bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-139 Development of a Culturally Competent Skills and Knowledge Assessment Tool for Patients with Diabetes
Authors: Hakimian Stephanie , Karam Susan , Pardilla Kim , Coyne Kasey , Touma Emilie K , Larsen Diane , Holl Jane L , Wallia Amisha , Grace Prince 
Published: May 2020

Abstract
Training of diabetes (DM) skills is critical to assure competency of DM survival skills (e.g. glucose testing) for immediate self-care. While DM assessments exist, we sought to develop a culturally acceptable DM Skills and Knowledge Assessment (DM-SKA) tool. A systematic search of Pubmed/Medline and Scopus (1980-2017) of assessments for DM knowledge was performed. 24 studies were identified, only 33% reported minority populations. Studies were classified by topic: measurement of DM skills, objectives of DM training, assessments of DM education, and other non-patient assessments. Content from existing assessments was adapted to create a 12 question DM-SKA to address 6 domains: DM, blood glucose and self-monitoring, support services, identification management of hypo and hyperglycemia, and insulin administration. To assess cultural acceptance, cognitive evaluations were conducted in individual user sessions and focus groups. The DM-SKA had a baseline Flesch reading score of 81.3 (low complexity language) and Flesch-Kincaid reading grade level of 5.3. Of 39 approached, 85% (N=33) participated (6 inpatients refused, feeling “overwhelmed”). Participants were diverse, including 8 clinicians, 10 patients/caregivers, and 15 laypersons; 46% were non-Hispanic whites, 33% non-Hispanic blacks, 12% Hispanics, and 9% Asian Americans. Mean age of patient/caregiver/laypersons was 57.8±17 (44% &gt; age 65) and 40.1±12 years for clinicians (12.5% &gt; age 65). All clinicians reported that appropriate DM skill domains were included and felt patients would complete the tool. All patients/caregivers and laypersons (N=25) verbalized adequate comprehension of each question; 96% reported willingness to complete the DM-SKA if provided and 88% reported their family, friends or someone in their community would be willing to complete it. However, both providers (N=2) and patients (N=2) reported concerns about assessment format and delivery [e.g. “testing” or “quiz”]. Some younger (&lt;65 years) patients/caregiver/laypersons (N= 4) reported concerns about potential willingness of elderly family members to complete the tool. However, acceptability of the DM-SKA was noted from all participants &gt;65 years. Vision problems and older age were identified as potential barriers. Of those offered the assessment (N = 25), 5 (20%) participants needed assistance [N=2 vision, N=3 English as second language]. Mean DM-SKA score was 10.2±1.7 of 12. Incorrect answers mostly occurred for questions with multiple correct answers. The DM-SKA has acceptable literacy characteristics, cognitive validity, and cultural acceptability by racial/ethnic minority populations, including elderly persons. Future work includes integration into clinical workflows and incorporation of patient preferences.
MON-363 Massive Bony Exostoses and Diffuse Osteosclerosis Secondary to Hepatitis C: Case Report
Authors: Shelden Daniel , Choksi Palak 
Published: May 2020

Abstract
Introduction:
Acquired osteosclerosis due to hepatitis C is a rare complication. While there are previously published case reports of this condition, to our knowledge this is the first case reported with diffusely increased osteosclerosis and prominent bony exostoses.
Clinical Case:
A 52-year old woman was evaluated in the Metabolic Bone Clinic for non-radiating left hip pain and visibly prominent hard, non-tender masses at the lateral aspect of her bilateral hips and proximal humerus. She denied history of fragility fractures, radiation exposure, risk factors for sexually transmitted diseases or substance abuse. Laboratory evaluation showed vitamin D deficiency with a value of 18 ng/mL (reference range: 25-100 ng/mL), elevated alkaline phosphate of 426 IU/L (reference range: 30-116 IU/L) and markedly increased serum C-telopeptide with a value of 1901 pg/mL (reference range: &lt;1008 pg/mL). Plain radiographs showed multiple exostoses at the pelvis, hip, and shoulders. MRI showed extensive thoracic spine endplate sclerosis and increased sclerosis throughout the pelvis and proximal femurs. Massive calcifications adjacent to the greater trochanters were also identified. A total body bone scan revealed intensely increased uptake in multiple bones consistent with a “super scan.” Bone biopsy showed sclerotic bone with extensive remodeling. Computed tomography of the chest, abdomen, and pelvis was negative for malignancy. Given the symmetric nature of these lesions and diffusely increased uptake, the diagnosis of metabolic bone disease was considered. Further testing revealed hepatitis C Ab positivity confirmed with HCV Quant PCR 1553475 IU/mL (reference range: undetected). Pathologic findings were attributed to hepatitis C and treatment for hepatitis c was initiated with subsequent improvement in alkaline phosphate to 273 IU/L.
