bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of bioactive substances involved in the induction of bone augmentation using demineralized bone sheets
Authors: Saito Haruka , Chiba-Ohkuma Risako , Yamakoshi Yasuo , Karakida Takeo , Yamamoto Ryuji , Shirai Mai , Ohkubo Chikahiro
Published: November 2022

Purpose

To investigate the bone augmentation ability of demineralized bone sheets mixed with allogeneic bone with protein fractions containing bioactive substances and the interaction between coexisting bioactive substances and proteins.

Methods

Four types of demineralized bone sheets mixed with allogeneic bone in the presence or absence of bone proteins were created. Transplantation experiments using each demineralized bone sheet were performed in rats, and their ability to induce bone augmentation was analysed by microcomputed tomography images. Bioactive substances in bone proteins were isolated by heparin affinity chromatography and detected by the measurement of alkaline phosphatase activity in human periodontal ligament cells and dual luciferase assays. Noncollagenous proteins (NCPs) coexisting with the bioactive substances were identified by mass spectrometry, and their interaction with bioactive substances was investigated by in vitro binding experiments.

Results

Demineralized bone sheets containing bone proteins possessed the ability to induce bone augmentation. Bone proteins were isolated into five fractions by heparin affinity chromatography, and transforming growth factor-beta (TGF-β) was detected in the third fraction (Hep-c). Dentin matrix protein 1 (DMP1), matrix extracellular phosphoglycoprotein (MEPE), and biglycan (BGN) also coexisted in Hep-c, and the binding of these proteins to TGF-β increased TGF-β activity by approximately 14.7% to 32.7%.

Conclusions

Demineralized bone sheets are capable of inducing bone augmentation, and this ability is mainly due to TGF-β in the bone protein mixed with the sheets. The activity of TGF-β is maintained when binding to bone NCPs such as DMP1, MEPE, and BGN in the sheets.
Milk beverages can reduce nutrient inadequacy among Brazilian pre-school children: a dietary modelling study
Authors: Lenighan Yvonne M. , Tassy Marie , Nogueira-de-Almeida Carlos A. , Offord Elizabeth A. , Mak Tsz Ning
Published: November 2022

Background

Previous studies found high prevalence of inadequate intakes of vitamins E, D and K, calcium and potassium among Brazilian pre-school children, with suboptimal consumption of dairy products. Dietary modelling was applied to determine the theoretical impact of improving dairy products consumption on nutrient adequacy in 4–5-year-old Brazilian children.

Methods

Adherence to the dairy recommendation of two servings/day was calculated using data from the Brazil Kids Nutrition and Health Study (KNHS) (n = 228). Two modelling scenarios were applied to test the impact on nutrient intakes of (1) adding one or two servings of a frequently consumed cow’s milk or a widely available fortified alternative: pre-school children milk (PCM), and of (2) substituting the current milk consumed by PCM. Mean nutrient intakes and percentage of children adhering to the nutrient recommendations were determined at baseline and after applying modelling scenarios.

Results

Seventy-six percent (n = 174) of children did not meet the recommended daily two servings of dairy products, 56% had less than one serving of dairy products on the day of recall. The mean consumption of whole milk (fortified and unfortified) was 147 g/d, yoghurt 114 g/d and cheese 34 g/d. The addition of one serving of cow’s milk demonstrated a 17% reduction in calcium inadequacy, 18% reduction in vitamin A and 3% reduction in zinc inadequacy. Adding one serving of PCM further reduced calcium inadequacy from 87 to 41%, vitamin E from 81 to 37%, and zinc inadequacy by 10%. Replacing the child’s current milk with a PCM resulted in further reduction of micronutrient inadequacies, including calcium, vitamin D and vitamin E.

Conclusions

Dairy products consumption in pre-school children should be encouraged to reduce nutrient inadequacies. In particular, consumption of PCM would help to reduce calcium, vitamin D and vitamin E inadequacy, nutrients of concern in this population.
Longitudinal study of a procedure for training low-proficiency english language students
Authors: Aljohani Nouf Jazaa
Published: November 2022

In this research study, unlike previous studies that have examined the advantages of peer review for low proficiency students, uses a longitudinal action mixed methods design is used to explore the impact of peer review on the academic writing of students with low English proficiency. The format was a longitudinal action study, which analyzed the written peer review feedback, essays, and reflections of 40 learners. Results showed that at the beginning of the study, the students experienced challenges in identifying problems with rhetorical content of their peers and by the end of 11 weeks, they were able to provide succinct peer feedback that included examples and explanations of classmates’ grammatical and rhetorical errors. Results also showed improvement in their own writing skills. Implications for implementing peer review in foriegn language writing contexts are discussed.
COVID-19 pandemic and the changing views of mobility: the case of Nepal–Malaysia migration corridor
Authors: Wahab Andika , Hamidi Mashitah
Published: November 2022

For decades, Malaysia has been heavily dependent on unskilled and temporarily contracted migrant workers to fulfil labour gaps in the country. While Malaysia’s economy continues to rely on migrant workers, the COVID-19 pandemic has further aggravated their precarious working and living conditions. In-depth interviews with Nepali migrant workers and community leaders in Malaysia and Nepal in 2021 revealed the incidence of labour rights violations, compounded by the lack of access to justice and effective remedies. Besides, workers are allegedly no longer benefiting from the competitive wages, subsequently limiting the value of their remittance to Nepal. We argue that these incidents serve as the drivers of the changing views of mobility, eventually influencing the emigration environment in which the social construction of migration exists in Nepal. This study examines the migratory realities in the Nepal–Malaysia migration corridor during the pandemic, subsequently contributing to current debate on the aspiration–ability model as a class of research.
Brace and Physiotherapeutic Scoliosis Specific Exercises (PSSE) for Adolescent Idiopathic Scoliosis (AIS) treatment: a prospective study following Scoliosis Research Society (SRS) criteria
Authors: Karavidas Nikos , Tzatzaliaris Dionysios
Published: November 2022

Background

A growing scientific evidence for conservative treatment of AIS has recently proved that bracing is superior to natural history. Our aim was to investigate the effectiveness of a combined treatment with brace and PSSE for AIS.

