bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-LB109 Transcutaneous Magnetic Stimulation: A Novel Treatment of Diabetic Peripheral Neuropathy
Authors: Satyarengga Medha , Munir Kashif M 
Published: May 2020

Abstract
Objective: Transcutaneous Magnetic Stimulation (TCMS) is reported to be an effective treatment in multiple neurologic conditions such as migraine headaches, lower back pain, and post-traumatic peripheral neuropathic pain1-3. The efficacy and safety of TCMS for diabetic peripheral neuropathy is not known. We evaluated whether TCMS is effective and safe in patients with diabetic peripheral neuropathy. Method: Eight patients with a previous diagnosis of diabetic peripheral neuropathy and baseline numerical pain-rating scale (NPRS) of 5 or greater in both feet were enrolled. NPRS scale was set from 0 to 10, 0 represents no pain and 10 representing the most severe pain. Each patient was treated with a single session of TCMS applied first on the plantar then the dorsal surface of both feet. Magnetic pulses (1.2 Tesla) were delivered every 6 seconds for 5 minutes in each foot on the plantar and dorsal surfaces, respectively. NPRS was repeated post-treatment over the course of 28-days follow-up period. Results: The mean baseline NPRS was 5.8 (± 1.0). Immediately post-treatment, mean NPRS improved to 1.3 (± 1.9), a 77.7 (± 36.5) % decrease. Mean NPRS at 7 and 28 days of follow-up was 2.9 (± 2.8) and 4.1 (± 3.3), respectively. These represent a 53.2(± 42.4) % improvement at 7 days and 30.5(±52.4) % improvement at 28 days of follow-up compared to baseline NPRS. None of the patients reported significant discomfort during the treatment, and no major side effects were observed during the study period. Conclusion: In this pilot study of patients with diabetic peripheral neuropathy, TCMS appears to be a safe and effective alternative in providing temporary pain relief. Longer and more frequent treatment sessions need to be explored to see if these can increase the effective duration.
References: 1. Barker AT, Shields K. Transcranial Magnetic Stimulation: Basic Principles and Clinical Applications in Migraine. Headache. 2017 Mar;57(3):517-524. 2. Leung A, Fallah A, Shukla S. Transcutaneous Magnetic Stimulation (tMS) in Alleviating Post-Traumatic Peripheral Neuropathic Pain States: A Case Series. Pain Medicine. 2014 Jul; 15(7): 1196-1199. 3. Lim YH, Song JM, Choi EH, Lee JW. Effects of Repetitive Peripheral Magnetic Stimulation on Patients with Acute Low Back Pain: A Pilot Study. Ann Rehabil Med. 2018 Apr; 42(2): 229-238.
SUN-LB73 Is It Possible to Optimize Resources in Bone-Alkaline Phosphatase Medical Request?
Authors: Sequera Ana M , Ruibal Gabriela Fernanda , Chavarria Eleonora Nuñez , Fideleff Gabriel , Iparraguirre María Jose , Farelo Hilda Ines 
Published: May 2020

Abstract
INTRODUCTION: Bone metabolism assessment includes total alkaline phosphatase (ALP) and more specifically the bone-alkaline phosphatase (BAP) as markers of bone formation. Its measurement is important for diagnosis and in bone pathology treatment following-up. In our setting, a ten-fold price for BAP has raised the necesity to review in how many cases its request has been justified. AIM: Establish through an appropiate statistical analysis, cut-off values of ALP that could guarantee to perform BAP measurements. Its analysis would allow us to make a demand adequacy. MATERIALS AND METHODS: A retrospective study was carried out on laboratory analysis orders of 405 adult women. We separate them into the following groups: (G1): 48 premenopausal womens (pre) and 357 post menopausal women (pos): (G2)133 &lt;60 years-old, (G3)135: 60-69 years-old and (G4)89: &gt;70 years-old. All patients had measurements of both analytes; ALP (colorimetric method, Roche Cobas, Reference value (RefV)=40-130 UI/L) and BAP (QLIA, Liaison Diasorin, RefV pre=3-19 ug/mL, pos=6-26 ug/mL). Statistic analysis: ROC-Plot to define cut-off value (we define as true positive BAP values over RefV). Kruskal Wallis, Dunn test to compare all the groups. RESULTS: (median and range): ALP(UI/L) G1: 