bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-439 Graves’ Disease and Papillary Thyroid Cancer: A Rare Clinical Case?
Authors: Volkova Natalia , Davidenko Ilia , Dzherieva Irina , Zibarev Alexander , Ganenko Lilia , Reshetnikov Igor , Sorokina Julia , Brovkina Snezhana 
Published: May 2020

Abstract
Background: Nodules on the background of Graves’ disease are less common among men than among women, but more than one in three patients have carcinoma. Despite the improvement of diagnostic methods, most often thyroid cancer is a random histological finding after thyroidectomy for Graves’ disease. Clinical case: A 55-year women complained of discomfort in the neck, sweating, irritability, palpitation. From anamnesis: in 2012 she was diagnosed with thyrotoxicosis syndrome. For 5 years, the patient was treated with thyrostatics, but when trying to reduce the dose, the syndrome of thyrotoxicosis recurred. In March 2017, the patient’s condition worsened, at the time of treatment she took Thyrosol 30 mg/day. Objectively: hypersthenic body type, BMI 33 kg/m2. Thyroid gland visually was increased in volume, dense with palpation, homogeneous, mobile. Elevated titer of antibodies to the TSH receptor was discovered, according to the ultrasound - increase thyroid gland 30.2 cm3, hyperechogenic formation of the left lobe 10х10х9 mm with hypoechoic rim, clear smooth contours, intranodular blood flow. As a result, the Graves’ disease, goiter grade 2, manifest thyrotoxicosis was verified, surgical treatment was recommended. Thyroidectomy, histological examination was performed: Graves’ disease was confirmed, papillary microcarcinoma with metastasis to 1 regional lymph node was revealed. Diagnosed: papillary thyroid cancer I st (pT1aN1aM0x), 2 clinical group. The patient was prescribed suppressive therapy with L-thyroxine 100 µg/day, against which after 3 months TSH reached the target values (0.2–0.5 Mme/l). Taking into account the histological characteristics of the tumor, the nature and volume of the lesion, age, the patient belongs to the group of intermediate cancer risk of progression of cancer. According to scintigraphy residual functioning thyroid tissue (20x15 mm) was detected. Radioiodine therapy was carried out in a specialized hospital. Suppressive therapy of L-thyroxine 150 µg/day, target values of TSH 0.1 - 0.5 Mme/l was recommended. After 6 months, TSH reached target values, and according to the results of ultrasound of thyroid gland no data for structural relapse was found. Conclusion: Patients with long-existing, often recurrent Graves’ disease and questionable effect of conservative therapy, in the presence of nodular formation should be assigned to the risk group for the presence of thyroid cancer and carefully examined, because the need for further surgery depends on it.
SAT-552 Epigenetic Regulation of 11beta-Hydroxysteroid Dehydrogenase 1 and 2 Gene in Salt-Sensitive Hypertensive Rats
Authors: Takeda Yoshiyu , Takeda Yoshimichi , Karashima Shigehiro , Kometani Mitsuhiro , Hashimoto Atsushi , Aono Daisuke , Higashitani Takuya , Yoneda Takashi , Horike Shinichi 
Published: May 2020

Abstract
ENDO 2020
Epigenetic regulation of 11beta-hydroxysteroid dehydrogenase 1 and 2 gene in salt-sensitive hypertensive rats
[Objective]11Beta-hydroxysteroid dehydrogenase type1 (11-HSD1) is the modulator of glucocorticoid hormone and type2 (11-HSD2) is the modulator of mineralocorticoid hormone. We investigated the effect of high salt diet on the methylation of both enzyme gene in salt-sensitive hypertensive (SSH) rats [Methods]SSH rats were fed a high (7% NaCl) or normal (0.45%) salt chow for 4 weeks. Body weight, blood pressure, plasma and urinary aldosterone concentration and PRA were measured. DNA was extracted from kidneys and visceral fats. Bisulfite sequencing and Pyrosequencing were done for the analysis of methylation status of 11-HSD1 and 2 gene. [Results] High salt diet significantly decreased methylation ratio of 11-HSD1 gene in the visceral fats of SSH rats compared with controls (p&lt;0.05). The methylation ratio of 11-HSD2 gene in the kidney of SSH rats was not influenced by high salt diet. [Discussion and Conclusion]11-HSD1 overexpression in visceral fats in mice was reported to show SSH. We reported decreased 11-HSD2 activity in the artery in SSH rats. In this study high salt diet affected methylation status of 11-HSD1 in the adipose tissue but not 11-HSD2 gene in the kidney in SSH. Food intake such as salt may influence the epigenesis of 11-HSD and induce hypertension.
MON-348 Surgical Management of Bilateral Hip Fracture in a Patient with Fibrodysplasia Ossificans Progressiva Treated with Palovarotene
Authors: Singh Sukhmani , Kidane Joseph , Wentworth Kelly Lee , Motamedi Daria , Morshed Saam , Hsiao Edward Chiaming 
Published: May 2020