Clinical Lessons:
Osteosclerosis represents a little-known complication of hepatitis C. It is postulated that hepatitis C itself or other unknown agents may stimulate hepatic growth factors that increase osteoblast action. The radiographic and bone scan findings are classic for acquired osteosclerosis seen as increased cortical thickening with an intensely increased uptake in multiple bones. It frequently affects the lower extremity and this condition may take years to develop. Bone formation markers such as alkaline phosphate are typically elevated and bone biopsies show increased rates of remodeling as seen in our patient. While bisphosphonates may improve the serum markers for bone formation, they have not been shown to reverse or halt the progression of skeletal changes. Thus far, there has been a single case report showing improvement in sclerosis following treatment for hepatitis C with ribavirin and interferon. Natural history, progression and treatment of this condition have not been well established.
MON-480 Isolated Hyperthyroxinemia - Does Everyone Needs Treatment?
Authors: Bashir Bilal , Banerjee Moulinath , Bharaj Harnovdeep Singh , Krishnan Simmi , Khan Atir , Williams Carolyn , Basu Ambar 
Published: May 2020

Abstract
Background: Raised free thyroxine (T4) with normal thyroid stimulating hormone (TSH) levels should be identified and interpreted with caution. Some of these conditions do not need treatment. We present three cases with similar biochemical abnormalities from three different causes.
Case 1: A 62-year-old clinically asymptomatic lady was referred to us with Free T4 34.9 pmol/L (10.0 – 24.0 pmol/L), TSH 0.81 mU/L (0.2 – 5.0 mu/L) and negative TSH receptor antibodies (&lt;0.9 IU/L). She was trialled on antithyroid drugs for 6 months. Her Free T4 stayed elevated between 29.0 – 35.0 pmol/L with normal TSH. We worked up for assay interference by running tests on two analysers, Roche Cobas e801 and Siemens ADIVA Centaur CP, both yielded similar results. Alpha1 glycoprotein subunits and SHBG were normal with clinical euthyroid status making TSHoma less likely. Serum protein electrophoresis did not detect any abnormal albumin. We were unable to perform equilibrium dialysis due to non-availability of facility at our centre. Due to strong clinical suspicion and family history of thyroid dysfunction that never needed a treatment, we tested her genetically for familial dysalbumineic hyperthyroxinemia (FDH) using mutation surveyor and fluorescent sequence analysis showed her to be heterozygous for c.725G&gt;A ALB variant confirming diagnosis of FDH.
Case 2: A 65-year-old clinically asymptomatic lady, was referred to us with Free T4 28.8 pmol/L (10.0 – 24.0 pmol/L) and TSH 2.50 mU/L (0.2 – 5.0 mu/L). Given inappropriately normal TSH levels, we repeated her TFTs using 3 different analysers, Roche cobas e801, Siemens ADIVA centaur CP and Abbot ARCHITECT i1000SR. Roche and Siemens assays yielded similar results, however Abbot assay showed normal thyroid function tests with TSH 1.01 mu/L (0.4-5.0 mu/L) and free T4 18.7pmol/L (9.0-19.0 pmol/L), confirming assay interference. As Siemens and Roche uses streptavidin-biotin immobilizing system while Abbot uses a magnetic bead-based capture system, the abnormal results could be due to biotin interference.
Case 3: A 65-year-old lady, clinically asymptomatic was referred to us with Free T4 29.2 pmol/L (10.0 – 24.0 pmol/L) and TSH 1.59 mU/L (0.2 – 5.0 mu/L), 3 months after stopping amiodarone, which she took for 3 weeks for atrial fibrillation. This was thought to be due to amiodarone, owing to its long half-life of 58 days. We repeated thyroid function tests in 3 months from first clinical encounter i.e. 6 months after stopping amiodarone that showed Free T4 24.2pmol/L and TSH 2.30 mU/L and repeated further 3 months later that were normal, confirming amiodarone induced abnormal biochemical profile requiring no treatment.
Conclusion: Hyperthyroxinaemia with normal TSH need to be interpreted with caution as illustrated above. Some of them do not need treatment and inappropriate interpretation can potentially cause anxiety for the patient and harm due to unnecessary treatment.