Methods

Prospective study, following SRS research inclusion criteria (> 10 years, 25ο – 40ο, Risser 0–2, < 1-year post-menarche, no prior treatment). 102 consecutive patients (87 females-15 males, mean age 12.8 years, Risser 0.48, Cobb Thoracic 29.2ο, Lumbar 27.8ο) received treatment with Cheneau brace and PSSE. Average follow-up time was 26.4 months. A scale from A to C was used to evaluate compliance with brace and PSSE (A: full-compliant, B: partially compliant, C: non-compliant). 7 subjects dropped-out (6.8%), so finally 95 patients included for statistical analysis, using paired t-test.

Results

Sixty-two patients (65.3%) remained stable, 22 improved > 5ο (23.2%) and 11 progressed (11.5%). In-brace correction (IBC) was 49.7% for thoracic and 61.7% for lumbar curves. Analysis of progressed cases revealed that IBC (31.7% for thoracic and 34.4% for lumbar curves) and compliance (81.8% C for brace, 63.6% C for PSSE) was lower than average. Group A for treatment compliance (65.3%), showed significantly better results (70.9% stable, 29.1% improved, 0% progressed).

Conclusion

A combination of bracing and PSSE can effectively treat AIS, according to SRS inclusion criteria. 88.5% of patients avoided progression > 5ο and only 6.4% overpassed 40ο. IBC and compliance are the most important prognostic factors for successful treatment result. Early detection of AIS is also necessary for increased possibilities of effective conservative treatment.
A 72-channel receive array coil allows whole-heart cine MRI in two breath holds
Authors: Klarenberg Hugo , Gosselink Mark , Coolen Bram F. , Leiner Tim , Nederveen Aart J. , Bakermans Adrianus J. , Lamb Hildo J. , Boekholdt S. Matthijs , Froeling Martijn , Strijkers Gustav J.
Published: November 2022

Background

A new 72-channel receive array coil and sensitivity encoding, compressed (C-SENSE) and noncompressed (SENSE), were investigated to decrease the number of breath-holds (BHs) for cardiac magnetic resonance (CMR).

Methods

Three-T CMRs were performed using the 72-channel coil with SENSE-2/4/6 and C-SENSE-2/4/6 accelerated short-axis cine two-dimensional balanced steady-state free precession sequences. A 16-channel coil with SENSE-2 served as reference. Ten healthy subjects were included. BH-time was kept under 15 s. Data were compared in terms of image quality, biventricular function, number of BHs, and scan times.

Results

BHs decreased from 7 with C-SENSE-2 (scan time 70 s, 2 slices/BH) to 3 with C-SENSE-4 (scan time 42 s, 4–5 slices/BH) and 2 with C-SENSE-6 (scan time 28 s, 7 slices/BH). Compared to reference, image sharpness was similar for SENSE-2/4/6, slightly inferior for C-SENSE-2/4/6. Blood-to-myocardium contrast was unaffected. C-SENSE-4/6 was given lower qualitative median scores, but images were considered diagnostically adequate to excellent, with C-SENSE-6 suboptimal. Biventricular end-diastolic (EDV), end-systolic (ESV) and stroke volumes, ejection fractions (EF), cardiac outputs, and left ventricle (LV)-mass were similar for SENSE-2/4/6 with no systematic bias and clinically appropriate limits of agreements. C-SENSE slightly underestimated LV-EDV (-6.38 ± 6.0 mL, p < 0.047), LV-ESV (-7.94 ± 6.0 mL, p < 0.030) and overestimated LV-EF (3.16 ± 3.10%; p < 0.047) with C-SENSE-4. Bland-Altman analyses revealed minor systematic biases in these variables with C-SENSE-2/4/6 and for LV-mass with C-SENSE-6.

Conclusions

Using the 72-channel coil, short-axis CMR for quantifying biventricular function was feasible in two BHs where SENSE slightly outperformed C-SENSE.
Funding has no effect on clinical outcomes of total joint arthroplasty emerging technologies: a systematic review of bibliometrics and conflicts of interest
Authors: Via Garrhett G. , Brueggeman David A. , Lyons Joseph G. , Ely Isabelle C. , Froehle Andrew W. , Krishnamurthy Anil B.
Published: November 2022

Background

The use of new total joint arthroplasty technologies, including patient-specific implants/instrumentation (PSI), computer-assisted (CA), and robotic-assisted (RA) techniques, is increasing. There is an ongoing debate regarding the value provided and potential concerns about conflicts of interest (COI).

Methods

PRISMA guidelines were followed. PubMed, MEDLINE, and Web of Science databases were searched for total hip and knee arthroplasties, unicompartmental knee arthroplasties (UKA), PSI, CA, and RA. Bibliometric data, financial COI, clinical/functional scores, and patient-reported outcomes were assessed.

