bluuebunny/crossref_metadata_2025 huggingface dataset:
SUN-304 Hypophisitis in Patients with and Without Autoimmune Rheumatological Disease
Authors: Vázquez Aguirre Marlon Vladimir , Godoy-Alonso Juan Pablo , Cruz Germán González-de la , Rocha-Haro Andrea , Ordaz-Candelario Karla Krystel , Balbuena-Álvarez Juan , Martínez-Jiménez Angélica , Flores-Cárdenas Romina , Roldan-Sarmiento Paola , Gómez-Sámano Miguel Ángel , Gómez-Pérez Francisco Javier , Higuera-Calleja Jesús , Hinojosa-Azaola Andrea , Martin-Nares Eduardo , Cuevas-Ramos Daniel
Published: May 2020

Background: Hypophysitis is an inflammatory process of the pituitary gland with different origins. Infundibulum may be also involved, called infundibulum-hypophysitis. Sometimes, enlargement of pituitary gland causes mass effect and anterior or posterior hormonal dysfunction, including hypopituitarism, and diabetes insipidus (DI), respectively. Hypophysitis is a rare autoimmune disease, however, the number of cases have been recently increasing due to higher detection related with more magnetic resonance imaging (MRI) studies. In addition, hypophysitis may be related with autoimmune rheumatologic disease (ARD) such as generalized lupus erythematosus (GLE), granulomatosis with polyangeitis (GPA), IgG4-related disease, and rheumatoid arthritis (RA). Aim: to compare the clinical and biochemical findings among patients with hypophysitis grouped depending on the presence of coexistent ARD activity. Methodology: it is a comparative and cross-sectional study. We registered all data from cases followed-up in Neuroendocrinology and Rheumatology units, from January 1987 to July 2019. Results: 24 patients showed confirmed diagnosis of hypophysitis. Majority of them (n=17, 71%) do not have coexistent diagnosis of ARD. However, 7 cases (29%) presented pituitary involvement with coexistent activity of GPA (n=4, 17%), GLE (n=1, 4%), RA (n=1, 4%) and IgG4-related disease (n=1, 4%). Female gender predominate in hypophysitis cases with and without ARD (p=0.9). Interestingly, age of hypophysitis diagnosis was significantly younger in cases without (38±14) vs. with (49±5) ARD (p=0.01). MRI results showed similar and typical findings related with hypophysitis independently of the presence of ARD. Hypopituitarism was present in the majority of cases, however, none of cases with hypophysitis and ARD showed hypogonadism (p=0.02). DI was present in 15 patients (63%), three of them with ARD (all with GPA). All cases received only medical therapy (i.e., glucocorticoids, rituximab, or azathioprine). Surgery or radiotherapy was not necessary in any case. Conclusions: Almost a 30% of cases with hypophysitis may have coexistent ARD. Pituitary function should be evaluated in cases with previous ARD diagnosis. However, hypogonadism was not present in cases with ARD and hypophysitis. Patients with ARD presented hypophysitis at older age. The remaining clinical and radiological data were similar between groups.

References: 1) Clinical Diabetes and Endocrinology. December 2016;2(1). 2) Clin Rheumatol. 2019 Aug 24. doi: 10.1007/s10067-019-04735-7
SAT-643 Predictors of Technology Success in Cystic Fibrosis Related Diabetes
Authors: Jain Ashna , Kaminski Beth Anne , Kutney Katherine
Published: May 2020

Background: As patients with cystic fibrosis live longer, cystic fibrosis related diabetes (CFRD) is becoming a more common complication. CFRD has a negative impact on lung function, nutrition, and survival. The ADA guidelines recommend that patients with CFRD be treated with insulin and monitor their glucose at least three times a day. Continuous glucose monitors (CGM) allow glucose to be measured by scanning a reading device or by automatic updates every 5 minutes. Little is known about factors predicting successful CGM use in patients with CFRD.

Methods: We completed a retrospective chart review of all patients with insulin-treated CFRD at a single center. Successful CGM implementation was defined as CGM use for 3 months or more. Patient characteristics (age, BMI, ppFEV1, HbA1C, diabetes duration, insurance type) were compared between the CGM and no CGM groups. For the CGM group, HbA1C, ppFEV1, and BMI, were compared before and after CGM implementation. Paired and unpaired t-tests were used to evaluate continuous variables and fisher’s exact test was used to evaluate dichotomous variables.

Results: Of the 55 patients eligible for inclusion, 12 patients (22%) had successfully implemented CGM in their diabetes routine. Age, BMI, ppFEV1, HbA1C, and insurance type were not significantly different between the CGM and no CGM groups. CGM users appeared to have a slightly longer duration of diabetes than non-implementers but this did not meet statistical significance (6.6 vs. 4.8 years, p=0.08). Among CGM users, BMI, ppFEV1, and hemoglobin A1C did not change significantly after implementation of CGM. The documented number of glucose checks did increase at the CFRD visit immediately after implementing CGM (1.9 vs. 3.3 checks per day, p=0.002).

Conclusions: No patient factor was found to predict successful CGM implementation in our cohort. Our small study suggests that longer duration of diabetes may be associated with successful CGM implementation. Longer follow-up is needed to determine whether CGM therapy improves A1C, BMI, or ppFEV1 in patients with insulin-treated CFRD.
MON-037 Vitamin D Levels in Women with Polycystic Ovary Syndrome: Influence of Obesity
Authors: Maidana Patricia Nieves Amelia , Fernández Gladys Isabel , Fritzler Analy , Ropelato María Gabriela , Eugenia Lamas-Majek , Lopez Mariana , Gonzalez Diego , Rosales Mónica , Leiderman Susana Mabel , Fabre Bibiana , Mesch Viviana
Published: May 2020

Introduction: Polycystic ovary syndrome (PCOS) is the most frequent cause of hyperandrogenism in women of reproductive age. Among its metabolic complications, vitamin D deficiency has been described in relation with insulin resistance’s pathophysiology and other metabolic risk factors. However, it is not clear if this deficiency is inherent to PCOS or it depends on adiposity degree. As well, it is also suggested that vitamin D could regulate leptin levels and high leptin levels should be associated with vitamin D defiency in obesity. Our aim was to evaluate the relationship between vitamin D, leptin and obesity degree in PCOS patients.

