bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT-LB119 Diabetic Ketoacidosis With PUMP Failure: Analysis of the 2006-2016 U.S. Kid Inpatient Database
Authors: Everett Estelle , Copeland Timothy , Moin Tannaz , Wisk Lauren 
Published: May 2020

Abstract
Background: Insulin pumps are valuable tools in diabetes management and their use has increased dramatically over the past decade. Unfortunately, insulin pump use has also been associated with diabetic ketoacidosis (DKA), relating to pump malfunctions that result in the disruption in insulin administration. Our objective was to examine the prevalence and characteristics of DKA admissions associated with pump failure among pediatric patients. Methods: We used the national Kids’ Inpatient Database to identify pediatric admissions with a primary diagnosis of DKA in years 2006, 2009, 2012, and 2016. We defined a DKA-pump failure admission as an admission with either a primary diagnosis of DKA plus a secondary diagnosis of pump failure/complication or conversely, a primary diagnosis of pump failure/complication with a secondary diagnosis of DKA. We used descriptive statistics and logistic regression to describe the annual trends and characteristics of children admitted for DKA with or without pump failure. Lastly, logistic regression was used to assess the impact of pump failure on length of stay and severity of illness during DKA admissions. Results: Our dataset included 166,583 DKA admissions, of which 2,291 (1.4%) were associated with a primary or secondary diagnosis of insulin pump failure. Between 2006 and 2016, the number of total DKA admissions increased by 58%. Admissions for DKA with pump failure increased from 387 to 665 admissions during this time. Among all children admitted with DKA, those with pump failure were primarily older (60% above age 12), mostly white (63%), female (57%), from urban areas (78%), and almost 2/3rds had private insurance (60%). Adjusted analyses revealed that compared to DKA admissions without pump failure, pump failure was associated with older age, white race, residing in a rural area, private insurance, and higher income. Pump failure admissions were more likely in western and southern hospitals, otherwise there were no significant differences with respect to hospital characteristics. Compared to DKA admissions without pump failure, DKA admissions associated with pump failure had a longer mean length of stay (2.6 vs 1.5 days) and were more likely to have a higher severity of illness category. Conclusion: In this national sample, DKA with pump failure was more often observed among white, privately insured and high income children; these patient characteristics likely reflect the population of youth with diabetes who are more likely prescribed pumps in the US. Admissions for DKA concurrent with insulin pump failure accounted for a minority of pediatric DKA admissions but these admissions were associated with longer lengths of stay and severity of illness. Pump failure has important implications for care and management of children with diabetes.
MON-LB88 Positive Predictive Value of TP53 Variants in Bethesda III/IV Thyroid Fine-Needle Aspirates
Authors: Livhits Masha J , Hu Mimi I , Waguespack Steven G , Wirth Lori J , Ladenson Paul W , Stack Brendan C , Hao Yangyang , Babiarz Joshua E , Kennedy Giulia C , Kloos Richard T 
Published: May 2020

Abstract
Introduction: Somatic DNA variants in the tumor suppressor gene TP53 have been reported in papillary thyroid carcinoma (PTC), Hürthle cell carcinoma (HCC), poorly differentiated thyroid cancer (PDTC), and anaplastic thyroid carcinoma. However, TP53 variants are uncommon among cytologically indeterminate thyroid nodules, so their positive predictive value (PPV) for malignancy, when identified, is unknown. The original Afirma Xpression Atlas reported genomic variants from the mRNA of 511 genes, including TP53. Here we report the PPV of TP53 alterations among Afirma Genomic Sequencing Classifier (GSC) Suspicious Bethesda III/IV nodules in real-world clinical practice.
Methods: A consecutive cohort of Afirma GSC Suspicious Bethesda III/IV nodules submitted to Veracyte for molecular analysis and positive for only TP53 alterations by the Xpression Atlas was identified. Local surgical pathology diagnoses were sought with IRB approval. One nodule per patient was included.