Results

Eighty-seven studies were evaluated, with 35 (40.2%) including at least one author reporting COI, and 13 (14.9%) disclosing industry funding. COI and industry funding had no significant effects on outcomes (P = 0.682, P = 0.447), and there were no significant effects of conflicts or funding on level of evidence (P = 0.508, P = 0.826). Studies in which author(s) disclosed COI had significantly higher relative citation ratio (RCR) and impact factor (IF) than those without (P < 0.001, P = 0.032). Subanalysis demonstrated RA and PSI studies were more likely to report COI or industry funding (P = 0.045). RA (OR = 6.31, 95% CI: 1.61–24.68) and UKA (OR = 9.14, 95% CI: 1.43–58.53) had higher odds of reporting favorable outcomes than PSI.

Conclusions

Author COIs (about 40%) may be lower than previously reported in orthopedic technologies/techniques reviews. Studies utilizing RA and PSI were more likely to report COI, while RA and UKA studies were more likely to report favorable outcomes than PSI. No statistically significant association between the presence of COIs and/or industry funding and the frequency of favorable outcomes or study level of evidence was found.

Level of evidence

Level V Systematic Review
Diagnosis of subclinical psoriatic arthritis in patients with psoriasis using CASPAR criteria: a sonographic study
Authors: El-Sherif Sherine Mahmoud , Gaweesh Tamer , Genedy Rasha Mahmoud
Published: November 2022

Background

We aimed at screening for subclinical psoriatic arthritis (PsA) among psoriatic patients without musculoskeletal complaints using ultrasonography of the lower limbs and finding the best predictor for its development.

Results

Subclinical inflammatory articular affection was found by ultrasound in 33 patients, among whom 26 had psoriatic nail affection. According to CASPAR criteria, those 26 patients could be diagnosed as PsA (subclinical). The only statistically significant difference between psoriatic patients with PsA and those without was the mean quadriceps tendon thickness as well as the presence of enthesophytes and bilateral quadriceps thickening. The best and only predictor for subclinical PsA was the presence of enthesophytes.

Conclusion

Ultrasound was more sensitive than clinical examination in detecting subclinical psoriatic arthritis which is highly prevalent in patients with psoriasis even in the absence of manifest arthritic complaints. The best and only predictor for subclinical PsA was the presence of enthesophytes.
The Influence of Instructor Behaviors and the Perceived Motivational Climate on Undergraduate Students’ Experiences in College STEM Laboratories
Authors: Wineinger Troy O. , Fry Mary D. , Moore E. Whitney G.
Published: November 2022

This article breaks new ground in understanding biology teaching and learning by bringing an established theory applied to other educational fields to the college biology laboratory setting. The results of this study identify instructor behaviors that can facilitate creating an optimal motivational climate resulting in positive student outcomes.
Current Status and Implementation of Science Practices in Course-Based Undergraduate Research Experiences (CUREs): A Systematic Literature Review
Authors: Buchanan Alaina J. , Fisher Ginger R.
Published: November 2022

This systematic literature review of CUREs published within the years 2000 through 2020 assesses each CURE curriculum for inclusion of the five primary components of CUREs as well as four specific science practices key to scientific reasoning. CUREs are compared according to their STEM discipline, subdiscipline in biology, and course level.
Introduction to this special section: Geohazards
Authors: Uhlemann Sebastian , Bedle Heather
Published: November 2022

Communities and infrastructure networks are increasingly exposed to natural hazards such as earthquakes, landslides, sinkholes, flooding, and wildfires. Aging infrastructure poses additional hazards due to decreasing structural integrity and rising maintenance costs. Climate change and the related rise in extreme weather events, such as longer droughts and stronger storms, are also contributing to escalated hazard, and expanding urbanization, which is moving communities into areas known to be hazardous, elevates the risk these communities face.
PSAT089 Lack of Effect of Metformin in Murine Pheochromocytoma Model
Authors: Ghayee Hans K , Vanova Katerina Hadrava , Pacak Karel , Uher Ondrej
Published: November 2022

Metformin, a lipophilic biguanide inhibiting hepatic gluconeogenesis and improving peripheral utilization of glucose, is a well-established medication for the management of type 2 diabetes. Furthermore, metformin has been shown to have pleiotropic effects targeting oxidative phosphorylation via complex I inhibition. Thus, it regulates the energy supply to cells from mitochondrial complex I respiration along with reduced glycolytic metabolism. Several pre-clinical in vitro studies on cell lines derived from pheochromocytoma (PHEO) have suggested anti-proliferative potential of metformin which hints that metformin could be used as a potent candidate for PHEO anti-cancer therapy. However, these results have yet to be confirmed in vivo.

Murine PHEO MPC cells and human progenitor hPheo1 cells were treated with metformin in vitro to study the effect on cell proliferation and ATP production. Mice were injected with MTT cells subcutaneously and when the tumors reached the average volume of 120.2±48.1 mm3, they were randomized into 3 groups (n=5) treated with vehicle, 125 mg/kg metformin i.p. daily (6 times a week), or the drug dissolved into drinking water (5 mg/ml). Tumor progression and survival data were collected.

Metformin effectively decreased PHEO cell proliferation and overall ATP production in dose-dependent manner in vitro. Tumor progression was similar in both metformin-treated groups and control group with no significant effect on the growth or mice survival. Even though the metformin showed antiproliferative effects in both murine and human derived cells in vitro, we did not observe tumor growth limitation in our model of murine pheochromocytoma in vivo. However, further studies including newer models and variable treatment conditions including timing, are needed to clarify the lack of efficacy in vivo.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT122 The Changing Face of Drug-Induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System
Authors: Dalmazi Guido D , Raschi Emanuel , Fusaroli Michele , Massari Francesco , Mollica Veronica , Repaci Andrea , Ardizzoni Andrea , Poluzzi Elisabetta , Pagotto Uberto
Published: November 2022

Importance: Adrenal insufficiency is a life-threatening condition complicating heterogenous disorders across various disciplines, with challenging diagnosis and a notable drug-induced component.