Subjects and methods: In 84 PCOS women (19 -37 years) and 49 controls (22-45 years), 25 hidroxi-vitamin D (25 OH-D) was measured by direct chemoluminiscence. Body mass index (BMI) was calculated; 20% of PCOS women were overweight and 46% were obese. Waist circumference (WC) was measured as an indicator of abdominal obesity. The lipid accumulation product (LAP) index, a secondary marker of insulin resistance, was calculated (LAP: [waist (cm) - 58] x triglycerides (mmol/l)). In a subgroup of 26 patients, leptin levels were determined by ELISA method. Statistical analysis was performed through SPSS 22.

Results: Variables are expressed as mean ± SD or median (range) according to distribution. The following parameters were higher in PCOS women than in controls, BMI: 29.3 (18.6-48.2) vs 22.4 (18.1-37.4) kg/m2; WC 95 ± 16 vs 82 ± 11 cm and LAP: 47.9 (1.1-198.2) vs 17.5 (6.8-93.4) cm.mmol/L, p<0.0001 in all cases. 25 OH-D was lower in PCOS: 14.5 (10.0-39.0) vs 17.0 (10.0-38.8) ng/ml, p=0.024. Leptin levels in PCOS women were 10.1 ± 5.4, 26.4 ± 7.0 and 33.8 ± 16.9 ng/ml in normal weight, overweight and obese patients, respectively. After a logistic binary regression analysis, differences in 25 OH-D between groups were lost when BMI and WC were considered (p=0.556; RR=0.978; IC95% [0.909-1.063]). 25 OH-D levels were negatively associated with WC (r=-0.286, p=0.006), LAP (r=-0.333, p=0.002) and leptin (r=-0.462, p=0.017).

Conclusions: although 25 OH-D levels were lower in PCOS women than in controls and negatively associated with LAP, an insulin resistant marker, the fact than differences between groups was lost after correction by BMI and WC, in addition to the correlation found between 25 OH-D and leptin levels, indicates that obesity degree and abdominal fat distribution should be responsible of decreased vitamin D levels in PCOS.
MON-194 Phaeochromocytoma-Paraganglioma (PPGL): Post-Operative Hypotension Is a Vanishing Phenomenon
Authors: Osher Esther , Tordjman Karen Michele , Klausner Joseph , Nachmany Ido , Sagie Boaz , Stern Naftali , Lahat Guy , Wolf Ido , Zac Lilach , Otremski Sorina , Barnes Sophie , Aizic asaf , Zohar Naomi Even , Greenman Yona
Published: May 2020

Background: Treatment of hemodynamic instability in patients with PPGL in the intra-and postoperative periods is challenging. Persistent postoperative hypotension is a common and serious complication, reportedly occurring in 30-60% of PPGL patients. This phenomenon reflects 1) high doses of pre-operative antihypertensive drugs; 2) low intravascular volume secondary to chronic catecholamine-induced vasoconstriction with pressure natriuresis; 3) the sudden drop in circulating catecholamines after surgery. It has been shown that tumor size and preoperative levels of catecholamines are directly related to the need for treatment with vasopressor agents in the early period after tumor removal. The aim of this study was to evaluate the efficacy and safety of the current perioperative treatment protocol for PPGL used in our Institute. Methods: We retrospectively reviewed the rate of hemodynamic instability and postoperative hypotension in relation to catecholamine levels, and the efficiency of preoperative pharmacological preparation in consecutive patients with PPGL treated between 2000-2019. Results: There were 39 patients (F/M 19/20; mean age 50.4 ±16.5 years) 33 of which had adrenal lesions and 6 had extra-adrenal tumors. Mean tumor size was 3.9 ±2.2 cm. Median metanephrine and normetanephrine levels were 5 and 10 fold the upper limit of the normal range respectively. All patients were treated with α-blockade (phenoxybenzamine-17, mean dose 60±38 mg/day; doxazosin-22; mean dose 9.6±6.1mg/day) along with β- blockade, and high sodium diet and IV saline 24 hours before the operation. The length of the preoperative preparation period was 3.4±2 weeks. Within the first 24-48 hours from surgery, no episodes of hypotension (<90 mmHg systolic pressure) were recorded. Mean systolic BP was 121 ±14 (range 95-150) with a mean diastolic BP of 70 ±11 (range 89-46). In contrast, intraoperative hypotension occurred in 22% of the patients; and BP surge occurred in 36% of patients, mostly during tumor manipulation. There were no differences between subjects with and without such BP rises/falls in terms of pre/post- surgical BP, catecholamine levels or type of medical treatment. Conclusion: In contrast with older literature and previous reports, the patients in our cohort did not experience postoperative hypotension. This is most likely due to tight BP control while avoiding pre-operative hypotension, and adequate volume control. We propose that proper preoperative management in the modern era can drastically minimize intraoperative hemodynamic instability and post-operative hypotension.
OR05-06 The Androgen Receptor Is a Tumour Suppressor in Estrogen Receptor Positive Breast Cancer
Authors: Hickey Theresa E , Selth Luke , Chia Kee Ming , Milioli Heloisa , Roden Daniel , Laven-Law Geraldine , Jindal Shalini , Hui Mun , Ebrahimie Esmaeil , birrell Stephen , Stelloo Suzan , Caldon Elizabeth , Findlay-Schultz Jessica , Abdel_Fatah Tarek , Ellis Ian , Zwart Wilbert , Palmieri Carlo , Sartorius Carol Ann , Swarbrick Alex , Lim Elgene , Carroll Jason S , Tilley Wayne D
Published: May 2020

