2022

59-year-old female with PMH of Bipolar disorder and Pituitary macroadenoma presented to the ER yesterday for worsening Headache associated with nausea, vomiting and double vision. Detailed imaging of the pituitary gland demonstrated a hypo enhancing sellar and suprasellar mass extending asymmetric to the right, appears to fill and expand the right cavernous sinus. This was associated with T2 hypo intensity. The hypo enhancing mass measured around 2.9 cm AP by 2.7 cm transverse by 3.5 cm CC, previously 2.9×2.4×3.1 cm. Of note, she was found to have this pituitary macroadenoma non-functional on prior testing. Important to note that she had history of bipolar disorder and it was refractory to many medications and was started on Lithium 10 months prior to this presentation. She underwent Image Guided Endoscopic Trans nasal Transsphenoidal Resection of Pituitary Tumor with reconstruction with Nasoseptal Flap, Lumbar Drain Placement, and Injection of Intrathecal Fluorescein Dye. Her postoperative course was complicated by Central DI and was started on DDAVP treatment. Eventually she developed Panhypopituitarism and needed Levothyroxine and Hydrocortisone replacement therapy. She had a prolonged hospital course due to post-surgical meningitis resulting in fever and encephalopathy. She had persistent hypernatremia and lithium was discontinued given the fact she was found to be in Nephrogenic DI and her hypernatremia requiring intravenous D5 water fluid treatment for a brief period.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON153 Changes in size of pituitary microadenomas, a retrospective cohort study
Authors: Min Le , Hordejuk Dawid
Published: November 2022

Background

The estimated prevalence of pituitary lesions is 22.5% in radiologic studies. The solid and/or cystic lesions are usually described as incidentaloma. Most pituitary incidentalomas are microadenomas (lesion size <1 cm). In 2011, The Endocrine Society published guideline on following incidental pituitary lesion. However, few studies evaluated the dynamic changes in pituitary incidentaloma.

Method: In this retrospective cohort study, patients with pituitary microadenomas were identified from our institution database by the Research Patient Data Registry from 11/2003 to 3/2021. We performed chart review to collect data relevant to demographic and pituitary imaging findings. The study was approved by our institution IRB.The patients with the diagnosis of pituitary microadenoma (tumor size < 10 millimeter (mm)) were included in this study. To eliminate the medication effects on the tumor size, we excluded the patients with diagnosis of prolactinoma and patients on dopamine agonists or somatostatins. We performed linear regression test. We performed Kaplan-Meier survival curve analysis.

Results

Over 15 years, among total 177 subjects, 78 (44%) had unchanged size of the microadenoma, 49 (27%) had increase size, 34 (19%) had decrease in size, and 16 (9%) had both increased and decreased size. Ten (6%) subjects had transsphenoidal pituitary tumor resection. Among 128 female subjects, 53 (41%) had unchanged size, 35 (27%) had increased size, 28 (22%) had decreased size, and 12 (9%) had both increased and decreased size. Seven subjects (5%) had transsphenoidal pituitary tumor resection. Among 49 male subjects, 25 (51%) had unchanged size, 14 (27%) had increased size, 6 (12%) had decreased size, and 4 (8%) had both increased and decreased size. Three patients (6%) had tumor resection. Over the 15 years, the changes in the size of microadenomas are between -6 mm to 6 mm. There were 6 (3%) subjects with tumor size increase into macroadenoma category. The slope by linear analysis was 0.85 (95% CI: -0.28 to 1.99) in percentage change. The slope was 0.02 (95% CI: -0.012 to 0.054) in tumor size change in mm. The slope was not significantly deviated from zero by percentage change (p = 0.14) or size change in mm (p = 0.21). The median time of microadenomas remained unchanged were 6.5, 7.7, and 6.5 years in total, male and female respectively. There was no significant difference in size change among total, male and female (p = 0.947).

Conclusion

Our study has shown that majority of pituitary microadenomas remain unchanged or decreased in the size over 15 years. The maximal size increase was 6 mm. There were no significant changes in tumor size over the study period. Our study suggests that less frequent surveillance pituitary MRI in incidental pituitary microadenomas is safe.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON53 Resistance to weight gain and obesity in mice lacking the IGF-1 receptor in GHRH neurons
Authors: Al-Samerria Sarmed , Nandankar Nimisha , Negrón Ariel , Radovick Sally
Published: November 2022

IGF-1 signaling plays a pivotal role in regulating GH production through a negative feedback mechanism at the level of the hypothalamus and pituitary. We created a transgenic mouse model with ablation of the IGF-1R in GHRH-neurons (GIGFRKO) that exhibited normal linear growth, however, when fed a normal chow diet, began to have a sustained decrease in weight gain velocity. This was associated with greater energy expenditure and a lower body fat mass, with no change in caloric intake. The aim of the current study was to determine whether this metabolic phenotype would be sustained with a high fat diet challenge. At 4 weeks of age, the mice were placed on a 45% fat diet for 16 weeks. The GIGFRKO mouse model fed a HFD had normal linear growth, but at 10 weeks of age, both male and female mice began to have a sustained decrease in weight gain velocity compared to their age and sex-matched controls. The metabolic assessment demonstrated that the GIGFRKO transgenic mice had higher O2 consumption, lower CO2 production, a reduction in body fat mass, an elevation in energy expenditure, and improved glucose tolerance compared to the control mice on HFD. This was not associated with changes in food intake or activity and was present in males and females. In conclusion, the GIGFRKO transgenic mice are resistant to diet-induced obesity due to the critical role of the GHRH-GH axis in controlling energy expenditure and fat metabolism.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.