81(38-265) G2: 88(47-211)*, G3: 85(39-213) y G4: 80(40-138) (*p&lt;0.05 G2vsG4). BAP (ug/L) G1: 13.6(5.1-106), G2: 14.3(3.5-61.5)*, G3: 13.9(2.9-52.5) and G4: 11.6(2.0-29.6), (*p&lt;0.05 G2vsG4). We observe that 73% of G1, 93.5% of G2, 92.6% of G3, 97.7% of G4 has showed normal values. The ROC plot analysis showed the best cut-off for ALP in G1=87 (S=92%,Sp=85%,AUC=0.955). If, using this cut off we had processed 18 BAP which 6 patients would have been normal (33.4%). In G2=127 (S=100%, Sp=97.6%, AUC=0.996) using this cut off we had processed 13 BAP, which 4 patients would have been normal (30.8%). Meanwhile in G3=102(S=100%, Sp=85.6%, AUC=0.97) we had processed 30 BAP and G4=120 (S=100%, Sp=96.5%, AUC=0.966) we had processed only 6 BAP. CONCLUSIONS: Application of the calculated cut-off allowed us to investigate 97% of the pathological BAPs. The measurement of ALP first, would guarantee to process only 17% of the requested BAPs. This suggestion would result in a significant saving of our resources, maintaining the quality of care. It is necessary to apply cut-off according to age to justify the BAP assesment. Physicians must define the appropriate exceptions.
MON-LB111 Evaluation of Mixed Meal Test on the Diagnosis of Hyperinsulinemic Hypoglycemia After Bariatric Surgery
Authors: Asato Marilia Tomiyoshi , Azuaga Carolina Croce , Scalissi Nilza , Medeiros Monica De Aguiar , Salles Joao Eduardo , Parente Erika Bezerra , Napoli Thiago Fraga , Cury Adriano Namo , Scalco Renata Da Cunha , Franco Pedro Campos , Umeda Luciana Mela , Fukunaga Erika , Fernandez Monica , Lima Jose Viana 
Published: May 2020

Abstract
Background and aims: The physiopathology of hyperinsulinemic hypoglycemia (HH) after gastric bypass (GB) is not well understood, although it is a common adverse event after this procedure. The fast absorption of glucose after a meal, the high glucose variability, the increase in glucagon peptide 1 secretion or the hyperplasia of beta cell have been postulated as possible hypothesis. Mixed Meal Tolerance test (MMT) is used in clinical practice during HH investigation, but there is no consensus for HH diagnosis after bariatric surgery. In this scenario, we evaluated the MMT for the diagnosis of HH after GB. Material and Methods: This is an observational cross sectional descriptive study of adult (&gt; 18 years) patients submitted to a MMT after GB from July 2016 to October 2019. 51 patients were divided in two groups: Group 1, with a history of predominantly neuroglycopenic symptoms (n = 24) and Group 2 (control) without symptoms of postprandial hypoglycemia (n= 27). The patients had no diagnosis of diabetes and weren’t using any hypoglycemic drugs. All subjects performed the MMT composed by a typical Brazilian breakfast with the following composition: 494 Kcal with 63.4% carb, 27.5% fat and 9.1% protein, in the morning after 8h fasting and blood samples (glucose, insulin, C peptide) were collected before the meal and every 30 minutes for 5 h after it. A positive test was considered if patient presents Whipple’s Triad: HH (plasma glucose was ≤ 55mg/dL with insulinemia ≥ 3 µU/mL, C peptide ≥ 0.6 ng/mL) and hypoglycemic symptoms. Statistical analysis were done using SPSS 13.0 version. Results:​ From 51 patients, 46 were female, mean age was 46.8 ± 9.2 years. 15 of the 24 patients with predominantly neuroglycopenic symptoms (Group 1) developed laboratory HH, but only 9 (37.5%) presented the Whipple’s Triad. Only one subject of the control group presented HH. All patients with neuroglycopenic symptoms during the test presented HH. From those with HH, 43% presented hypoglycemia at 90’, 50% at 120’ and 6.2% at 150’ during MMT. There were no difference between the two groups when compared the amount of weight loss neither the period of follow up after GB. Conclusion: Since all patients with neuroglycopenic symptoms during the test presented HH it might be a useful tool to exclude HH in patients with hypoglycemic symptoms after GB. This study suggests that the BMT doesn’t need to be 5h, since all of hypoglycemic episodes occur until 150’.