Results: Thirty-eight TP53 variants were present among &gt;13,000 Bethesda III/IV Afirma GSC Suspicious samples. Among the 22 with only a TP53 alteration, the first 16 consecutive nodules were included (7 nodules were Bethesda III and 9 nodules were Bethesda IV). Local surgical pathology diagnoses were available for 11 of these nodules. Seven nodules (64%) were malignant on surgical pathology: 3 cases of HCC, 1 PDTC, 1 follicular thyroid carcinoma (FTC), 1 follicular variant PTC, and 1 classical PTC. The mean size of malignant nodules was 3.6 cm (range 1-7.7 cm). The remaining four nodules (36%) were benign on surgical pathology, with a mean size of 2.6 cm (range 1.5-4.2 cm). Benign cases included 2 follicular adenomas (FA), 1 Hürthle cell adenoma (HCA), and 1 adenomatoid nodule (AN). Seven different TP53 variants were identified, and only one was observed at least 3 times (TP53: p.R248Q in 2 cases of HCC and 1 adenomatoid nodule). Given the small numbers, meaningful estimates of the variants’ individual PPVs could not be calculated.
Conclusions: TP53 variants among Afirma GSC Suspicious Bethesda III/IV nodules are very rare and associated with malignancy in 64% of nodules based on local pathology review. A broad range of both benign and malignant neoplasms, including HCC, PDTC, FTC, PTC, FA, HCA, and AN, were reported among nodules with TP53 alterations. The prognostic value of finding an isolated TP53 variant in Afirma Suspicious nodules remains unknown.
MON-LB115 Ready-To-Use Glucagon for the Prevention of Exercise-Induced Hypoglycemia in a Clinical Research Setting
Authors: Aronson Ronnie , Riddell Michael , Close Nicole C , Junaidi Khaled 
Published: May 2020

Abstract
OBJECTIVE: A mini-dose of a novel ready-to-use liquid stable glucagon (RTUG; Xeris Pharmaceuticals) was evaluated for the prevention of exercise-induced hypoglycemia (EIH) during and after moderate-to-high intensity aerobic exercise, in both a clinical research center (CRC) and outpatient setting. The observations from the CRC setting are reported here.
METHOD: A Phase 2 randomized, placebo-controlled, double-blind, two-treatment, crossover study enrolled 48 adults with Type 1 diabetes (T1D) treated with continuous subcutaneous insulin infusion, to evaluate the efficacy of pre-exercise RTUG in addition to standard of care basal insulin rate reduction. The CRC setting included 2 separate daytime exercise sessions 2 to 28 days apart. At 5 minutes prior to each exercise session, subjects reduced their basal rate of insulin infusion by 50% and self-administered placebo or RTUG 150 micrograms (μg) before performing 45 minutes of moderate-to-high intensity, aerobic exercise with a target of 80% maximum heart rate. Blood glucose was measured before, during, and after exercise to evaluate the incidence and severity of hypoglycemia.
RESULT: Of the 45 subjects (93.8%) that completed both exercise sessions in the CRC, EIH occurred more in placebo (n=8) compared to RTUG (n=1). More subjects used glucose tablets to treat EIH in placebo (n=4) compared to RTUG (n=1). Placebo-treated participants consumed 7-fold greater glucose tablets during and after exercise, and experienced more episodes of post-exercise hyperglycemia (blood glucose &gt;250 mg/dL), compared to RTUG. Treatment emergent adverse events with RTUG were comparable to placebo. RTUG 150 μg caused no edema, erythema, nor injection site reactions. RTUG was safe and well tolerated and no serious adverse events occurred.
CONCLUSION:RTUG 150 μg adequately maintained euglycemia during and following prolonged, continuous, moderate-to-high intense aerobic exercise in the controlled CRC setting. When used prior to moderate-to-high intensity aerobic exercise, RTUG may reduce exercise-induced hypoglycemia in adults with T1D. These findings support the continued evaluation in the outpatient setting.