Objective

To describe the spectrum and main features of drug-induced adrenal insufficiency through adverse drug event reports received by the Food and Drug Administration (FDA).

Design: We conducted a retrospective disproportionality analysis within one of the largest publicly accessible spontaneous reporting system.

Setting

The FDA Adverse Event Reporting System (FAERS) collecting more than 15 million reports.

Participants: Adverse event reports extracted from FAERS over the past 2 decades (2000-2020), with a focus on the 2015-2020 period.

Main Outcomes and Measures: Descriptive statistics were used to assess the reporting trend of drug-induced adrenal insufficiency. Cases were selected if they contained any of the preferred terms in the Medical Dictionary for Regulatory Activities describing adrenal hypofunctions. We computed the reporting odds ratio (ROR) with relevant 95% confidence interval (CI) using Bonferroni correction to identify signals of disproportionate reporting for drugs recorded in at least 10 cases as primary suspect.

Results

We identified 8,496 cases (5,282 in the 2015-2020 period), 97.5% being serious and 41.1% requiring hospitalization. We identified 56 drugs (out of 164) associated with significant disproportionality within various pharmacological classes: glucocorticoids (N=1971, constant over time), monoclonal antibodies (1,330 out of 1,644 cases with immune checkpoint inhibitors, reaching 76% in 2020), hormone therapy (N=291), anti-infectives (N=252), drugs used for hypercortisolism or adrenocortical cancer diagnosis and/or treatment (N=169), protein kinase inhibitors (N=138).

Conclusions and Relevance

This comprehensive insight into the evolution of drug-induced adrenal insufficiency highlighted the heterogeneous spectrum of culprit drugs classes, including the consolidated role of topical and systemic corticosteroids and the emerging increased reporting of immune checkpoint inhibitors. Targeted screening and educational programs are needed to urgently identify predictive factors.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT123 Pheochromocytoma Resection and Coronary Artery Bypass Surgery: Chicken or the Egg??? - A Case Report
Authors: Abdelmasih Randa , Abdelmaseih Ramy , Tuna Kubra , Saeed Zainab , Patel Jiger
Published: November 2022

Introduction

Pheochromocytoma (PCC) is a rare catecholamine-secreting neuroendocrine tumor with an incidence of 8 per million person-years. Advanced Coronary artery disease (CAD) and PCC may coexist secondary to chronic sympathetic activation, resulting in irreversible vascular wall growth and accelerated vascular atherosclerosis. The hemodynamic management of this association often represents a challenging dilemma due to the dramatic consequences of the hypertensive crisis caused by excessive catecholamine release. here we present a case of concomitant triple vessel disease and PCC to shed a light on our sequence of management to help guide providers as currently due to the rarity of the disease and the association, the available data regarding the sequence of management is controversial and is decided on a case by case basis.

Case presentation

a 55-year-old male with a history of uncontrolled hypertension, Chronic headaches, and kidney disease presented due to abrupt onset of crushing chest pain and was admitted for further evaluation of hypertensive emergency and NSTEMI with a blood pressure of 260/170 and Troponin of 3.8 ng/L. Coronary Angiography showed significant triple-vessel disease. Due to persistent hypertension and high suspicion of PCC, Serum metanephrine and normetanephrine, and fractioned catecholamines were ordered and showed significant elevation. CT of the abdomen and pelvis showed a 1.5 cm heterogeneous left adrenal mass. Nuclear medicine scan showed increased uptake of radiotracer in the left adrenal gland suggestive of PCC.

Discussion

PCC presents a high risk of morbidity and mortality, especially during surgical procedures if left untreated. The management of concomitant advanced CAD and PCC poses a unique challenge in terms of appropriate sequence and time interval between the two procedures. After a multidisciplinary team discussion including cardiology, cardiothoracic surgery, and endocrinology we decided to perform CABG first with preoperative preparation including Alpha-adrenoreceptor blockage for 1 week prior to surgery, followed by PCC resection at a later stage. The patient underwent coronary revascularization with grafting of three vessels. The perioperative course was uneventful. After three weeks the patient underwent successful PCC resection, with successful gradual down titration of alpha locate therapy.

Conclusion

A two-stage approach of CABG was PCC the section at a later stage under optimal preoperative preparation appears to be a safe and feasible modality in patients with advanced CAD and PCC.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSUN17 Magnetic iron oxide nanoparticles for the delivery of thermal therapy for the treatment of primary aldosteronism
Authors: Sorushanova Anna
Published: November 2022

To minimize damage to surrounding tissues, targeted delivery of therapeutics to the tumor is highly desirable, and the development of nanotechnology has shown promising results. Magnetic iron oxide nanoparticles (MIONPs) have been gaining traction over the years for applications such as drug delivery, molecular imaging and delivering hyperthermia for treatment of various cancers (1). MIONPs have great therapeutic potential as they can be produced in various sizes and shapes, with the ability to modify the surface by coating the nanoparticles. MIONPs have the ability to be activated by external magnetic field to generate heat and to cause hyperthermia (2).

Translationally, the delivery of thermal therapy offers an option for minimally invasive definitive treatment of primary aldosteronism, an endocrinopathy of aldosterone excess/dysregulation which represents the commonest secondary form of hypertension. In this study, MIONPs have been used at different concentrations to evaluate nanoparticle uptake and rate of uptake by adrenal cortical and endothelial cells, as well as gain understanding of the location of nanoparticles within the cell.