SUN-LB3 Relationship Between BMI and PCOS Symptoms Among Flo App Users in the United States
Authors: Negris Olivia , Brown Dannielle , Galic Isabel , Zhaunova Liudmila , Klepchukova Anna , Jain Tarun 
Published: May 2020

Abstract
Polycystic ovary syndrome (PCOS) is known to affect 6%-12% of women of reproductive age in the United States. PCOS is a heterogeneous condition associated with menstrual cycle irregularity and androgen excess. Though many women with PCOS have a BMI classified as overweight or obese, information is limited on how specific symptoms and BMI mediate PCOS diagnoses in the general population. A questionnaire on PCOS-related symptoms and previous PCOS diagnosis was available to Flo users during one month (2019). Women aged 18-44 years seeking to track their cycle or to conceive, who were not pregnant, on active contraception or in stabilization mode after pregnancy, and had Flo app running in English met the study inclusion criteria. Participant characteristics including age and BMI were also collected from Flo app users during the sign-up process. All users in the study had agreed to the use of their de-identified and aggregated data for research purposes. The differences in clinical manifestation of PCOS symptoms between BMI groups were analyzed. Of US users with BMI data in the whole cohort, 8,808 women reported having physician-diagnosed PCOS, 5,551 women reported not having a PCOS diagnosis, and 58,478 reported that they had not been checked for PCOS. Of women with PCOS, 19.5% were normal weight (BMI 18.5-24.9), 19.7% were overweight (BMI 25.0-29.9), 20.4% were obese (30.0-34.9), 17.8% were severly obese (BMI 35.0-39.9), and 21.0% were morbidly obese (BMI 40+). The most common symptoms among PCOS positive women were bloating (38.7%), hirsutism (38.2%), and irregular cycle (26.0%). A direct relationship exists between BMI and having PCOS, as the percentage of PCOS in obese, severely obese, and morbidly obese BMI groups was higher (1.37, 1.87, and 2.12 times, respectively) than in the whole cohort. Similarly, among women who report acne, skin hyperpigmentation, bloating, hirsutism, heavy menses, baldness, family history of PCOS, high cholesterol, irregular cycle, and inability to conceive for &gt; 1 year, there is a direct relationship between BMI and the percentage of women with PCOS. Moreover, when identifying symptoms and findings serving as strong predictors of a positive PCOS diagnosis, hirsutism, high glucose, and high levels of both cholesterol and glucose were the top symptoms and findings for women with BMI 18.5-34.9. Hirsutism, high glucose, and inability to conceive for &gt; 1 year were the strongest predictors of PCOS for women with BMI 35+. Among all users with hirsutism, the percentage of women with PCOS increased 3.65 times compared to the whole cohort, making it the strongest predictor of PCOS. Understanding BMI patterns as they relate to PCOS symptoms allows for better understanding the pathophysiology of PCOS. Among women with PCOS in the United States, changes in BMI are associated with variations in the many symptoms of PCOS.