SAT-LB2 Elevated Testosterone Secondary to Leydig Cell Hyperplasia in Bilateral Ovaries
Authors: Ali Sarah , Jaffee Ian , Kirkeby Kjersti Meyer 
Published: May 2020

Abstract
Background: Postmenopausal hyperandrogenism can be caused by androgen use, ovarian hyperthecosis, ovarian neoplasms, and adrenal neoplasms. Clinical case: A 64 year old post-menopausal woman presented for evaluation of hirsutism. She had developed generalized hair loss, terminal hairs on face and chest, and new onset acne after discontinuing hormone replacement therapy. During workup for hirsutism, she was found to have elevated testosterone at 119 ng/dL (reference range: 2-45 ng/dL). Other hormonal evaluation came back within normal limits, with DHEA sulfate &lt;15 mcg/dL (reference range &lt;186 mcg/dL), estradiol 25 pg/ml (reference range &lt;12-32 pg/ml), FSH 34.9 mIU/ml (reference range 23-116.3 mIU/ml), and LH 30.1 mIU/ml (reference range 15.9-54 mIU/ml). Transvaginal ultrasound did not reveal any abnormal adnexal masses. CT abdomen showed a 1.0 cm nodule in the left adrenal gland consistent with a lipid rich adenoma. Further work up showed a normal 24 hour urine free cortisol at 25 ug/24h (reference range: 4-50 ug/24h), normal 24 hour urine metanephrines at 709 ug/24h (reference range: 224-832 uh/24h), normal aldosterone at 13 ng/dL (reference range &lt;21 ng/dl) and renin at 0.37 ng/mL/h (reference range 0.25-5.82 ng/mL/h). MRI of the adrenal glands showed a slightly lobular left adrenal gland and no discrete adrenal mass. MRI of the pelvis showed mildly prominent ovaries bilaterally, but no adnexal or ovarian masses. After repeat laboratory testing showed consistently elevated testosterone levels up to 170 ng/dl and symptoms of hyperandrogenism persisted, the patient underwent bilateral salpingo-oophorectomy. Testosterone level post-operatively dropped to 18 ng/dl and remained within normal limits on repeated measurements. Her symptoms of hyperandrogenism resolved over the next several months. Surgical pathology showed endosalpingiosis, benign paratubal cysts, and confluent aggregates of Leydig cell hyperplasia in bilateral ovaries. Conclusion: Leydig cell hyperplasia is a rare cause of hypertestosteronemia that may be considered in patients with negative work up for alternative etiologies for post-menopausal hirsutism.
SUN-LB121 Nifedipine Worsens Glucose Tolerance in C57BL/6J Mice Exposed to Intermittent Hypoxia
Authors: Cardenas Stanley M Chen , Shimoda Larissa A , Punjabi Naresh M 
Published: May 2020

Abstract
Background: Intermittent hypoxemia (IH), a pathognomonic component of obstructive sleep apnea (OSA), has been independently associated with development of glucose intolerance, insulin resistance, and type 2 diabetes. L-type calcium channel blockers (CCB) influence glucose homeostasis including insulin sensitivity and secretion. To date, the potential impact of the combined effects of L-type CCB and IH on fasting glycemia and glucose tolerance have not been examined. The objective of this study was to determine whether CCB alters glucose metabolism in a murine model of IH. Methods: Adult male C57BL6/J mice (age 19-week-old) were exposed to IH using an automated system with specially-modified cages that oscillated FiO2from 21% to 5.5% at a target rate of 60 events/h during a 12 h (7am – 7pm) light cycle to simulate severe OSA for 5 days. The L-type CCB, nifedipine, or vehicle (polyethleneglycol-400) were administered at a dose of 20mg/kg/day via subcutaneous osmotic pumps (Alzet model 2001). Mice were exposed to IH or intermittent air (IA) with four resulting groups: IA-vehicle (n=12), IH-vehicle (n=16), IA–nifedipine (n=10), and IH–nifedipine (n=13). Fasting glucose, intraperitoneal glucose tolerance test, and insulin levels were