Magnetic iron oxide nanoparticles (MIONPs) were provided by Kansas University. Adrenal Cortical cell-lines (MUC1, H295R and HAC15) and Endothelial cell-line (HUVEC) were used in this study. MIONPs were added at concentrations of 0.5, 5, 10, 20 and 50 µg/ml to the cells and incubated overnight. MIONP uptake efficiency, rate of uptake and cytotoxicity was assessed by Flow Cytometry. Confocal Microscopy was used to image the cells following MIONP incubation. Cellular proliferation was assessed by Xcelligence system and alamarBlue. Cellular respiration was assessed by "Seahorse" technology. MIONP location within the cells was assessed by transmission electron microscopy (TEM).

Following overnight incubation with MIONPs, Flow Cytometry showed significant uptake by MUC1, HAC15 and HUVEC cells at 10 µg/ml MIONP concentration. Confocal Microscopy and Transmission Electron Microscopy (TEM) images revealed MIONPs in the cytoplasm and in the vesicles for all cell types. Live Confocal imaging showed MIONP phagocytosis specific uptake by the HAC15 cells.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN19 One-step serum screening for discriminating subtypes of congenital adrenal hyperplasia in metabolic signatures of adrenal steroids
Authors: Choi Man-Ho , Shim Jaeyoon , Ho Ahn Chang , Lee Chaelin , Noh Jongsung , Lee Sang Won , Kim Jung Hee
Published: November 2022

Various metabolic signatures may be associated with individual subtypes of congenital adrenal hyperplasia (CAH). However, the ability of commonly used antibody-based immunoassays is limited to discriminate the different subtypes. To address this, liquid chromatography-mass spectrometry (LC-MS) based quantitative profiling of 34 serum adrenal steroids was developed. The validated LC-MS assay has been then applied to serum samples obtained from 67 CAH patients and 38 healthy subjects to characterize their different subtypes. The significantly increased serum levels of 17α-hydroxyprogesterone (17α-OH-Prog; AUC = 0.997, P < 1×10-16) and 21-deoxycortisol (21-deoxyF; AUC = 0.993, P < 1×10-15) and the increased their metabolic ratios to cortisol (AUC = 1.0, P < 1×10-16 for both) were observed in 21-hydroxylase deficiency (21-OHD; N=63), while the 11-deoxyF/17α-OH-Prog could also be practical marker (AUC = 1.0, P < 1×10-16). Higher levels of mineralocorticoids, including corticosterone (B), 18-hydroxyB, and pregnenolone sulfate (Preg-S) and lower levels of dehydroepiandrosterone sulfate (DHEA-S) indicated 17α-hydroxylase deficiency (17α-OHD; N=3), which was associated with significantly decreased metabolic ratios of 17α-OH-Prog/Prog and DHEA-S/Preg-S. The patient with 11β-hydroxylase deficiency (11β-OHD; N=1) showed remarkably increased levels of 11-deoxyF and tetrahydro-11-deoxyF, while the metabolic ratios of 11β-hydroxytestosterone/testosterone and 11β-hydroxyandrostenedione/androstenedione were characterized. Although both 17α-OHD and 11β-OHD groups included a small number of patients, the present LC-MS screening panel with proposed individual steroids and their metabolic ratios could be valuable for assessing different CAH subtypes in clinical practice through a single run.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN43 Anti-phospholipid syndrome presenting with bilateral adrenal hemorrhage in a young female
Authors: Abdelrahim Baha , Alam Mustafa , Singavi Arun , Horani Mohamad
Published: November 2022

Patient is a 29-year-old female with PCOS and morbid obesity and recent admission for abdominal pain is found to have bilateral adrenal hemorrhage and prolonged PTT. Patient was found to be anemic with hemoglobin of 6.1 a week prior to presentation, attributed to dysfunctional uterine bleeding and was treated with subsequent transfusion. She presents a week after her initial presentation with recurrent constant sharp pulsating abdominal pain, and reported pain was worse in mid-epigastric area radiating into her back, with a temperature of 38.2 and heart rate of 135, troponin level 2.64, with a negative CT for PE, but incidental bilateral adrenal hemorrhage absent on CTA from last week, with a CBC showing WBC 21.7 RBC 3.5 Hgb 8.6 MCV 76.9 MCH 24.7 RDW 17.6, with normal folate and B12. Patient was monitored closely and was started on IV hydrocortisone 50 mg every six hours, her PTT was found to be 88 and PT of 17.5, so antiphospholipid syndrome was suspected and confirmed with positive lupus anti-coagulant (LAC) and anticardiolipin IgG ab, and B2 glycoprotein. Patient had no evidence of adrenal infract that could have converted to hemorrhage.

Objectives

Antiphospholipid syndrome (APS) is an autoimmune systemic disorder characterized by persistent antiphospholipid antibodies including lupus anticoagulant, anticardiolipin or anti B2- glycoprotein I antibodies, presenting with arterial venous or small vessel thrombosis or recurrent early pregnancy loss. Other manifestation including livedo reticularis, cutaneous ulceration, thrombocytopenia, and hemolytic anemia, valvular heart disease and nephropathy. In our case, the patient APS was confirmed by the presence of the markers, but no evidence of adrenal infracts what could have converted to hemorrhage was found.