SUN-LB23 Translational Feasibility of Steroidogenic Factor-1 Antagonists as a Novel Targeted Therapy for Adrenocortical Cancer
Authors: Crowe Paul D , Tao Haiyan , Fox Ray , Raheja Neil , Thacher Scott McNear 
Published: May 2020

Abstract
Adrenocortical carcinoma (ACC) is an aggressive cancer with devastating outcomes. ACC is usually locally advanced or metastatic at diagnosis and, despite tumor resection plus chemotherapy, has a high rate of recurrence. The 5-year survival rate among metastatic ACC patients is less than 15%. ACC responds poorly to the single FDA-approved drug, mitotane, which is non-specifically adrenolytic and highly toxic. Other chemotherapy regimens tested have been unsuccessful in improving overall survival. Steroidogenic factor-1 (SF-1 or NR5A1) is an orphan nuclear receptor essential for growth and development of the adrenal gland and is the major, active transcription factor in ACC (1,2). To address the need for a targeted therapy in ACC, we have identified potent small molecule SF-1 antagonists that block SF-1 transcriptional activity through the ligand-binding domain (IC50 = 15-20 nM in a CHO cell reporter assay). In short-term dissociated cell cultures established from SJ-ACC3 (3), a pediatric ACC patient-derived tumor xenograft (PDX), the SF-1 antagonists OR-907S and OR-070 blocked DNA synthesis as measured by inhibition of EdU incorporation in SF-1+ cells (IC50 = 500-600 nM, &gt;80% efficacy at 10 μM) whereas OR-907R, the 100-fold less potent enantiomer of OR-907S, is nearly inactive. Because the SF-1 antagonist sensitivity of the dissociated SJ-ACC3 cells declines markedly with repeated passage of the PDX in immunocompromised (C.B-17 SCID) mice, we have utilized an alternative model system for evaluating tumor target engagement and growth inhibition: the rat Leydig tumor cell line (R2C), which is growth-inhibited by the SF-1 antagonists OR-907S and OR-070 in vitro (IC50 = 60-100 nM) and as a xenograft in immunocompromised mice (CD-1 nude). The SF-1-responsive gene signature identified by RNAseq in R2C cell cultures by comparison of OR-907S and OR-907R was replicated by OR-070 and other orally-bioavailable lead antagonists in R2C xenografts following 3 days of dosing, indicating engagement of SF-1 by these compounds. Significantly, R2C tumors were growth-inhibited following daily oral dosing for 4 weeks with OR-070 (10-30 mg/kg). These findings suggest that SF-1 antagonists could be a targeted therapy for ACC. OR-070 has &gt;30% oral bioavailability in rat and dog, indicating that this structural class of SF-1 antagonists has potential for clinical development.References: (1) Mohan, et al., Curr. Opin. Endocrinol. Metab. Res., 2019; 8:72; (2) Corces, et al., Science, 2018; 362:eaav1898; (3) Pinto, et al., Clin. Cancer. Res., 2013; 19:1740.
SAT-LB71 Is Late Diagnosis of Postsurgical Hypoparathyroidism the Rule, Not the Exception?
Authors: Fahrleitner-Pammer Astrid , Kern Martin , Scherkl Mario , Mader Julia K , Tmava-Berisha Adelina , Amrein Karin 
Published: May 2020

Abstract
Background The most prevalent etiology for hypoparathyroidism is postsurgical. In the literature, years or even decades of delay for the diagnosis have been reported, with sometimes extremely low calcium levels and dramatic clinical manifestations including heart failure and seizures requiring treatment in the emergency room or intensive care unit. Often,,typical“ hypocalcemic symptoms are absent in these patients.
Methods In this retrospective Austrian single-center cohort at the Medical University of Graz, we identified patients with low parathyroid hormone concentration (&lt;25 pg/ml) and hypocalcemia using the hospital information system during 2004 and 2014. The time between neck surgery and the first reported diagnosis of postsurgical hypoparathyroidism and/or available low calcium levels was collected.
Results We identified a total of 119 patients treated between 2004 and 2014 at our institution. Most patients were women (78%), the average age was 61 ± 17 years. 12% had nonsurgical etiologies (ie. AIRE or 22q11 mutations), and 88% had postsurgical hypoparathyroidism (n=105). The median time between surgery and diagnosis of hypoparathyroidism was 5.5 years (range 0 -67 years). Only a third of all patients was diagnosed within the first year after surgery. Paresthesia and tetany were present in most patients at diagnosis, but in extreme hypocalcemia, other,,non-classic“ symptoms including severe heart failure, dyspnea and seizures appeared to be more prevalent.