obtained after exposures. Results: In the absence of a L-type CCB, IH increased fasting (105.1 vs. 71.2 mg/dL; p&lt;0.001) and 2-hour glucose levels (104.8 vs. 82.0 mg/dL; p=0.003). The area under the glucose tolerance curve (AUC) was also higher with IH than IA in mice treated with vehicle (17896.3 vs.13965.8 mg-min/dL; p&lt;0.001). Although the effects of IH on fasting glucose levels were comparable with and without L-type CCB treatment, the 2-hour glucose levels and the AUCs were substantially different. A statistically significant interaction was noted for the 2-hr glucose levels between IH and treatment with a L-type CCB (IH-CCB: 193.7; IH-V: 122.6; IA-CCB: 103.5; and IA-V: 82.0 mg/dL; p&lt;0.05 for interaction between IH and CCB). Finally, the AUC for IH-CCB treated mice was significantly higher than the AUC for IH-V treated mice (IH-CCB: 30223.1; IH-V: 17896.3. mg-min/dL; p=0.0001) Conclusions: In a murine model of IH, treatment with an L-type CCB exacerbates the deleterious effects of IH on glucose tolerance. Thus, use of CCB in patients with OSA should take into consideration these unfavorable effects particularly in those who are metabolically compromised.
SUN-LB110 The Nutrition Education Using a Health Care Application With Artificial Intelligence in Patients With Diabetes Mellitus
Authors: Higashitani Takuya , Kometani Mitsuhiro , Oka Rie , Gondo Yuko , Nomura Akihiro , Yasugi Ayaka , Aono Daisuke , Karashima Shigehiro , Yoneda Takashi 
Published: May 2020

Abstract
Background: Diet control is the basis of the treatment of type 2 diabetes. However, the education and practice of diet control for the patients with type 2 diabetes mellitus (T2DM) need a lot of manpower and time. In 2009, we have developed a telemedicine model that nutritionists analyze photos of T2DM patients’ meal and supervise them remotely. Our system resulted in the improvement of glycemic control of T2DM patients. Recently, the image analysis technology using the artificial intelligence (AI) progresses rapidly. The smart device application “Asken” has an AI-powered photo analysis system which analyzes the photo of the entire meal and identifies the frame of each item as well as its menu and serving amount. In addition, this application delivers individualized dietary messages and feedbacks. Case reports: We report two T2DM cases who conducted nutrient intervention by this application. One case was a 72-year-old man whose HbA1c decreased from 7.2% to 6.6% and weighed from 58.7kg to 57.5kg in 4 months. However, his total cholesterol increased from 119mg/dl to 200mg/dl, and low-density lipoprotein cholesterol (LDL) also increased from 47mg/dl to 106mg/dl. Another case is a 60-year-old man whose HbA1c improved from 7.0% to 6.6% and his weight decreased from 78.0kg to 76.0kg in 3 months. Total cholesterol was 140mg/dl to 128mg/dl, and LDL-cholesterol was from 65mg/dl to 54mg/dl. Conclusion: Using this application might be useful for diet control of T2DM patients. The effects of AI-supported nutrient intervention using application like this should be further clarified in the large number of patients.
SAT-LB306 A Case of Synchronous Non-Functioning Paraganglioma of the Urinary Bladder and Prostate Cancer
Authors: Choi Moon Kyung , Mahmood Ejaz , Ginzburg Serge , Minimo Corrado , Blocher Nissa 
Published: May 2020

Abstract
Introduction
The bladder is an uncommon site for a paraganglioma, with only &lt;1% of all paragangliomas occurring in the bladder. Management of non-functioning bladder paraganglioma is uncharted due to its rarity, and there is even less data for cases with synchronous malignancy. We found two case reports of synchronous paraganglioma and prostate cancer, only one in the bladder. Here we report a second case and discuss management.