There is strong interest in targeting the androgen receptor (AR) in estrogen receptor (ER) positive breast cancer, but widespread confusion exits as to what therapeutic strategy - agonism or antagonism - is appropriate. Current understanding of AR predominantly stems from the field of prostate cancer, where AR is the key oncogenic driver and therapeutic target. An ensuing assumption is that AR promotes malignancy in breast cancer and should be therapeutically antagonised. However, compelling pre-clinical data to support this assumption is lacking. Since estrogen stimulates and androgen inhibits the development of normal breast tissue, we hypothesized that AR acts as a tumour suppressor in the breast and that AR agonism is the appropriate therapeutic strategy for ER-driven breast cancer. We tested this hypothesis using a large suite of cell line and patient-derived explant (PDE) and xenograft (PDX) models of breast cancer, including those that were resistant to current therapies and those harbouring genomic anomalies of ESR1 associated with treatment-resistant disease. Across the diverse models we found compelling evidence that AR agonism, but not antagonism, potently and durably inhibited tumour growth. A signature of AR activity derived from the xenograft models positively predicted disease survival in multiple large clinical cohorts of ER+ breast cancer, out-performing other breast cancer-specific prognostic signatures. We also show that an AR agonist can be combined with current ER target therapies such as Tamoxifen or a CDK4/6 inhibitor to maximize growth inhibition. Mechanistically, agonist-bound AR opposed ER signalling by repositioning ER and the co-activator p300 in the chromatin landscape, resulting in down-regulation of cell cycle genes. Introduction of an AR DNA binding mutant had no effect on ER signalling or estrogen-stimulated growth in breast cancer cells. As part of this study, we have generated consensus AR cistromes representing ER+ breast cancer cell lines and ER+ tumours that provide a new understanding of AR activity and clearly show differences to those associated with prostate cancer cell lines and tumours. In conclusion, our data provides a compelling biological rationale for AR agonism as a therapeutic strategy in multiple, clinically relevant contexts of ER-positive breast cancer. These findings should dispel widespread confusion over the role of AR in ER-driven breast cancer, an issue that currently hinders progress in leveraging modern AR-targeted therapies (e.g. selective androgen receptor modulators) that lack the undesirable side-effects of androgens for clinical benefit.
SAT-477 Melanoma Treated with Pembrolizumab Leading to Thyroiditis and Subsequent Hypothyroidism
Authors: Fishel Heather
Published: May 2020

Background: Pembrolizumab (PD-1) is an immune checkpoint inhibitor used for treating melanoma and has been associated endocrine immune-related adverse events.

Case Presentation: 76-year-old Caucasian male presented for evaluation of abnormal thyroid labs. Significant co-morbidities included recurrent melanoma, heart failure, atrial fibrillation, coronary artery disease, type 2 diabetes, hypertension. Patient’s melanoma was being treated with Pembrolizumab. Further history revealed no family/personal history of thyroid disease but a history of mouth cancer treated with radiation over 30 years ago. He denied any recent glucocorticoid or biotin use. Symptoms included worsening fatigue, weight loss, and diarrhea. He was afebrile and vitally stable. Physical exam was unremarkable. Prior to this year, patient had normal thyroid labs. Recent thyroid labs showed TSH of 0.01 uIU/mL (normal 0.34-4.94 uIU/mL), confirmed with repeat labs a week later (TSH: < 0.01, Free T4: 2.23 ng/dL, normal Free T4: 0.7-1.48 ng/dL). There was a high suspicion that these labs were related to Pembrolizumab, but other etiologies were evaluated. Completed thyroid uptake and scan showed no evidence of increased activity (4-hour uptake: 1.6%, 24-hour update: 1.2%). Repeat thyroid labs indicated recovering thyroid function with a TSH: 0.14 uIU/mL, Free T4: 0.49 ng/dL, Free T3: 1.5 pg/mL (normal Free T3 2.3-4.2 pg/mL), TSI: 96% (normal < 140%), TPO Ab: 111 IU/mL (normal TPO Ab < 9 IU/mL). One month later thyroid tests resulted as TSH: 72.81 uIU/mL, Free T4: < 0.40. He was started on levothyroxine, which was titrated over several weeks.

Discussion: Pembrolizumab (PD-1) is an IgG4 programmed cell death 1-directed monoclonal antibody, whose mechanism of action is to inhibit cancer cells ability impede T-cell activation. However, because of this mechanism, some T-cells, will remain activated, leading to autoimmune diseases. PD-1 has been associated with thyroid dysfunction, with an incidence rate as high as 14-20%. The clinical presentation varies from isolated thyrotoxicosis to overt hypothyroidism. In our patient, he developed thyrotoxicosis with subsequent development of hypothyroidism. Generally, the timing of thyroid dysfunction after the initiation of PD-1 ranges from 3 to 40 weeks, with the median onset at week 6. Baseline TSH and free T4 should be obtained with rechecking of these labs monthly for the first 6 months. For patients who present with thyrotoxicosis, Grave’s disease should be ruled out, and initial treatment should include beta-blockers. Hypothyroidism should be treated with levothyroxine with titration to normal thyroid function tests. What remains to be determined is the mechanism in which PD-1 causes thyroid dysfunction and if specific patient characteristics, such as thyroid antibodies, can be used to risk stratify the likelihood of a patient developing thyroid dysfunction.
SUN-700 Fournier’s Gangrene and Diabetic Ketoacidosis Caused by Canagliflozin
Authors: Stamatiades George Alexiades , Kasbawala Kinjal , Gugger Aristea Sideri , Elahee Mehreen , Majumdar Sachin K
Published: May 2020

Introduction

Sodium glucose co-transporter 2 (SGLT2) inhibitors have become an appealing treatment for diabetes due to their favorable cardiac and renal outcomes. However, reports continue to emerge describing potentially life-threatening adverse events such as Fournier’s gangrene (FG) and diabetic ketoacidosis (DKA) associated with their use. Herein, we report a case of simultaneous FG and DKA in a patient taking canagliflozin.