Conclusion Our data suggest that diagnosis of permanent postoperative hypoparathyroidism is often delayed, as in our Austrian retrospective cohort the time lag between surgery and diagnosis or onset of hypoparathyroidism was often years or even decades. Whether this is truly a delayed occurrence of the disease or a delayed diagnosis of a condition already present for years or a combination of both can not be answered with our data, but certainly merits more intense research in the future.
MON-LB71 Adult Hypophosphatasia and Postmenopausal Osteoporosis: A Challenging Case
Authors: Abramof-Ness Rosane , Eizenberg Yoav , Sapir Mzia , Brill Gherta , Herzberg Dana 
Published: May 2020

Abstract
Introduction: Hypophosphatasia (HPP) is a rare disease that cause osteomalacia and premature tooth loss due to abnormal bone mineralization. The clinical presentation ranges from severe neonatal and infantile HPP with a high morbidity and mortalilty to mild Adult HPP. The ranging spectrum is possibly due to autosomal recessive versus autosomal dominant missense mutations at the gene that encodes TNSALP. The hallmark of the disease is a low serum total alkaline phosphatase level (ALP). It is important to diagnose adult HPP particularly to refrain from treating with bone antiresorptive medications. Low levels of alkaline phosphatase generally are undectected in the adult population even in patients with osteoporosis and fractures. We describe a case of a woman with postmenopausal osteoporosis without fractures diagnosed with adult HPP. The clinical course and management is described below. Case Description: A 62 y.o. women was referred for evaluation and treatment of osteoporosis. She had no fractures, including during childhood, no history of premature deciduous teeth loss, dental problems or nephrolithiasis. No family history of osteoporosis or fractures. Menopause at age 48 without hormone replacement therapy. Evaluation for secondary causes of osteoporosis was normal including serum TSH, calcium, phosphate, PTH, 24 hours urinary calcium and vitamin D-25. ALP ranged from 33-40 U/L (nl 37-126) before therapy. She was treated with raloxifene for 2 years. Therapy was switched to alendronate due to a decrease in bone density. She subsequently treated with alendronate for 5 years until 5/2012. Due to a decrease in bone density alendronate therapy was reinstituted between Jan 2013-Jan 2016 but in spite of therapy and a CTX level of 333 pg/ml bone density in the spine decreased significantly. In view of the low ALP and decreasing bone density while on bisphosphonate and a high B6 level (B6= 37 nl: -27) a genetic test for HPP and a compound heterozygote mutation in ALPL gene was detected. Her daughter was also found to have low ALP and carries the same mutation. Bone density has been stable since bisphosphonate therapy was stopped (spine T -3.2, LT femoral neck T -2.9) CTX 360 pg/ml. Recently therapy with raloxifene was initiated in view of the low bone density and high risk of fractures. Conclusion: The proper diagnosis and management of patients with adult HPP is challenging because the diagnosis may be missed in patients with borderline low ALP and on the other hand the proper managent of osteoporosis in these patients is not known.