MON-604 Conscious and Pre-Conscious Attentional Bias to Food in Patients Submitted to Bariatric Surgery
Authors: Friedman Rogerio , Heredia Mariana L D C , Weydmann Gibson 
Published: May 2020

Abstract
Obesity is the result of a positive energy balance. Cognitive biases have been shown to co-occur with obesity, highlighting the hypothesis that certain cognitive functions increase the risk for obesity. Attentional bias (AB) to food stimuli is one of the cognitive components that seem to contribute to the onset and course of obesity. The treatment of obesity still represents a major health challenge. The most effective treatment for severe obesity is bariatric surgery (BS). Patients with higher degrees of adiposity – the so-called “superobese” (SO), whose body mass index (BMI) is ≥ 50 kg/m2 - seem to lose more weight after BS than the non-SO patients. On the other hand, SO patients are more likely to regain weight. Differences in behavior and cognition before and after BS may explain weight regain differences. The aim of this study was to assess food AB in a sample (n = 59) submitted to Roux-en-Y gastric bypass (RYGB) and to compare food AB between the subjects who were SO before surgery, and those who were non-SO. 59 patients underwent anthropometric assessment, clinical interview, psychometric questionnaires, and AB behavioral assessment. Participants were mostly white (n = 46, 78%), had incomplete elementary school (n = 23, 39%), did not work (n = 31, 52.5%), and were in socioeconomic class C1 (n = 24, 40.7%). BMI before BS was 49.70 ± 1.25 kg/m² (mean ± S.D.). The last available BMI after surgery (assessed within 30 days from the assessments) was 33.60 ± 7.31 kg/m². The mean postoperative follow-up time at assessment was 47.76 ± 3.04 months. Most participants were above the cutoff points for binge eating disorder (n = 54, 91.5%) and impulsivity (n = 45, 76.3%). The overall sample showed food AB ​​(16.30 ± 7.09) when food stimuli were exposed during 2000 msec, suggesting a conscious attention towards food stimuli (t (58) = 2.303, p = .025, d = 0.29). SO and non-SO were compared using post-operative time as a covariate. Food AB was significantly higher in SO (24.06, SEM 8.55) than in non-SO (-12.98, SEM 8.11) when food stimuli were exhibited during 500 msec, indicating a pre-conscious attention to food stimuli in SO (F (2, 106) = 5.124, p = .008, η²partial = .083). At 500 msec, AB value was significantly different from 0 only in SO (t= 2,763, p = .010, d = 0.53, n=27), indicating an AB to food stimuli when attention orientation was less possible. Overall, the food AB observed in the whole sample indicates that all patients show a conscious attention toward food stimuli after BS, which may influence weight maintenance. Notwithstanding, the result was different when SO and non-SO were compared considering the post-operative time. The longer the time elapsed since surgery, the higher the food AB at 500 msec in SO. Given that SO patients have a higher risk of weight regain, these data suggest that a non-conscious AB after bariatric surgery may be one of the inductors of food ingestion, thus predisposing to weight regain.
SUN-126 Distinct Molecular Phenotypes of Non-Diseased Breast Adipose Tissue of Pre-Menopausal Obese and Non-Obese Women May Underlie Differing Breast Cancer Risks
Authors: Alhallak Iad , Wolter Keith G , Simmen Frank A , Ward Richard Jon , Petty Stacy A , Simmen Rosalia C M 
Published: May 2020

Abstract
Obesity is a major risk factor for many chronic diseases including postmenopausal breast cancer. Paradoxically, breast cancer susceptibility is inversely linked to obesity in pre-menopausal women. Adipose tissues are active endocrine organs that play major roles in tumor development and progression; however, fat depots at different anatomical sites are biologically and functionally distinct and their singular influence on breast epithelial biology remains unclear. To study the early events by which breast adiposity may provide a microenvironment predisposing normal breast epithelial cells to tumorigenesis, we collected breast tissue from pre-menopausal (n=10/group) non-obese (NO, BMI=27.6±0.8) and obese (O, BMI=44.5±2.8) women of comparable ages (NO: 36.1± 3.3; O: 40.0±2.0) with no breast cancer and undergoing elective breast reduction surgery. Breast adipose tissue and corresponding glandular cells were analyzed histologically and evaluated for expression of genes (adipokines, cytokines, steroid hormone signaling) by QPCR and proteins (proliferation, apoptosis, inflammation) by IHC. Adipocyte size distributions from NO and O breasts did not differ (P=0.9). However, adipose mRNA levels for pro-inflammatory cytokines (IL-6, IL-8, CSF-1, MCP-1) and adipokines (LEP, CFD) were higher for O than NO (P&lt;0.05). AdipoQ, ER-α, and ER-β transcript levels were lower for O than NO (P&lt;0.05), while those for CYP19 and PTGS2 showed reverse trends (O&gt;NO, P&lt;0.05). In the corresponding glandular cells, NO had higher mRNA levels for IL-6, IL-8, ER-α, and ER-β than O (P&lt;0.05). Immunostaining with anti-Ki67 antibodies indicated