Case Presentation

A 37-year-old woman with a history of type 2 diabetes mellitus, peripheral neuropathy, and morbid obesity (BMI of 45.8 kg/m2) presented to the hospital with left gluteal pain associated with dysuria despite 5-day treatment with trimethoprim/sulfamethoxazole for a presumed urinary tract infection. Approximately 1 month prior, sitagliptin and canagliflozin were added to her regimen due to poor glycemic control on metformin (HbA1c 9.8%). On examination her temperature was 36.9oC, pulse 117 beats/minute, blood pressure 144/79 mmHg and respiratory rate was 19 bpm. She appeared lethargic and had suprapubic tenderness and induration in the left gluteal region extending to the perineum. Laboratory findings revealed an arterial pH of 7.23 and PCO2 of 34 mmHg, a blood glucose of 402 mg/dL, serum bicarbonate 12mmol/L (20-30mmol/L), an elevated anion gap of 24mmol/L (7-17mmol/L) and a lactate of 1.8 mmol/L. Urinalysis showed 4+ glucose and 1+ ketones. Serum β-hydroxybutyrate was 2.49 mmol/L (0.02-0.27mmol/L). A CT scan of the abdomen and pelvis showed marked inflammatory changes with subcutaneous edema and air within the medial left gluteal soft tissues and locules of air extending into the presacral soft tissues suggestive of Fournier’s gangrene. The diagnoses of Fournier’s gangrene and DKA were made. The patient was started on empirical antibiotic treatment and required six surgical explorations with debridement. Interestingly, initial DKA management included only subcutaneous insulin. Only when serum ketones were identified and the anion gap persisted, insulin infusion with aggressive fluid resuscitation was initiated with successful resolution of anion gap metabolic acidosis. She was discharged with a urinary catheter, vacuum dressing, colostomy with instructions to start insulin glargine 18U and discontinue the oral anti-diabetic medications.

Discussion

To the best of our knowledge, this is the first case describing the simultaneous occurrence of two potentially fatal adverse effects of SGLT2 inhibitor therapy; Fournier’s gangrene and DKA. In light of the FDA’s warnings and the growing popularity of SGLT2 inhibitor therapy it is important to be mindful of their more serious and potentially fatal complications. It is also important to promptly terminate SGLT2 inhibitors when harmful adverse effects are suspected to prevent further progression.
MON-319 Impact of Tumor Characteristics and Preoperative IGF-1 Levels on Postoperative Hormonal Remission Following Endoscopic Transsphenoidal Surgery in Patients with Acromegaly: A Single-Surgeon Series
Authors: Cardinal Tyler , Rutkowski Martin , Patel Tanu , Shiroishi Mark , Carmichael John David , Zada Gabriel
Published: May 2020

Introduction:

Acromegaly is a potentially fatal neuro-endocrinopathy caused by a growth hormone (GH)-secreting pituitary adenoma (PA). A lack of consensus on factors that reliably predict patient outcomes in acromegalic patients following endoscopic endonasal approaches (EEA) warrants additional investigation.

Methods:

Pre- and postoperative tumor and endocrinological characteristics from 55 acromegalic patients who underwent EEA for resection of a GH-secreting PA were evaluated as potential predictors of postoperative hormonal remission (defined as age- and sex- normalized IGF-1 levels).

Results:

The 55 patients included had a mean age of 50.1 ± 13.5 years and a mean follow-up time of 18 ± 17.4 months. Fifty-three patients (96%) presented with dysmorphic craniofacial features, with 22 (40%) presenting with prognathism, 22 (40%) exhibiting frontal bossing, and 18 (33%) presenting with macroglossia. Ten (18%) had microadenomas and 45 (82%) had macroadenomas. Five (9.4%) had giant adenomas. Forty-five (92%) tumors were invasive, with 44 (83%) exhibiting infrasellar invasion, 17 (32%) extending above the sella, and 9 (18%) with cavernous sinus invasion. Thirty-three patients (66%) underwent gross total resection (GTR; mean maximal tumor diameter = 1.52 cm), and 17 (34%) underwent subtotal resection (STR; mean maximal tumor diameter = 2.77 cm). Invasive tumors were significantly larger and Knosp scores were negatively correlated with GTR. Thirty-three patients (65%) achieved hormonal remission after EEA resection alone, which increased to 80% with adjunctive medical therapy. Additionally, 90% of patients who underwent GTR and 63% of patients who underwent STR demonstrated postoperative remission. Six patients (11%) exhibited biochemical remission after postoperative medical therapy with an average time to remission of 5.2 months. These patients all had significantly higher preoperative IGF-1 levels and larger tumors than patients who remitted immediately postoperatively. In all patients preoperative IGF-1 levels were inversely correlated with hormonal remission.