Abstract
Background: Fibrodysplasia Ossificans Progressiva (FOP) is a rare genetic disorder marked by painful, recurrent flare-ups and progressive heterotopic ossification (HO) in soft tissues. The bone formation can be idiopathic or provoked by trauma, illness, or inflammation. There are limited treatment options, with glucocorticoids and non-steroidal anti-inflammatory agents being used for palliative treatment. Palovarotene (PVO), an investigational retinoic acid receptor gamma agonist, offers a potential avenue to prevent HO development.
Clinical Case: The patient was a 29 year-old male, diagnosed with FOP at age 9, who enrolled in a study evaluating chronic PVO (5mg/day) for the treatment of FOP. Major joints affected at enrollment were his spine, jaw, shoulders, right hip and ankles. One year after starting PVO, he had a fall that resulted in a left intertrochanteric fracture. He underwent intramedullary nailing of the femur shaft with screw placement at the distal femur. After surgery, he received flare-dosing PVO at 20 mg/day for 4 weeks, then 10 mg/day for 8 weeks. Post-surgical imaging 12 weeks after the surgery showed new bridging HO at the site of intramedullary rod insertion and around the distal screw.
Nine months after the fracture the patient had a second fall resulting in a right intertrochanteric fracture. He underwent intramedullary nailing of the right hip, in a modified procedure which did not require distal screw placement. PVO was increased similarly to the above flare protocol, but, at the time of fracture occurrence rather than post-surgery. He had no skin or healing complications with either treatment regimen.
After each fracture the patient had prolonged recurrent flare-ups at the injury sites, significantly increasing his number of flare-ups per year. After the fractures there was new Brooker class D HO at the left hip, originating at the insertion of the intramedullary rod, and new class B HO at the right greater trochanter, again near the insertion site of the intramedullary rod compared to his pre-surgery baseline. In contrast, there was no new HO at the right distal intramedullary rod whereas HO occurred around the screw placement site at the left distal rod.
Conclusion: This case suggests that PVO in the dosing regimen received by this patient can be tolerated in an individual with FOP following major surgery. HO still occurred in this patient, particularly along the rod insertion track, suggesting that the PVO regimen may need to be optimized for surgical cases or that poly-trauma events may not be adequately blocked by the dosing regimen received by this patient. However, PVO did not negatively impact fracture healing or osteointegration, and no major skin healing effects were identified. Further investigation is needed to assess whether PVO can lead to a dose-dependent reduction in HO in the setting of trauma and surgery.
SUN-519 Hypokalemic Periodic Paralysis
Authors: Godfrey Sean , Hudspeth Victoria , Amoako Patricia , Drewno Michael 
Published: May 2020

Abstract
Background:Hypokalemic periodic paralysis is a rare disorder associated most often with a genetic defect in electrolyte channels, which can also occur in the setting of thyrotoxicosis. The presenting state in the acquired form has a low potassium, low TSH, high free T4 or high T3. It is more common in men, and in the Asian population with an approximate incidence of 2%. Symptoms can last from hours to days and are often precipitated by stress, exercise, and/or high carbohydrate intake. It is believed that the excess thyroid hormone creates an increased catabolic state which drives potassium inward and hyperpolarizes the muscle membrane to create a paralytic state. Case:A 23 year old African American male presented with chest discomfort and palpitations. TSH was &lt;0.01 μU/mL (normal 0.530 - 6.340) with a free T4 of 3.31 ng/dL (normal 0.60–1.60). EKG showed ventricular conduction delay and he was sent home on propranolol 20mg daily and methimazole 5mg three times daily. He returned 5 days later with worsening palpitations and now new onset weakness. He was found to have a potassium of 1.4 mmol/L (normal 3.5–5.1) and magnesium of 1.2 mg/dL (normal 1.6–2.5). EKG showed normal sinus rhythm at a rate of 97, prolonged QT at 524msec (normal 330–470 msec), with repeat EKG 20 minutes later showing atrial tachycardia with a rate of 114 (normal 60–100). He was not able to move anything beyond his head, other than minor upper extremity hand movements, and could not sit up in bed. His potassium was initially repleted with eight doses of 10mEq KCl given q1h. His paralysis significantly improved within the first 4hrs, and was completely resolved by the next morning. Additional lab workup revealed thyroid stimulating antibody level of 13.00% (normal 0.0–0.55). He was discharged on methimazole 10mg twice daily and propranolol 10mg twice daily with instruction to follow up closely with his primary care physician and endocrinology. Conclusion:This patient presented with acute onset of weakness and palpitations in the setting of hyperthyroidism from Graves’ disease and hypokalemia consistent with thyrotoxic periodic paralysis. The physiology behind the presentation is not clear, but the current hypothesis is that depolarization of the neuromuscular junction leads to a tonic state from hyper-polarization. Thyroid hormone increases the metabolic demand, which along with an increase in sympathetic tone drives the sodium-potassium ATPase activity into overdrive, thus decreasing extracellular potassium. Thyrotoxic periodic paralysis is rare presentation, but should be considered for any patient that presents potassium abnormalities and symptoms of thyrotoxicosis.
MON-718 Abundant Circulation of Functional Short Non-Coding RNAs Expressed from the Intergenic Area in Mouse Serum
Authors: Habib Tanwir , Fadda Abeer , Mackeh Rafah , Marr Alexandra K , Kino Tomoshige 
Published: May 2020