Conclusions

Although APS leads to a hypercoagulable state which can lead to adrenal vein thrombosis, leading to adrenal hemorrhage which can be fatal. Screening for antiphospholipid antibodies should be considered in all patients with unknown etiology of adrenal hemorrhage to promote diagnosis and timely management.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
RF09 | PSAT94 Challenging the Status Quo: Are Routine Post-Operative Day 1 Non-Endocrine Labs Necessary After Adrenalectomy?
Authors: Shariq Omair , McKenna Nicholas , Glasgow Amy , Foster Trenton , Dy Benzon , Lyden Melanie , Habermann Elizabeth , McKenzie Travis
Published: November 2022

Background

The Choosing Wisely campaign from the American Board of Internal Medicine (ABIM) Foundation has scrutinized the practice of routinely ordering tests that offer limited or no benefit to patients, and have the potential to cause harm. Although postoperative day 1 (POD1) hormonal testing is necessary for certain patients who undergo adrenalectomy (i.e. those with functional tumors), the clinical utility of routinely checking POD1 non-endocrine labs is unclear, particularly in patients with non-functional adenomas. We sought to investigate how often these non-endocrine labs were abnormal after adrenalectomy and whether they represent value-added care.

Methods

Patients who underwent open or laparoscopic adrenalectomy at our institution from 2011-2020 were identified, and those with non-endocrine serum labs (hemoglobin, potassium, creatinine, or glucose) obtained before 0800 on POD1 were analysed. The frequency of abnormal labs, and any associated intervention(s), was recorded. Exclusion criteria varied by lab type and included: preoperative hemoglobin <8 g/dL or intraoperative blood transfusion (hemoglobin analysis), presence of chronic kidney disease (potassium and creatinine analyses), diagnosis of primary aldosteronism (potassium analysis), and pheochromocytoma or diabetes mellitus (glucose analysis). Costs were calculated using the 2020 Medicare Clinical Laboratory Fee Schedule.

Results

Of 936 patients (56% female) who underwent adrenalectomy (92% laparoscopic), 91% (n=847) had ≥1 POD1 non-endocrine lab drawn. Only 0.4% (n=3) of 785 eligible patients had an abnormal POD1 hemoglobin (<8 g/dL), and 1 patient received a blood transfusion. Potassium abnormalities were present in 3.4% (n=21) of 624 eligible patients, including 9 with hypokalemia (<3.5 mmol/L) and 12 with mild hyperkalemia (5.5-5.9 mmol/L). Specific interventions for hypo/hyperkalemia were required in 5 patients (0.8% of all potassium values). AKI (creatinine increase of 0.3 g/dL or ≥1.5x baseline) was diagnosed in 4% of 759 eligible patients (n=28) and all were stage 1. Hyperglycemia (>180 mg/dL) was identified in 1% (n=6) of 577 eligible patients, and 1 patient received short-acting insulin. Of a total of 2,745 lab values, while only 2% were abnormal, the total aggregate cost of routine POD1 labs was ∼$17,000 during the study period.

Conclusions

Routine POD1 hemoglobin and creatinine testing are rarely abnormal after adrenalectomy and infrequently impact clinical management. Although patients with functional disease may require monitoring of electrolytes and/or glucose on POD1, in the current era of value-based healthcare, routine ordering of these labs may be unnecessary in selected patients with non-functioning tumors.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:18 p.m. - 1:23 p.m.
LBODP020 Treatment Of Hypercalcemia Due To Prolonged, Excessive Vitamin D Intake
Authors: Abdelrahman Houda , Martinez-Palmer Meaghan , Muammar Ahmad , Merolli Alisa
Published: November 2022

Case

A 66-year-old man with history of anxiety, depression, and complex regional pain syndrome presented to a psychiatric hospital with suicidal ideation. Admission laboratory studies demonstrated hypercalcemia (Ca 14.2 mg/dL) with kidney injury (Cr 3.26). He endorsed taking 5 to 16 (average 8-9) tablets of 1000 IU Vitamin D daily for 10 years. He had heard about the health benefits of Vitamin D and believed it gave him a euphoric effect. Work-up demonstrated elevated ionized calcium (1.63 mmol/L), normal serum phosphorus (3.8 mg/dL), low total protein (6.24 g/dL), normal total albumin (3.42 g/dL), and negative serum protein electrophoresis. Intravenous hydration with normal saline at 200 cc/hr was initiated along with intravenous furosemide. Additional work up demonstrated a suppressed parathyroid hormone level (10pg/ml). 25-hydroxyvitamin D3 (25-(OH)D3) levels were elevated beyond the measurable range (> 155.9 pg/mL). The plasma 1α,25-dihydroxyvitamin D3 (1α,25 (OH)2D3) was normal at 44 pg/mL (range 18-64 pg/mL). With intravenous fluid administration, the patient's ionized calcium level decreased and his creatinine improved. However, 48 hours after the fluids were discontinued on hospital day 3, the ionized calcium and serum creatinine rose once again. Due to the long half-life of Vitamin D and the up-trending calcium levels, he received 60mg of intravenous Pamidronate on hospital day 8. On discharge on hospital day 11, his renal function was stable (Cr 2.24) with normal ionized calcium (1.27 mmol/L). His psychiatric symptoms had resolved.

Discussion

The two most common causes of hypercalcemia are primary hyperparathyroidism and malignancy. Less commonly, vitamin D-mediated hypercalcemia may result from ectopic 1,25-dihydroxyvitamin D production or excessive Vitamin D ingestion. The known upper limit of daily Vitamin D intake in an adult that will cause no adverse risk is 4000 IU per day. Vitamin D is a fat-soluble vitamin with a half-life of approximately 2 months. The liver converts Vitamin D3 to the metabolite 25-(OH)D3, which has a half-life of 15 days, and the kidney further metabolizes this to 1α,25 (OH)2D3, which has a half-life of 15 hours. Therefore, this patient's 25-(OH)D3 was expected to remain at toxic levels for an unknown time period, placing him at risk of prolonged hypercalcemia with further deterioration of his renal function. There is no standard of care established for patients with vitamin D toxicity. Pamidronate, normally contraindicated for GFR <30 mL/min, was administered after nephrology consultation. Information about vitamin D toxicity is primarily gleaned from case reports and series. This case report serves as a model for study of Vitamin D toxicity in humans for understanding the long-term management in patients with chronic vitamin D toxicosis presenting with renal failure.