Conclusions:

This study indicates that endoscopic transsphenoidal resection of growth hormone secreting pituitary adenomas is a safe and highly effective management strategy for achieving hormonal remission and tumor control for patients with acromegaly. When combined with postoperative medical therapy, we observed endocrinological remission rates of 80% based on normalized IGF-1 levels. Our results support the conclusions of current literature that smaller and less invasive tumors are more likely to be fully resected. We additionally suggest that patients with lower preoperative IGF-1 are more likely to undergo postoperative biochemical remission, irrespective of tumor size and invasion.
SAT-186 Metastatic Paraganglioma Secondary to SDHB Gene Mutation: A Case Report and Review of New Therapies
Authors: Tetlay Maryam , Hasan Farhad
Published: May 2020

Background: Paragangliomas (PGL) are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, majority of which are benign. 0-36% of PGL patients can develop metastatic disease, depending on the genetic mutation. We present a case of a patient with metastatic PGL due to an SDHB gene mutation. We then summarize published and ongoing trials of therapies for metastatic pheochromocytoma/PGL.

Clinical Case: A 54 years old male presented to the Emergency Department with severe left lower quadrant pain. He additionally reported recent episodes of headaches and uncontrolled hypertension, as well as an approximate weight loss of 50 pounds in the preceding two years.

A CT abdomen and pelvis demonstrated an 8 cm left peri-aortic retroperitoneal mass, along with a 2 cm solitary hepatic lesion concerning for metastatic disease. Normetanephrine levels were elevated at 1210 pg/mL (normal 0-145 pg/mL). Endoscope-guided biopsy of the retroperitoneal mass demonstrated findings consistent with a PGL.

The patient was referred to a genetic counsellor where he underwent PGLNext testing. He tested positive for a c.418G>T mutation in the SDHB gene, consistent with a diagnosis of hereditary paraganglioma - pheochromocytoma (PGL-Pheo) syndrome.

Patient was planned for surgical debulking of his PGL, and was treated pre-operatively with Phenoxybenzamine, followed by B-blockers. He underwent resection of the retroperitoneal mass and wedge resection of the hepatic mass. Surgical pathology revealed a 10.5 cm extra adrenal PGL and a 2 cm metastatic PGL involving the liver with negative margins of resection.

Patient did well in the post-operative period, and was discharged with plans to repeat plasma metanephrines in 6-8 weeks. The patient was referred to the National Cancer Institute (NCI) for enrollment in a clinical trial using Lu-177-DOTATATE.

Conclusion: Though rare, pheochromocytomas (pheo) and PGL can be lethal if not diagnosed and managed appropriately. As of 2019, at least 19 genes have been identified that predispose to familial pheochromocytoma/PGL. Importantly, PGL that are associated with SDHB, the mutation our patient had, are more likely to appear in the abdomen (rather than the head and neck), are usually secretory (most commonly norepinephrine) and are more likely to become metastatic (21-79%).

Patients with metastatic pheo/PGL require complex care in specialized centers by a multidisciplinary team of specialists. Patients with advanced or non-resectable metastatic pheo/PGL should preferably be offered a referral to NCI or an NCI designated cancer center for enrollment in a clinical trial of targeted therapies.
Frailty for Perioperative Clinicians: A Narrative Review
Authors: McIsaac Daniel I. , MacDonald David B. , Aucoin Sylvie D.
Published: May 2020

Frailty is a multidimensional syndrome characterized by decreased reserve and diminished resistance to stressors. People with frailty are vulnerable to stressors, and exposure to the stress of surgery is associated with increased risk of adverse outcomes and higher levels of resource use. As Western populations age rapidly, older people with frailty are presenting for surgery with increasing frequency. This means that anesthesiologists and other perioperative clinicians need to be familiar with frailty, its assessment, manifestations, and strategies for optimization. We present a narrative review of frailty aimed at perioperative clinicians. The review will familiarize readers with the concept of frailty, will discuss common and feasible approaches to frailty assessment before surgery, and will describe the relative and absolute associations of frailty with commonly measured adverse outcomes, including morbidity and mortality, as well as patient-centered and reported outcomes related to function, disability, and quality of life. A proposed approach to optimization before surgery is presented, which includes frailty assessment followed by recommendations for identification of underlying physical disability, malnutrition, cognitive dysfunction, and mental health diagnoses. Overall, 30%–50% of older patients presenting for major surgery will be living with frailty, which results in a more than 2-fold increase in risk of morbidity, mortality, and development of new patient-reported disability. The Clinical Frailty Scale appears to be the most feasible frailty instrument for use before surgery; however, evidence suggests that predictive accuracy does not differ significantly between frailty instruments such as the Fried Phenotype, Edmonton Frail Scale, and Frailty Index. Identification of physical dysfunction may allow for optimization via exercise prehabilitation, while nutritional supplementation could be considered with a positive screen for malnutrition. The Hospital Elder Life Program shows promise for delirium prevention, while individuals with mental health and or other psychosocial stressors may derive particular benefit from multidisciplinary care and preadmission discharge planning. Robust trials are still required to provide definitive evidence supporting these interventions and minimal data are available to guide management during the intra- and postoperative phases. Improving the care and outcomes of older people with frailty represents a key opportunity for anesthesiologists and perioperative scientists.
The Visual Economy of “Precious Books”
Authors: Maasri Zeina
Published: May 2020

Shedding light on the postcolonial Arabic book, this article expands the literary and art historical fields of inquiry by bringing into play the translocal design and visual economy of modern art books. It is focused on the short-lived Silsilat al-Nafa'is (Precious Books series, 1967–70), published in Beirut by Dar an-Nahar and edited by modernist poet Yusuf al-Khal (1917–87). The series engaged prominent Arab artists and foregrounded the aesthetic dimension of the printed Arabic book as a “precious” art object. Situated historically at the threshold of contemporary globalization, this publishing endeavor formed a node connecting transnational modernist art and literary circuits with book publishing and was thus paradigmatic of new forms of visuality of the Arabic book. This materiality was enabled by a network of changes in the visual arts, printing technologies, and the political economy of transnational Arabic publishing in late 1960s Beirut. Relations between these three fields are analyzed through a multifaceted lens, focusing on the book as at once a product of intellectual and artistic practice, a commodity in a capitalist economy of publishing, and a translocal artifact of visual and print culture.
The Politics of What Is Islam?
Authors: Idris Murad
Published: May 2020