Clinical Case
A 72-year-old man with high risk prostate cancer, Grade group 5 on biopsy, was found to have a 1.2 x 1.6 cm bladder wall mass on staging CT scan. The transmural mass was only partially resectable via transurethral approach. Pathology unexpectedly revealed paraganglioma, confirmed by immunohistochemical stains for Synaptophysin, Chromogranin, and CD56.
The patient had longstanding hypertension controlled on losartan and denied any symptoms of catecholamine excess. He had no family history of paraganglioma, pheochromocytoma, or related neoplastic syndrome. Plasma free metanephrine and normetanephrine levels were 57pg/mL (normal 57pg/mL) and 157pg/mL (normal 148pg/mL), respectively. Urinary studies were not performed due to stage 4 chronic kidney disease.
Staging CT scan and bone scan did not show any other lesions. Even in cases of known distant metastases of paraganglioma, surgical resection of all tissue is recommended if possible. Thus, he underwent radical prostatectomy, bilateral pelvic lymphadenectomy and partial cystectomy. Prostate cancer was downgraded to Grade group 2, pT3aN0Mo and complete excision of the paraganglioma was confirmed.
Evaluating for metastases and follow up are challenging in all paraganglioma cases, but especially non-functioning paragangliomas. Bladder paragangliomas carry a 10-15% risk of malignancy, but no separate data is reported for non-functioning ones. Histology scoring systems that are somewhat predictive in pheochromocytoma are less helpful in paragangliomas. Imaging is also challenging. CT, MRI, and a variety of functional imaging modalities have sensitivities for paraganglioma metastases in the range of 50 – 94% depending on location, functionality, and presence of germline mutation. For now, we recommend non-contrast CT with 18F-fluoro-2-deoxy-2-D-gluocse (FDG) PET. Though guidelines recommend annual biochemical surveillance, the usefulness in non-functioning paraganglioma is questionable.
Genetic testing is recommended for all patients with paraganglioma. Succinate dehydrogenase B (SDHB) is most important given the propensity for metastases. Thus, we recommended the SDHx germline mutation package.
Clinical Lesson
This case is the second reported synchronous bladder paraganglioma and prostate cancer. It highlights the challenge, lack of data, and need for advancement in our knowledge for the best management of incidental, non-functioning, extra-adrenal paragangliomas.
SAT-LB89 Choriocarcinoma Induced Hyperthyroidism: Molecular Mimicry Between HCG and TSH
Authors: Ankireddypalli Anvitha Reddy , Chandran Chandriya , Lamichhane Rabindra , Chirag Boradia , Nambi Sridhar Srinivasan 
Published: May 2020

Abstract
Introduction: Human chorionic gonadotropin(HCG) induced hyperthyroidism is a rare cause of hyperthyroidism. It is usually seen in conditions with extremely high beta HCG levels like hyperemesis gravidarum, hydatiform moles and germ cell tumors. We present a young male patient who had primary mediastinal choriocarcinoma with widespread lung metastasis and hyperthyroidism. Case: 18-year-old male presented to the emergency department for a fever of 105 F, cough, shortness of breath and night sweats for 9 days. He also reported unintentional weight loss for the past few weeks. Upon presentation, he was tachycardic at 104 beats/min, tachypneic and febrile. Physical examination revealed bibasilar crackles. Thyroid and scrotal examination were unremarkable. Laboratory work was significant for leukocytosis of 18.7 k/cmm, AST: 69 Unit/L, ALT: 60 Unit/L, ALP: 123 unit/L and LDH: 438Unit/L. Chest radiology showed bilateral multiple cannonball lesions with mediastinal and periaortic lymphadenopathy. CT chest, abdomen, and pelvis revealed innumerable diffuse bilateral lung masses, large anterior mediastinal mass, enlarged periaortic and paratracheal lymph nodes. Infectious workup was unremarkable. MRI brain revealed leptomeningeal involvement and vasogenic edema. Ultrasound of testicles revealed bilateral severe microlithiasis. CT guided biopsy of