Abstract
The human genome expresses numerous and different forms of non-protein-coding (nc) RNAs from over 80% of its sequence in addition to mRNAs. Although their overall functions and biological importance are still under intensive investigation, they appear to be important for supporting complex human biology. Some of these ncRNAs are recently identified in several human fluids, such as serum, urine and saliva. Here we present a comprehensive analysis on the short RNAs presented in mouse serum by employing three organs, adrenal gland, liver and ovary, as controls. We found that serum has numerous sRNAs. Among them, short ncRNAs (sncRNAs) expressed from the intergenic area (intergenic sncRNAs) dominated the majority (~97%) in serum with their read numbers equivalent to those found in three control organs. In contrast, known sncRNAs, such as ribosomal RNA fragments, transfer RNAs, micro RNAs, piwi-interacting RNAs, small nuclear and small nucleolar RNAs, were very minor components in serum, and were significantly low compared to control organs. Few short RNA fragments derived from mRNAs or long non-coding RNAs were also identified. The principal component analysis for the intergenic sncRNAs found in serum and three control organs revealed that the former was distinct from the latter. Indeed, ~90% of serum intergenic sncRNAs were not identified in each control organ in one-by-one comparisons. Multiple comparison between serum and all three control organs demonstrated a similar tendency: ~75% of the serum intergenic sncRNAs were distinct from the intergenic sncRNAs found in the three control organs, whereas these control organs shared 53% of them. The genomic areas encoding these intergenic sncRNAs tended to distribute around -20 - +20 kbs from the transcription start site of their nearby protein-coding genes. Among four selected serum intergenic sncRNAs, overexpression of the one located closely to the olfactory receptor 1322 gene exerted in a mouse hepatoma cell line the robust transcriptional regulatory activity on ~100 protein-coding genes that were accumulated in several distinct biological pathways. Our results indicate that mouse serum contains biologically active intergenic sncRNAs in addition to other known forms. The results also suggest their potential biological importance and/or usefulness in disease diagnosis and treatment in humans.
MON-327 Soluble Alpha Klotho and IGF-I Before Surgery as Prognostic Factors to Acromegaly Long-term Remission
Authors: de Oliveira Longo Schweizer Junia Ribeiro , Schilbach Katharina , Haenelt Michael , Wang Xiao , Bizzi Mariana Ferreira , Giannetti Alexandre Varella , Schopohl Jochen , Stoermann Sylvère , Rocha Beatriz Santana Soares , Ribeiro-Oliveira Antonio , Bidlingmaier Martin 
Published: May 2020