SUN-LB97 Targeted Metabolomics as a Screening Tool in the Diagnosis of Endocrine Hypertension
Authors: Erlic Zoran , Amar Laurence , Larsen Casper K , Tetti Martina , Pamporaki Christina , Prehn Cornelia , Adamski Jerzy , Prejbisz Aleksander , Boscaro Marco , Eisenhofer Graeme , Mulatero Paolo , Assié Guillaume , Blanchard Anne , Zennaro Maria-Christina , Beuschlein Felix 
Published: May 2020

Abstract
Arterial hypertension [HT] is a global epidemic that requires adequate treatment to reduce cardiovascular morbidity and mortality. Secondary causes of HT and specifically endocrine hypertension [EHT] (primary hyperaldosteronism [PA], pheochromocytoma/paraganglioma [PPGL] and Cushing syndrome [CS]) can potentially be cured by surgery or treated by targeted medication. However, diagnosis of EHT requires expertise in test selection and interpretation of test results. The availability of experts outnumbers its demand. Thus, preselecting tools are necessary to identify patients who require further referral to an expert. Since targeted metabolomics [TM] is a new method showing promising results in profiling cardiovascular diseases and endocrine conditions associated with HT, we tested the ability of TM in discriminating primary hypertension [PHT] from EHT cases. The study included 282 adult patients (52% female; mean age 49 years) from the European multicentre consortium ENSAT-HT (www.ensat-ht.eu). Of these, 59 were diagnosed with PHT and 223 with EHT (40 CS, 107 PA and 76 PPGL). TM was performed on stored blood samples with a mass spectrometry based approach using the AbsoluteIDQTM p180 Kit (BIOCRATES Life Sciences, Austria). In total, 188 metabolites were determined, of which 155 were eligible for statistical analyses according to established selection criteria. To identify relevant discriminating metabolites, a series of univariate and multivariate analyses were applied. Since the distribution of the patients between the clinical entities was different according to sex (p&lt;0.001) and age (p=0.001), analyses were also performed separately for each sex and age group (cut-off 50 years). Thereby, we identified 4 common metabolites (C18:1, C18:2, spermidine, ornithine) from the comparison of PHT with each endocrine hypertension subgroup (CS, PA, PPGL) separately. The ROC curve for discrimination between PHT and EHT built upon these 4 metabolites had an area under the curve (AUC) of 0.79 (95%CI 0.73-0.85). In the comparison of PHT and EHT as a common group 38 metabolites were identified. Using the top 15 metabolites from the latter comparison (C3-DC, C9, C16, C16:1, C18:1, C18:2, arginine, aspartate, glutamate, ornithine, spermidine, lysoPCaC20:4, PCaaC38:6, PCaaC40:6, PCaaC42:1) the AUC was 0.86 (95%CI 0.81-0.91). We conclude that TM is associated with distinct metabolic pattern in PHT and EHT and is a promising pre-screening tool for identifying EHT patients.
SAT-LB127 Regulation of ENaC by Exosomal Lipids in the Diabetic Kidney
Authors: Tuna Kubra M , Ramsay Hunter G , Nouri Mohammad-Zaman , Denslow Nancy D , Alli Abdel A 
Published: May 2020

Abstract
Effective treatment of hypertension (HTN) in patients with diabetes may help to significantly reduce the risk of those patients developing additional complications including vascular disease and diabetic nephropathy. Blockers of the renin-angiotensin system including angiotensin converting enzyme inhibitors and angiotensin receptor blockers are not always effective in treating HTN in diabetic patients. Therefore, the aim of this study was to use an animal model of type 2 diabetes to investigate a novel mechanism of diabetes associated HTN involving exosomal lipids in the upregulation of epithelial sodium channel (ENaC) activity in the kidney. We performed metabolic cages studies using male and female hypertensive (salt-loaded induced) diabetic db/db mice and healthy age-matched wild-type control mice in order to isolate and characterize urinary exosomes from each group by nanoparticle tracking analysis, Western blotting, and transmission electron microscopy. Our mass spectrometry based lipidomic studies identified key lipids that were differentially expressed in the kidney derived exosomes from the hypertensive diabetic mice compared to control mice. Sphingomyelin quantification assays showed total sphingomyelin content was elevated in the exosomes from the hypertensive diabetic mice compared to the control group. Single channel patch clamp studies showed urinary exosomes enriched in sphingomyelins from hypertensive diabetic mice compared to controls increase ENaC activity (at the level of channel density and open probability) in cultured distal tubule renal epithelial cells. Moreover, exogenous application of sphinomyelin-6 to cultured mouse cortical collecting duct (mpkCCD) cells resulted in an increase in amiloride-sensitive transepithelial current. Taken together, our data show various lipids are enriched in exosomes from hypertensive diabetic mice compared to controls and these exosomes positively regulate ENaC activity in distal tubule and collecting duct cells.