lung mass showed poorly differentiated choriocarcinoma. Treatment was initiated with systemic steroids, bleomycin, and cisplatin. Additional blood work revealed, B-HCG:736,598 mIU/mL, TSH:0.009UIU/ml, free T4:2.95ng/dL and total T3: 292.3ng/Dl. Thyroid radioiodine uptake scan was normal and planar imaging was also normal. Treatment with methimazole was deferred due to the up-trending transaminases and the resolution of tachycardia. Repeat labs after chemotherapy were TSH: 0.005UIU/mL, free T4: 2.04ng/dL, free T3:1.70pg/mL and BHCG: 202,471UIU/mL. Unfortunately, the patient had chemotherapy-resistant choriocarcinoma and succumbed to death after 4 cycles. Discussion: Beta HCG has an intrinsic thyroid-stimulating activity. The HCG -alpha subunit is common to all glycoprotein hormones like follicle-stimulating hormone, luteinizing hormone or thyroid-stimulating hormone. Frankly elevated levels should be treated symptomatically with beta-blockers and/or anti-thyroid drugs. Subclinical hyperthyroidism should be monitored closely. Some patients do not develop hyperthyroidism or a toxic goiter, as it is dependent on the timing of onset of cancer or due to the secondary modifications of HCG that can affect the bioactivity of HCG on the TSH receptor. This case draws our attention to the importance of focusing on the molecular mimicry of the HCG and TSH and management of HCG mediated hyperthyroidism.
MON-LB011 Retrospective Comparison of Cystic Fibrosis Related Diabetes Pediatric Screening Rates
Authors: Alkhatib Einas H , Kasim Nader 
Published: May 2020

Abstract
Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in those with CF, affecting 20% of adolescents and 40-50% of adults with CF. If uncontrolled, it can cause worsened pulmonary outcomes, increased hospital length of stay, and increased mortality. It is typically clinically silent, and hemoglobin A1C and fasting plasma glucose are not sensitive enough to diagnose it. Per national guidelines, the proper outpatient screening method is oral glucose tolerance test (OGTT), annually beginning age 10. Inpatient diagnosis involves fasting glucose &gt;126 mg/dl or 2 hour postprandial glucose &gt;200 persisting for more than 48 hours. It is believed that national screening guidelines are unfortunately not being met, particularly while inpatient. At our institution, there are 137 pediatric patients with CF; of those, 8 have a diagnosis of CFRD, and 4 have impaired glucose tolerance.
We aim to study the adherence of our institution to the best practice guidelines for CFRD screening in pediatric patients with Cystic Fibrosis.
Retrospective chart review is occurring through our institution’s EMR for inpatient data, and through a CF database (PortCF) for outpatient data. Inclusion criteria includes pediatric patients (below 1 day or above 17 years and 364 days) with CF. Exclusion criteria is those outside this age range, and those with CFRD. Consent is waived, as this is a retrospective data collection. Several variables including demographics, glycemic status, CFTR modulator and class, corticosteroid and vitamin use, and feeding regimen are also being reviewed. REDCap is being used for secure data entry and analysis. Descriptive statistical analysis will be used. Categorical data will be expressed as frequency (percent). Numeric data will be expressed as mean ± standard deviation or median [25th, 75th percentile], depending on normality of the data. Univariate analysis, like Chi square or Fisher’s exact test, will be used between successful and unsuccessful inpatient screens for CFRD.
Thus far, retrospective chart review of all outpatient data is complete. Preliminary analysis of those who should have received OGTT screening shows 11% have never been screened, and 32% were screened more than one year ago. Completion of inpatient data collection and all statistical analysis is anticipated within the next month. Future direction includes increasing inpatient CFRD screening with use of continuous glucose monitoring sensors during CF exacerbation admissions.