Abstract
BACKGROUND: Transsphenoidal surgery is the cornerstone of acromegaly treatment. However, cure is obtained in only ~50% of the cases. Until today, no biochemical marker has been identified to preoperatively predict surgical outcome and long-term remission. Recently, soluble alpha klotho (αKL) was proposed as new biomarker for diagnosis and follow-up of acromegaly. Therefore, we aimed to evaluate the potential of pre-surgery αKL concentrations as a prognostic factor to predict remission by surgery alone. Methods: We measured αKL concentrations (IBL-ELISA) and classical biomarkers (IGF-I and GHrandom, both by IDS-iSYS, GHnadir measured by IDS-iSYS (n=13) or DiaSorin-Liaison® (n=7)) in samples from a prospective study in treatment-naïve patients with acromegaly (total n=25). Patients were then followed for at least 6 months after surgery (median (range) 30.1 (6–142) months). Outcome was evaluated and classified as non-remission (NR: IGF-I&gt;1.2xULN (n=2) or continued need for medical treatment with somatostatin analogues (n=10)) or remission (R: improvement on clinical signs and symptoms and IGF-I&lt;1.2xULN without medical treatment, n=13). Results: Before surgery, all patients had elevated IGF-I (&gt;1.2xULN), GHnadir (&gt;0.4 ng/mL) and GHrandom (&gt;1.0 ng/mL). As expected, αKL (pg/mL) was also high (&gt;1.2xULN) in 92% patients. Before surgery, αKL was significantly higher in NR compared to R [6648 (4408–13951) vs. 3389 (2132–6837); p&lt;0.05), as was IGF-I (ng/mL) [NR: 879.7 (771.8–961.5) vs. R: 640.2 (448.6–862.6); p&lt;0.05). There was no difference in GHnadir and GHrandom (ng/mL) [10.42 (6.35–16.40) vs. 5.19 (1.19–10.70) and 12.39 (8.24–24.87) vs. 8.94 (4.24–15.55); p&gt;0.05 for both comparisons). ROC analysis indicated that concentrations of αKL&gt;4470pg/mL (~3.5xULN) (75% specificity, 62% sensitivity, AUC=0.72) and IGF-I&gt;3.8xULN (67% specificity, 85% sensitivity, AUC=0.79) indicate lack of long-term remission. Conclusion: High αKL (&gt;4470pg/mL, ~3.5xULN) and IGF-I (&gt;3.8xULN) concentrations before surgery are significantly associated with persistent disease activity after surgery. However, both biomarkers alone or in combination have insufficient specificity (though acceptable sensitivity) as predictors of surgical outcome.
SAT-573 Eruptive Xanthomas in a Patient with Hypertriglyceredemia and Type 2 Diabetes Mellitus
Authors: Masood Faryal T , Khan Umar 
Published: May 2020

Abstract
BACKGROUND: Eruptive xanthomas are rare, asymptomatic, cutaneous lesions and are markers for serious underlying metabolic disorders that demand an early diagnosis to prevent morbidity and mortality.
Clinical Case: A 27 years old obese female presented with generalized, pruritic eruptions. The eruptions had been present for approximately three weeks. Crops of firm yellow-red circumscribed Papules (diameter 1–3 mm) distributed on the extensor surfaces of both the upper and the lower extremities which were few in numbers to begin with but increased in density subsequently spreading to involve her back, abdomen, knees, and posterior thighs. The patient besides being obese had no other significant past medical or family history. Labs: FBS:258 mg/dl (80-100mg/dl), HbA1c:11.7%(&lt;5.6%), Total lipids: 3680 mg/dl (400–1000 mg/dl), Total Cholesterol: 857 mg/dl (120–200 mg/dl), Triglycerides: 5428 mg/dl (70–150 mg/dl), HDL:15mg/dl (45–64 mg/dl), LDL: 371 mg/l(&lt;130 mg/dl),VLDL: 402 mg/dl (&lt;30 md/dl). Results of kidney, liver and thyroid function tests were normal, as well as amylase and lipase. X-ray chest and abdominal ultrasound were unremarkable. Biopsy of the papules was not carried out due to non-affordability on the part of the patient. The patient was managed by an interdisciplinary approach for diabetes mellitus type 2 and hyperlipidaemia. Treatment was started with oral hypoglycaemic along with lipid lowering agents and the required lifestyle modifications including weight control, adopting a low-fat diet, and regular exercise were advised. The papules resolved within six weeks of the treatment and lab reports indicated improvement in her glycemic control and hypertriglyceridemia. It was clinically diagnosed as Eruptive Xanthomas of secondary hypertriglyceridemia due to diabetes mellitus.
CONCLUSION:
Recognizing eruptive xanthomas and being aware of its association with hypertriglyceridemia and diabetes mellitus can help to decrease any lag between a patient being seen by a physician and treatment for a serious medical conditions such as coronary artery disease and pancreatitis.
REFRENCES: Digby M; Belli R; McGraw T; Lee A (2011). “Eruptive xanthomas as a cutaneous manifestation of hypertriglyceridemia: a case report”. J Clin Aesthet Dermatol. 4: 44–6. PMC 3030216Freely accessible. PMID 21278899.
SUN-237 Sex Differences in the Effect of Osteocalcin and Exercise on Memory and Cognition
Authors: Winberg Jordan , Rentz Jesse , Darwish Lina , Swardfager Walter , Mitchell Jane 
Published: May 2020