Presentation: No date and time listed
LBSAT131 Extended-release Calcifediol Reduced Ipth And Normalized 1,25-dihydroxyvitamin D In Esrd.
Authors: Ashfaq Akhtar , Strugnell Stephen , Tabash Samir , Johnson Laura , Bishop Charles W
Published: November 2022

Background

Extended-release calcifediol (ERC) has been shown in randomized clinical trials to effectively and safely treat secondary hyperparathyroidism (SHPT) in adults with stage 3-4 chronic kidney disease (CKD) and vitamin D insufficiency when administered at 210 or 420 mcg per week (30 or 60 mcg/day), doses which gradually raise serum total 25-hydroxyvitamin D (25D) to mean steady-state levels of 50-56 ng/mL.

Clinical Case

A 41-year-old male Caucasian with end-stage renal disease (ESRD) requiring regular hemodialysis (HD) experienced an overdose during participation in a phase 2 study of ERC for treating SHPT. Medical history included hypertension, type II diabetes, glomerulonephritis, bilateral lower extremity edema, muscle cramps, pruritus, shortness of breath, sporadic hypercalcemia and hyperphosphatemia, and iron deficiency anemia. Treatment with ERC began at an incorrect dosage of 2,700 mcg per week (900 mcg per HD) for 10 weeks as the study coordinator misunderstood the protocol-specified dose of 900 mcg per week. A 2.5% calcium dialysate was used during the study. Serum 25D gradually increased from 19 to 339 ng/mL (32-100), serum total 1,25-dihydroxyvitamin D (1,25D) increased from 6.3 to 137 pg/mL (24-86), plasma iPTH decreased from 440 to 146 pg/mL (15-65), and corrected serum calcium (Ca) decreased from 9.3 to 9.1 mg/dL (8.6-10.4). The subject remained asymptomatic throughout. Discovery of the overdose was delayed due to limited monitoring access during the pandemic and occurred when the ERC supply was prematurely exhausted. A physical exam and retrospective review of study records were promptly undertaken with no abnormalities noted. ERC administration, after a 1-dose hiatus, resumed at the correct dose (900 mcg per week). Serum 25D decreased over the next 4 weeks to 251 ng/mL, 1,25D decreased to 46. 0 pg/mL, iPTH increased to 186 pg/mL, and Ca remained stable (9. 0 mg/dL). The subject completed the full 6-month treatment period without adverse events.

Clinical Lessons

Gradual elevation of serum 25D and 1,25D with ERC to high levels had no impact on serum Ca or adverse events in the described subject suggesting that hypercalcemia observed with other vitamin D therapies used during HD results from abrupt increases in these metabolites. Serum 1,25D normalized with 25D elevation despite the lack of functional kidneys, indicating that extra-renal 1,25D production can become sufficient to control increased iPTH in ESRD when serum 25D is elevated well above the current clinical practice target of 30 ng/mL.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
ODP080 Bisphosphonate treatment for osteoporosis in children with Gorham-Stout syndrome: a case report
Authors: Ahn Moon Bae , Shin Chungwoo
Published: November 2022

Background

Gorham-Stout disease (GSD) is a rare disease defined by progressive bone disappearance due to massive unicentric or multicentric osteolysis with proliferation of vascular structures. Symptoms and signs vary depending on the site of invasion. Including some self-limiting GSD, most treatments are palliative and limited to symptom management. Various treatments have been tried for GSD, but there are no standardized treatment protocols. Treatment includes radiological treatment, surgery, and medications such as bone absorption inhibitors (calcitonin, bisphosphonate (BP)), vitamin D and immune modulators (interferon alpha-2b, Sirolimus) Case presentation: A 4-year-old female patient presented with prolonged back pain after a fall. Pathologic compression fracture in T9, L1 vertebrae identified in simple spine image, and GSD was confirmed by MRI and biopsy finding as hemangioma in vertebrae. This patient has been treated with a combination therapy of Sirolimus and BP for 1 year. BP treatment consist with oral BP (Alendronate) between 3 intravenous BP (Pamidronate) every 4 months. After a year of treatment, BMD improved from initial -1.3 TBLH (z-score) to -0.5/0.4/0.6 Spine/Both femur (z-score), but MRI findings suggest mild aggravation of multiple compression fractures of spines of T9-L5. After 1-year of treatment, at present, the girl is alive and staying with tolerable condition.

Conclusions

Combination treatment with bisphosphonate and Sirolimus for childhood GSD can be helpful in slowing the demineralization of GSD without any significant adverse effect.

Presentation: No date and time listed
ODP086 Detecting Primary Hyperparathyroidism with Image Discordant Findings
Authors: Nikjoo Arya , Rashid Hytham , Hogan Connor , Raghavan Rajeev
Published: November 2022

Introduction

Primary hyperparathyroidism is a common cause of hypercalcemia, with 80-85% of cases being due to a single gland adenoma. The sensitivity of imaging modalities varies, with ultrasound at 76%, sestamibi scintigraphy at 63%, and 4-dimensional computed tomography (CT) scan at 89%.