This essay analyzes the role of politics and power in Shahab Ahmed's What Is Islam? It is framed around three questions: (1) What kind of question is “What is Islam?”—or rather, for whom is this a question, and from which spaces and out of which times does it arise? (2) Who is the Muslim subject foregrounded in this book, and what are this Muslim's political and theological commitments? (3) What relations of power are embedded in the elevation of the “Balkans-to-Bengal complex” as the normative temporal-geographic entity?
“What Is Religion?”
Authors: Sullivan Winnifred Fallers
Published: May 2020

This review of Shahab Ahmed's What Is Islam? The Importance of Being Islamic explores the value of Ahmed's theory of religion through an analysis of some objects presented in Heavenly Bodies, a 2018 exhibit of Catholic fashion at the Metropolitan Museum of Art in New York City.
Supervisory Incentives in a Banking Union
Authors: Carletti Elena , Dell’Ariccia Giovanni , Marquez Robert
Published: May 2020

We study the consequences for supervisors’ and banks’ behavior of a “hub-and-spokes” supervisory system where a centralized agency has authority over banks but relies on local supervisors to collect actionable information. The model entails a principal-agent problem between central and local supervisors that leads to tougher supervisory standards but less compliance on the side of the supervised banks. Centralization entails greater inspection effort by the local supervisor and less bank risk taking if the divergence in the intervention policy of the central and the local supervisors is sufficiently small, but less effort and riskier bank portfolios if the divergence is large. The model has implications for the design of supervisory frameworks within integrated economies.

This paper was accepted by Karl Diether, finance.
A CONSTITUIÇÃO ENUNCIATIVO-DISCURSIVA DO QUADRO HERMENÊUTICO NO CONTO MENINA BONITA BORDADA EM ENTROPIA, DE CIRILO S. LEMOS
Authors: Celestino Ricardo
Published: May 2020

Neste artigo temos como tema o estudo da constituição enunciativo-discursiva do quadro hermenêutico em discursos literários extraídos do conto Menina bonita bordada em entropia, de Cirilo Lemos. Por objetivo primário, examinamos as condições para a consolidação de um quadro hermenêutico sob o referencial teórico-metodológico da Análise do Discurso de tendência francesa (AD), especificamente proposta pelos estudos de Maingueneau (2014). Em seguida, temos como objetivos identificar as formações discursivas da Ficção Científica, da Física e da Metaficção, a fim de refletirmos como os três campos discursivos auxiliam-nos na consolidação do quadro hermenêutico. Identificamos que a Ficção Científica escrita no Brasil é produtiva para os estudos críticos, dado o desempenho estético de seus discursos e a exigência de um coenunciador maduro que abra mão da perspectiva realista e busque alternativas no interdiscurso para a construção dos efeitos de sentido de um novo mundo a ser desbravado e explorado. Ainda, a metaficção, proposta pela crítica literária pós-moderna, oferece-nos um caminho produtivo para a análise da prática enunciativo-discursiva dos textos literários do gênero. Por a FC empreender enunciados que provocam o estranhamento e a comparação constante de realidades por parte do coenunciador, a metaficção organiza caminhos para o estabelecimento de um quadro hermenêutico que amadurece o olhar do leitor sem levá-lo a uma leitura única do texto literário, limitando sua hermeneia.
O STEAMPUNK: UMA MÁQUINA LITERÁRIA DE RECICLAR O PASSADO
Authors: Girardot Jean-Jacques , Méreste Fabrice
Published: May 2020

TRADUÇÃO
O HORROR MELANCÓLICO: RESENHA DE BILE NEGRA, DE OSCAR NESTAREZ
Authors: Da Silveira Louise Farias
Published: May 2020

Recebido em 03 Mar 2020.Aprovado em 27 Mar 2020.
Rare health conditions 35: acoustic neuroma, rhabdomyolysis, Barth syndrome
Authors: Barber Chris
Published: May 2020

The purpose of this series is to briefly highlight a range of rare health conditions. Rare health conditions are those that affect no more and usually fewer than 1 person in every 2000 and many HCAs and nurses will encounter some of these conditions, given the high number of these conditions. This 35th article will briefly explore three of these conditions: acoustic neuroma, rhabdomyolysis, and Barth syndrome.
Camera calibration based on the common pole-polar properties between two coplanar circles with various positions
Authors: Liang Sixin , Zhao Yue
Published: May 2020

Computer vision camera calibration is widely performed using parallel circles. Various cases of two coplanar circles are algebraically explained, proving that the common pole is located at the line at infinity for all relative positions, and the corresponding polar passes through the centers of the two circles. The two common poles of the two coplanar circles are the points at infinity when concentric; one common pole of the two coplanar circles is a point at infinity when nonconcentric. Accordingly, the vanishing line can be obtained by using the common pole-polar properties of two groups of two coplanar circles, and the camera’s intrinsic parameters are solved according to the constraints between the image of the circular points and the imaged absolute conic. The camera calibration can be solved using only three images of two coplanar circles. Simulation and experiments verify that the proposed algorithms are effective.
High laser damage threshold liquid crystal optical switch based on a gallium nitride transparent electrode
Authors: Xing Zhibo , Fan Wei , Huang Dajie , Cheng He , Xia Gang
Published: May 2020