Abstract
Osteocalcin is a protein produced in the osteoblasts of bone and found both in the bone matrix and in circulation1. Mouse studies have demonstrated that osteocalcin administration improves type II diabetes through increased insulin release and sensitivity2. Further, osteocalcin can cross the blood-brain barrier and has been shown to restore memory and cognition in mice3. To date, experiments testing the effects of osteocalcin in mice have almost exclusively been conducted in only one sex and could not account for sex as a biological variable. We hypothesized that osteocalcin and exercise would improve behavioral outcomes and aimed to record any difference in response between sexes. In this study, we compare the effects of daily osteocalcin treatment, with or without daily treadmill exercise, in male and female mice (C57BL/6) on a high-fat diet induced model of type II diabetes. Mice were fed high-fat diet for eight weeks, followed by eight weeks of daily osteocalcin injections and/or treadmill exercise. During the final two weeks of treatment behavioural testing for depressive-like behaviour, anxiety-like behaviour, problem-solving, and memory was completed, and the results obtained in male and female mice were compared. The high-fat diet increased depressive-like behaviour and impaired problem solving in both sexes. Significant interactions between sex and exercise and sex and diet were observed. High-fat diet increased anxiety-like behaviour in females, but not males, while exercise increased anxiety-like behaviour in males. Both treatments improved behavioural outcomes, though no difference could be attributed to the combination of treatments. Exercise and osteocalcin decreased depressive-like behaviour in both sexes. Osteocalcin improved problem solving in both sexes, but exercise only improved problem solving in females. The effects of osteocalcin were similar in both male and female mice, however exercise improved problem-solving only in female mice. This suggests that both sexes benefit from osteocalcin treatment and exercise may be more beneficial in females. The results indicate that osteocalcin and exercise have similar but not identical effects on behaviour that may be reflected in overlapping mechanisms of action. References: (1) Lee et al., Cell. 2007; 130(3): 456-469. (2) Ferron et al., Bone. 2012; 50(2): 568–575. (3) Khrimian et al., J Exp Med. 2017; 214(10): 2859-2873.
SUN-359 Antenatal Oral Iron Supplementation, FGF23 and Bone Metabolism in Kenyan Women and Their Offspring: A Randomised Controlled Trial
Authors: Braithwaite Vickie S , Demir Ayse Y , Mwangi Martin N , Jones Kerry S , Prentice Ann , Prentice Andrew M , Andang’o Pauline E A , Verhoef Hans 
Published: May 2020

Abstract
Objectives: FGF23 decreases reabsorption and increases phosphate excretion in the kidney and regulates vitamin D metabolism. Maternal iron deficiency may be implicated in the pathogenesis of hypophosphataemia-driven rickets in offspring through perturbed FGF23 expression. We aimed to determine the effect of antenatal oral iron supplementation on maternal and neonatal markers of bone mineral regulation.
Methods: 470 rural Kenyan women with singleton pregnancies and haemoglobin concentrations ≥90g/L were randomly allocated to daily, supervised supplementation iron (60mg as ferrous fumarate) or placebo from 13–23 weeks gestational age until 1 month postpartum. We analysed maternal and neonatal plasma samples collected at birth, with primary outcomes being concentrations of FGF23 in its intact form (I-FGF23, the phosphate- and vitamin D-regulating hormone) and its C-terminal fragment (C-FGF23).
Results: In mothers and neonates, antenatal iron supplementation reduced C-FGF23 concentration by 62.6% (95%CI: -70.3% to -53.0%) and 15.2% (-28.4% to 0.3%), respectively; increased neonatal I-FGF23 concentration by 21.6% (1.2% to 46.1%); increased maternal hepcidin concentration by 136%, (86% to 200%); and decreased maternal 25-hydroxyvitamin D concentrations by 6.1nmol/L (1.2 to 11.0nmol/L). We found no effect on markers of bone turnover in either mothers or neonates. The magnitude of the effect of antenatal iron supplementation on concentrations of C-FGF23, I-FGF23 and phosphate, and on estimated glomerular filtration rate (a measure of kidney glomerular function) depended on maternal iron status at baseline
Conclusions: Antenatal iron supplementation may provide health benefits to pregnant women and their offspring beyond increasing iron status. Whether iron supplementation reduces present and future infant risk of rickets remains unclear.