Clinical Case

A 48-year-old woman with a remote history of iron deficiency anemia presented with 2 weeks of dry cough. She reported associated body aches and fatigue, but review of systems was otherwise negative. Family history was notable for a maternal grandmother with an unknown thyroid disease. On presentation, her blood pressure was 115/74 mm Hg, temperature was 37.1 Celsius, pulse was 64 beats per minute, with a respiratory rate of 16 breaths per minute, and oxygen saturation of 100 percent on room air. On exam, there was no thyromegaly, and there were decreased breath sounds. Initial labs were notable for calcium of 11.4 mg/dL (reference range: 8.4-10.2 mg/dL). Her rapid Covid antigen test was negative. A chest x-ray showed bilateral opacifications, suggestive of community acquired pneumonia. She was started on isotonic intravenous (IV) fluids, as well as ceftriaxone and azithromycin. The calcium remained persistently elevated and peaked at 12.6 mg/dL. Creatinine levels remained between 0.7-1. 0 mg/dL (reference range: 0.5-1. 0 mg/dL). Phosphorus level was 3.6 mg/dL (reference range: 2.5-4.5 mg/dL). Parathyroid hormone level was 174.6 pg/mL (reference range: 37.87-83.87 pg/mL). 24-hour urinary calcium was 660 mg (reference range: 0-320 mg). Ultrasound of the neck showed multiple mildly suspicious thyroid nodules, but no notable findings for the parathyroid gland. Subsequent nuclear medicine sestamibi scan revealed no discrete parathyroid adenomas. The 4-dimensional CT scan did not mention parathyroid pathology on the report. However upon review by a head and neck surgeon, a suspicious lesion was identified adjacent to the right thyroid lobe. Intervention was indicated given her age (<50), serum calcium > 1 mg/dL above the upper limit of normal, and 24-hour urinary calcium > 400 mg. The patient underwent a right neck exploration, and a right superior parathyroidectomy was performed.

Conclusion

The patient met the criteria for primary hyperparathyroidism based on her normal kidney function, elevated serum calcium, and elevated parathyroid hormone. While imaging is frequently ordered, it is important to note that it does not have a role in confirming or ruling out the diagnosis of primary hyperparathyroidism. It should instead be used to localize abnormal parathyroid glands for operative planning. This case highlights the importance of surgical consultation in primary hyperparathyroidism, especially in the setting of negative or conflicting imaging results.

Presentation: No date and time listed
ODP094 Hypercalcemia caused by Mycobacterium Avium Complex, with Excellent Response to Intravenous Pamidronate.
Authors: Khthir Rodhan
Published: November 2022

Background

Hypercalcemia caused by granulomatous diseases such as sarcoidosis and tuberculosis, is a well-recognized entity. The pathophysiology of hypercalcemia associated with granulomatous diseases is related to increase conversion of 25 hydroxyvitamin D to its active form, 1,25 dihydroxyvitamin D, via extra-renal 1 -α hydroxylase activity. We present a patient with moderately sever hypercalcemia caused byMycobacterium Avium complex (MAC) infection in association with Human Immunodeficiency Virus (HIV) infection.

Case Presentation

The patient is 53-year-old male with longstanding HIV infection since 2003. He was referred to the endocrine clinic after an acute presentation to a local hospital in August 2021 with pancytopenia, lymphadenopathy, and hypercalcemia (corrected total calcium 13.8 mg/dl) with acute kidney injury. He was treated with intravenous fluids and subcutaneous Calcitonin injection. Endocrine work up showed low parathyroid hormone (PTH) at 3 pg/ml (14-95 pg/ml) and Parathyroid related peptide (PTHrP) level was <0.4 pmol/l. His 1,25 dihydroxy-vitamin D was elevated at 172 pg/ml (18-64 pg/ml) . Computed Tomography (CT) study for neck, chest and abdomen showed hepatosplenomegaly, generalized lymphadenopathy involving the left cervical area, left supraclavicular area, mediastinal, retroperitoneal, mesenteric and inguinal lymphadenopathy. Bone marrow study from August 2021 showed no evidence of leukemia, lymphoma, tuberculosis or other bone marrow inflammatory or infiltrative processes. Left sided neck lymph node biopsy showed diffuse granulomatous disease and numerous acid-fast organism consistent with Mycobacterium Avium complex (MAC) He was treated with azithromycin 250 mg daily, ethambutol 1200 mg daily, and rifabutin 300 mg daily in addition to anti-retroviral therapy (bictegravir/emtricitabine/tenofovir). Hypercalcemia was treated with one dose of pamidronate 90 mg which normalized serum calcium within one week. Glucocorticoids was not considered due to concerns over sever immunosuppression due to HIV/ AIDS and pancytopenia. Denosumab, ketoconazole and hydroxychloroquine were also not considered due to concerns over side effects. His 1,25 dihydroxy-vitamin D level normalized after four months from starting treatment with anti MAC therapy. Most recent calcium level 9.1 mg/dl, with 1,25 dihydroxy-vitamin D level of 31 pg/ml.

Conclusion

Mycobacterium Avium Complex infection is a possible cause of hypercalcemia, especially in immunocompromised individuals. Glucocorticoids, usually the first line treatment for acute hypercalcemia induced by 1,25 dihydroxyvitamin D overproduction, might not be appropriate in all patients. Alternatives include hydroxychloroquine, ketoconazole and parenteral bone anti- resorptive agents. Our patient had an excellent response to one dose of pamidronate. Ultimately his1,25 dihydroxy-vitamin D normalized with effective anti MAC therapy.

Presentation: No date and time listed