High laser damage threshold optical switches and spatial light modulators are in urgent demand in high power laser fields. In this Letter, liquid crystal optical switches using Si-doped GaN and Mg-doped GaN as transparent electrodes are fabricated, and the influence of the conductive properties of GaN is analyzed. The transmission and absorption characteristics of GaN and its sapphire substrate are tested. The results show that the liquid crystal device based on gallium nitride can be expected to play an important role in the fields of visible and near-infrared laser regions with a high laser damage threshold of more than

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Ultralow-light-level color image reconstruction using high-efficiency plasmonic metasurface mosaic filters
Authors: Shah Yash D. , Connolly Peter W. R. , Grant James P. , Hao Danni , Accarino Claudio , Ren Ximing , Kenney Mitchell , Annese Valerio , Rew Kirsty G. , Greener Zoë M. , Altmann Yoann , Faccio Daniele , Buller Gerald S. , Cumming David R. S.
Published: May 2020

As single-photon imaging becomes progressively more commonplace in sensing applications such as low-light-level imaging, three-dimensional profiling, and fluorescence imaging, there exist a number of fields where multispectral information can also be exploited, e.g., in environmental monitoring and target identification. We have fabricated a high-transmittance mosaic filter array, where each optical filter was composed of a plasmonic metasurface fabricated in a single lithographic step. This plasmonic metasurface design utilized an array of elliptical and circular nanoholes, which produced enhanced optical coupling between multiple plasmonic interactions. The resulting metasurfaces produced narrow bandpass filters for blue, green, and red light with peak transmission efficiencies of 79%, 75%, and 68%, respectively. After the three metasurface filter designs were arranged in a

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format random mosaic pattern, this mosaic filter was directly integrated onto a CMOS single-photon avalanche diode detector array. Color images were then reconstructed at light levels as low as approximately 5 photons per pixel, on average, via the simultaneous acquisition of low-photon multispectral data using both three-color active laser illumination and a broadband white-light illumination source.
Como praticar a solidariedade em um contexto cada vez mais individualista e competitivo?
Authors: Oliveira Marina Cardoso de , Betanho Cristiane , Fernandes José Eduardo , Felice Elson de Oliveira
Published: May 2020

A Economia Popular Solidária se posiciona como uma abordagem crítica ao sistema capitalista. No entanto, na convivência com as dinâmicas de mercado, afloram relações individualistas entre os trabalhadores das organizações produtivas solidárias. Como enfrentar essa contradição e superá-la? Esse foi o objetivo de uma Roda de Conversa durante a V Jornada Universitária em Defesa da Reforma Agrária (JURA), ocorrida em maio de 2019 na Universidade Federal de Uberlândia. As trabalhadoras e os trabalhadores participantes apontaram ser imprescindível construirmos na prática relações socialmente referenciadas com a sociedade, expandindo a solidariedade para todos os trabalhadores que se relacionem a partir da Economia Popular Solidária, dentro e fora das iniciativas produtivas.
Práticas educativas críticas e o futuro da Economia Popular Solidária
Authors: Fernandes José Eduardo , Felice Elson de Oliveira , Betanho Cristiane
Published: May 2020

Este relato de experiência apresenta a reflexão dos participantes de uma Roda de Conversa durante a V Jornada Universitária em Defesa da Reforma Agrária da Universidade Federal de Uberlândia. Os participantes refletiram sobre a atual conjuntura sociopolítica e a realidade das iniciativas de trabalhadores que se propuseram a se organizar a partir dos princípios da Economia Popular Solidária. Os trabalhadores apontam a importância do desenvolvimento de práticas educativas críticas entre trabalhadores e incubadoras universitárias, para avançarmos para além da caridade e da solidariedade jurídica, para o reconhecimento do outro, no sentido da solidariedade de classe.
Electrospun Nanofibers and Applications: A Review
Authors: Jin Shixin , Xin Binjie , Kan Chi-wai
Published: May 2020

Electrospinning is one of the most effective ways of preparing nanofibers with a broad spectrum of potential applications. Its products can be used in air filtration, oil-water separation, sensors, carbon dioxide capture, supercapacitor, lithium-ion batteries, catalysts, tissue engineering, drug delivery, enzyme immobilization, and in many other fields. In this review, the mechanism, basic setup, and processing parameters are presented. Different kinds of methods for mass preparation and production devices are summarized and compared. Applications of electrospun nanofibers in different fields are also briefly discussed.
Changes in Knee Extension and Flexion Maximal and Rapid Torque Characteristics During a Collegiate Women's Soccer Season
Authors: Akehi Kazuma , Palmer Ty B. , Conchola Eric C. , Thompson Brennan J. , Kasl Alexa , Bice Matthew , Unruh Scott
Published: May 2020

Akehi, K, Palmer, TB, Conchola, EC, Thompson, BJ, Kasl, A, Bice, M, and Unruh, S. Changes in knee extension and flexion maximal and rapid torque characteristics during a collegiate women's soccer season. J Strength Cond Res 36(5): 1389–1395, 2022—The purpose of this study was to assess the changes in maximal and rapid torque capacities of the knee extensor and flexor muscles over the course of a competitive season in NCAA Division II women's soccer players. Eighteen female soccer athletes performed 2 maximal voluntary isometric contractions (MVICs) of the knee extensor and flexor muscles before, during, and at the end of the competitive season. Peak torque (PT) and rate of torque development (RTD) at 50 (RTD50), 200 (RTD200), and 100–200 (RTD100-200) milliseconds were extracted from each MVIC for both legs. The rapid (RTD50) to maximal force ratio (RTD:PT), hamstring-to-quadriceps (H:Q) strength ratio, and bilateral strength differences were also calculated. Results indicated that PT, RTD50, and RTD200 decreased 11–21% from the preseason to the midseason for the knee extensors (p < 0.02) and RTD50 increased approximately 11% from the midseason to the end of season for the knee flexors (p < 0.01). Rate of torque development-to-PT ratios for the knee extensors and flexors increased 12–25% at the end of the season (p < 0.05). Also, H:Q strength ratios using PT, RTD50, and RTD200 increased 12.5–24% after the season started (p = 0.001–0.04). There were no bilateral strength differences (dominant vs. non-dominant limbs) across the season (p > 0.05). These findings suggest that participation in a soccer season can change maximal and rapid torque production of the knee extensors and flexors. Coaches and clinicians should consider incorporating a season-long strength training and maintenance plan for soccer players with the aim to improve athletic performance and minimize the risk of musculoskeletal injuries to the lower extremities.
Effects of Gluteal Muscles Strengthening on Lower-Limb Injuries in Male Professional Handball Players: A Preliminary Study
Authors: Raya-González Javier , García-Esteban Sergio , Hume Patria , Castillo Daniel
Published: May 2020