that O glandular cells were 3-fold less proliferative than those for NO, consistent with their lower Cyclin D1 mRNA levels (P&lt;0.05). Galectin-1, a pro-fibrotic protein, showed predominant myo- vs. luminal epithelial localization, with staining intensities for O tending to be higher (P=0.07) than for NO. Perilipin immunostaining was specific for adipocytes and did not differ for O and NO. A non-targeted approach using a Human Cytokine Array (R&D Systems) was employed to further evaluate the inflammation status of O vs. NO adipose. The analyses confirmed the higher expression of IL-8, Leptin and CFD (by QPCR) in O vs. NO and identified C-reactive protein, EMMPRIN, Trefoil Factor-3, Cystatin-3 and Macrophage Migration Inhibitory Factor-1 as greater in O than NO (~2-fold). Our findings demonstrate marked differences in gene and protein expression patterns of O and NO breast adipose tissue, which were accompanied by a suppression of proliferation of O relative to NO breast epithelium. We speculate that early exposure of the breast epithelium to a highly inflammatory environment fueled by breast adiposity may promote a senescent state that confers protection from pre-menopausal breast cancer.
SUN-748 Functional Characterization of Estrogen-Regulated LncRNA16 in ER+ Breast Cancer
Authors: Yang Barbara , Ramos Enrique Ivan , Choudhari Ramesh , Zilaie Mina , Sanchez-Michael Laura A , Sedano Melina , Gadad Shrikanth 
Published: May 2020

Abstract
Long noncoding RNAs (lncRNAs) have been demonstrated to be involved in diverse cellular processes as important regulators, such as in cancer. However, their roles in breast cancer biology are greatly unknown so far. In our study, integrated analysis of subcellular fractionation RNA-seq with gene expression profile from human reproductive tissues yielded a comprehensive catalog of estrogen-regulated reproductive tissue-specific lncRNAs. We selected long intergenic noncoding RNA 16 (LINC16) for further study as it was the top upregulated lncRNA by estrogen and associates with clinical outcome. Analysis of RNA-seq data from different human tissues, we found that LINC16 is highly expressed in testis and followed by other reproductive organs, cervix and uterus. Interestingly, interrogation of expression data from human cancer tissues showed LINC16 is highly expressed in breast cancer compared to other cancers. We have determined the 5’ and 3’ ends of LINC16 and its exon/intron structure, and cloned LINC16 to study its function in molecular and cell-based assays. Our preliminary results suggest that LINC16 plays a critical role in ERα-dependent pathways.
MON-248 Tachycardia and Myocardial Injury Induced Natriuresis - a Rare Clinical Encounter
Authors: Bashir Bilal , Basu Ambar , Lomas John-Paul , Little Steven , Banerjee Moulinath 
Published: May 2020

Abstract
Introduction:
Hyponatremia in the context of cerebral salt wasting secondary to intracranial events has well been described due to increased release of natriuretic peptides. We describe a case of natriuresis leading to acute symptomatic hyponatremia associated with tachyarrhythmia and myocardial infarction.
Case:
A 72-year-old lady was admitted with atrial fibrillation with rapid ventricular rate between 130-150 beats per minute, troponin positive chest pain, with high sensitivity troponin T of 1307 ng/L (&lt;14 ng/L) and managed as type II myocardial infarction. 12 hours after admission she became acutely confused, agitated, associated with visual hallucinations and myoclonic jerks. On Examination she was dehydrated and there were no focal neurological features. Investigations showed acute hyponatremia with serum sodium (Na+) of 117 mmol/L (135 - 145 mmol/L) which 12 hours earlier, on admission, was 137 mmol/L, serum osmolarity 249 mosm/kg (275 - 295 mosm/kg), urine osmolarity 486 mosm/kg, urinary sodium of 160 mmol/L, pro-NTBNP 6575pg/ml (&lt;450 pg/ml), 9am serum cortisol 575 nmol/L (140 - 690 nmol/L), TSH 4.72 mu/L (0.2 - 5.0 mu/L), FT4: 18.6pmol/L (10.0 - 24.0 pmol/L) and normal chest x-ray. She was treated with hypertonic saline (2.7%) 200ml followed by 0.9% saline infusion that corrected her serum sodium levels to 136 mmol/L over next 48-72 hours along with clinical symptoms gradually went back to normal. Repeat pro-NTBNP after recovery was 3153 pg/ml. Echocardiography showed normal left ventricular systolic function with normal atrial size and moderate mitral regurgitation with pulmonary artery pressure of 30mmHg. Based on acute onset hyponatremia and raised urinary sodium, we proposed diagnosis of hyponatremia secondary to salt wasting and we believe that in absence of acute intracranial pathology and raised pro-NTBNP, renal salt wasting was induced by acute rise in natriuretic peptides of cardiac origin either secondary to myocardial infarction or tachyarrhythmia. Paroxysmal SVT is a known cause of transient polyuria after termination but is not known to cause hyponatremia. Although well described in context of intracranial events, this is the first case of myocardial injury or tachyarrhythmia induced natriuresis leading to acute hyponatremia.