Raya-González, J, García-Esteban, S, Hume, P, and Castillo, D. Effects of gluteal muscles strengthening on lower-limb injuries in male professional handball players: a preliminary study. J Strength Cond Res 35(6): 1593–1598, 2021—This study aimed to analyze the effects of a strength training injury-prevention program (STIPP) on injuries associated with weakness of the gluteal muscles in professional handball players. Twenty-seven professional Spanish male handball players from the same club, who competed at the Spanish Second National League level, participated in this study. The investigation was conducted over 2 consecutive seasons (2017–2018 and 2018–2019). The first season served as the control season (n = 21), and the second season served as the experimental season (n = 20). The STIPP was conducted 2 times per week, for 32 weeks, during the in-season period. There were no significant improvements in the injury incidence, pattern, or type for the experimental season group compared with the control season group (injury rate ratio [IRR] = 1.47; 95% confidence interval [CI]: 0.84–2.58; p = 0.17). However, there was a meaningful reduction in the number and burden of lumbar injuries after the STIPP (IRR = 55.83; 95% CI: 0.11–89.01; p = 0.001). In addition, burden values (number of absence days/1000 hours exposure) in all injury pathologies were lower during the experimental season compared with the control season. The STIPP focused on the gluteal muscles could be effective in reducing the number and burden of lumbar injuries in professional handball players.
Estimating Energy Cost of Body Weight Resistance Exercise Using a Multistage Exercise Test
Authors: Nakagata Takashi , Yamada Yosuke , Naito Hisashi
Published: May 2020

Nakagata, T, Yamada, Y, and Naito, H. Estimating energy cost of body weight resistance exercise using a multistage exercise test. J Strength Cond Res 36(5): 1290–1296, 2022—The purpose of this study was to examine energy cost of body weight resistance exercises with slow movement in young men using a multistage exercise test. Fifteen men aged 21–29 years performed 3 exercises (heel-raise, squat, and push-up) at different frequencies (1, 2, 3, 4, 5, and 6 repetitions·min−1). Oxygen consumption was measured using indirect calorimetry; we then computed a simple linear regression between aerobic energy expenditure (EE) and repetition frequency. The slope coefficient in the regression represents the energy cost of those exercises; we compared the extrapolated EE for a frequency of 10 repetitions·min−1. Gross EE increased linearly with repetition frequency in all subjects (y = ax + b). Energy cost was significantly greater in the case of the push-up than in the case of the squat {squat: 0.50 ± 0.14 (95% confidence interval [CI], 0.42–0.58); push-up: 0.77 ± 0.20 kcal (95% CI, 0.66–0.88); and the heel-raise elicited the lowest energy cost: 0.13 ± 0.04 kcal (95% CI, 0.11–0.15)}. Extrapolated EE at 10 repetitions·min−1 was 2.7 ± 0.5 kcal (2.3 metabolic equivalents [METs]), 6.3 ± 1.4 kcal (5.4 METs), and 9.2 ± 2.1 kcal (7.8 METs), respectively, according to the regression based on aerobic EE. These results will be useful for health professionals in prescribing resistance exercise programs improving muscle fitness and considering for weight management.
Psychophysiological Responses During a Cycling Test to Exhaustion While Wearing the Elevation Training Mask
Authors: López-Pérez María E. , Romero-Arenas Salvador , Colomer-Poveda David , Keller Martin , Márquez Gonzalo
Published: May 2020

López-Pérez, ME, Romero-Arenas, S, Colomer-Poveda, D, Keller, M, and Márquez, G. Psychophysiological responses during a cycling test to exhaustion while wearing the elevation training mask. J Strength Cond Res 36(5): 1282–1289, 2022—The aim of this study was to investigate the psychophysiological effects of wearing the elevation training mask (ETM). Twelve men performed time-to-exhaustion (TTE) tests at 75% of peak power output with and without wearing the ETM. Heart rate (HR), rating of perceived exertion (RPE), breathing discomfort (BD), and oxygen saturation (SpO2) were measured during the TTE. Prefrontal cortex (PFC) and vastus lateralis oxygenated, deoxygenated, and total hemoglobin were monitored using near-infrared spectroscopy. At the end of each test, blood lactate values (La-) were collected, and subjects completed the Beck Anxiety Inventory (BAI). The mask caused a reduction in the TTE (−37.7%; p < 0.001) and in the SpO2 (−2%; p < 0.001). Beck Anxiety Inventory scores were negatively correlated with the changes observed in the TTE (r = −0.77; p < 0.01). La-, HR, and muscle oxygenation displayed similar results across conditions. In conjunction with an increased hemodynamic response in the PFC, subjects reported higher RPE and BD values in the ETM condition (p < 0.01). Finally, BAI scores were negatively correlated with the changes observed in the TTE (r = −0.77; p < 0.01). This study suggests that wearing the ETM induces psychophysiological alterations affecting the exercise tolerance and limiting the performance.