Conclusion:
Salt wasting due to natriuretic peptides is not exclusive to intracranial events. Any cardiac event leading to sudden increase in natriuretic peptides can lead to natriuresis which if prolonged enough can lead to acute symptomatic hyponatremia.
Reference:
1. Yee AH, Burns JD, Wijdicks EF. Cerebral Salt Wasting: Pathophysiology, Diagnosis, and Treatment. Neurosurgery Clinics of North America, 21(2), pp.339-352.
2. Tan SY, Nolan J, Craig K, Swainson CP. Supraventricular tachycardia, right atrial pressure, atrial natriuretic peptide and polyuria—a necessary sequence? J Int Med 1993; 233: 415-17.
SAT-360 Out of Sight, out of Mind: PHEX 3’-UTR C.*231A&gt;G X-Linked Hypophosphatemia in Adults: A Case Study of One Family Pedigree with a Widely Variable Phenotype
Authors: Williams Alexander , Black Margo , Dahir Kathryn 
Published: May 2020

Abstract
Title: Out of Sight, Out of Mind: PHEX 3’-UTR c.*231A&gt;G X-Linked Hypophosphatemia in Adults: A Case Study of One Family Pedigree with a Widely Variable Phenotype
X-linked hypophosphatemia (XLH) is an inherited form of hypophosphatemia that is part of a group of disorders that leads to impaired bone mineralization, which can manifest as rickets in children and osteomalacia in adults. Mutations in PHEX, DMP1, ENPP1, and activating mutations in FGF23 have each been shown as genetic causes for XLH. PHEX is a zinc metallopeptidase which reduces expression of FGF23 through mechanisms that are not fully understood. Inactivating mutations in the PHEX gene cause elevated levels of FGF23, resulting in renal phosphate-wasting, impaired conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D and impaired bone mineralization with osteomalacia. Though the clinical significance of FGF23 levels is not clearly understood, it has also been shown that FG23 increases with age.
XLH has a reported prevalence of 3.9–5 per 100,000. We speculate that this may be under recognized and that diagnosis may be delayed for many years in those with mild forms of XLH due to non-specific symptoms. Diagnosis may be complicated by normal or low-normal serum phosphorus levels. Adults may be mistakenly diagnosed with ankylosing spondylitis, polyarthritis, osteoarthritis, diffuse idiopathic skeletal hyperostosis and other disorders that cause stiffness. Some clinical manifestations of XLH in adults include dental disease, skeletal and spinal disease, sensorineural hearing loss, kidney stones, renal impairment, and hyperparathyroidism. The PHEX 3’-UTR c.231A&gt;G near the polyadenylation signal has been previously described to cause milder severity in men and seemingly unaffecting women, but data for comparison is limited.
We present a large, multigenerational family with a mutation in the PHEX gene (3’-UTR c.*231A&gt;G) demonstrating variable penetrance in the pedigree. Of the members positive for the mutation, the most common symptoms were sensorineural hearing loss, enthesopathy, and dental disease. Most had normal or low-normal phosphorus levels in both genders. Two patients had prior diagnoses of ankylosing spondylitis/ seronegative spondyloarthropathy. In general, males with the mutation had more severe symptoms than females. However, females with a severe phenotype and low phosphorus was also observed. The disease burden was cumulative over time and correlated with serum phosphorus levels. Musculoskeletal symptoms were increased in the members over the age of 60.
Sources:
Chesher, Douglas et al. Outcome of Adult Patients with X-Linked Hypophosphatemia Caused by PHEX Gene Mutations. Vol. 41. Dordrecht: Springer Netherlands, 2018. Web.
Zhang, Cong et al. Clinical and Genetic Analysis in a Large Chinese Cohort of Patients with X-Linked Hypophosphatemia. Vol. 121. Elsevier Inc, 2019. Web.