bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-062 Psychiatric Co-Morbidities, Sexual Orientation, and Impact of Therapeutic Interventions in a Gender Non-Conforming Pediatric Practice
Authors: Figueredo Veronica M , Diaz Alejandro 
Published: May 2020

Abstract
Background: There is limited scientific literature regarding gender non-conforming (GNC) youth in pediatric practice. GNC patients of all ages have an increased risk for psychiatric co-morbidities and suicidal risk. An increasing number of GNC youth are seeking therapeutic options to develop physical characteristics to match their gender identity. The study aim is to describe the prevalence of psychiatric co-morbidities and sexual orientation among GNC pediatric patients in a clinic-based setting in Miami, Florida. A secondary aim is to compare the grade of dysphoria before and after therapeutic interventions among GNC youth. Methods: This is a retrospective chart review on records from 2014–2019 among transgender adolescents attending a pediatric endocrinology clinic in Miami. Data on demographics and clinical characteristics were obtained from electronic medical records. We performed descriptive statistical analysis using SPSS version and reported frequencies and percentages. Results: A total of 158 patients were included in this analysis. There were 107 (67.7%) affirmed males (female to male), 47 (29.7%) affirmed females (male to female), and 4 (2.5%) considered themselves non-binary. Median age at onset of gender dysphoria symptoms and beginning of social affirmation was earlier in affirmed females (7.21 and 12.36 years vs. 9.65 and 13.50 years). Among affirmed males, sexual orientation was self-reported as 38% straight, 47% bisexual, 12% homosexual and 1% asexual vs. among affirmed females, whose sexual orientation was reported as 54.3% straight, 37.1% bisexual and 8.6% homosexual. Prevalence of psychiatric co-morbidities in our study population was 78.5%. Depression was the most frequent diagnosis (66.5%), followed by anxiety (33.5%), attention deficit hyperactivity disorder (10.1%), bipolar disorder (1.9%), bulimia (1.3%), anorexia nervosa (0.6%) and post traumatic stress disorder (0.6%). Psychiatric co-morbidities were more common among affirmed males (84.1% vs. 66%). History of suicidal ideation was more common among affirmed males (70.1%) than affirmed females (49%). Self-injuring (cutting) was more common among affirmed males (56.1%) than in affirmed females (25.5%). Mean age at hormonal treatment onset was similar in both groups (15.75 years in affirmed males vs. 15.58 years in affirmed females). The degree of gender dysphoria before and after starting hormonal treatment, reported on a scale of 0 (no dysphoria) to 10 (highest possible dysphoria), declined for both genders (8.08/10 and 3.99/10) and affirmed females (7.87/10 and 2.96/10). Conclusion: The prevalence of psychiatric co-morbidities, suicidal ideation, and self-injuring behavior is high among GNC youth, but in this population, significantly worse among affirmed males. Both groups had significant improvement in the degree of dysphoria after beginning hormonal treatment.
SAT-682 Unusual Presentation of Diabetic Ketoacidosis Associated with Hypernatremia in Adult Patient
Authors: Aljaberi Asma Khaled , Hazin Fatemeh 
Published: May 2020

Abstract
Diabetic ketoacidosis (DKA) is an acute, life threatening complication of diabetes characterized by hyperglycemia, ketonemia and acidosis. It is known to commonly present with hyponatremia and rarely with hypernatremia. DKA can present with hypernatremia in pediatric population which carries poor prognosis when present.
We present a 27 year- old Ethiopian lady, previously healthy who was brought to emergency department (ED) with decreased level of consciousness. She had polyuria and polydipsia associated with weight loss for 1 month and flu like symptoms for 3 days prior to admission. On day of presentation, she was found to be confused, sleepy and not able to recognize people around her. In ED, patient was confused, GCS 8 severely dehydrated with poor skin turgor and marked delay in capillary refill &gt;3s. Patient was afebrile, with HR 115 bpm, BP 95/60mmHg, and BMI 20kg/m2. Initial labs revealed; severe acidosis pH 6.8, blood glucose (BG) &gt;38 mmol/l and corrected Na 155 mmol/l. Calculated serum osmolality 357mOsm/kg, lactic acid 5 mmol/l and HCO3 3 mmol/l. Further labs revealed K 4.4 mmol/l, Urea 10 mmol/l, Cr 150 micromole/l, WBC 26 and Ketones 3+ in urine. DKA was diagnosed and treated in ED with 4L IVF (2L bolus NaCl and other 2L of 0.23% NaCl given at 15 ml/hr) and NaHCO3 150 mmol. Continuous insulin regular infusion at rate of 0.1U/Kg/hr as per protocol was initiated. Patient was admitted to ICU for close monitoring of BG, GCS and electrolytes. After 9 hours of management, patient GCS improved to 13-14. Repeated labs revealed; improvement in PH 7.17, BG 22mmol/l, HCO3 5 mmol/l and lactic acid 1 mmol/l. There was worsening of Na 159 mmol/l and K dropped to 2.6 mmol/l. IV KCL bolus 20mmol followed by 40mmol IV continuous in IVF was initiated. IVF was changed from NaCl to D5W at 125ml/hr. Electrolytes were repeated after 7 hours and showed improvement in and Na and k levels. During her stay in ICU, patient recovered to baseline GCS 15 with no residual symptoms. IV insulin infusion was stopped on 3rd day and commenced on Insulin glargine and insulin Aspart boluses. Further investigations confirmed DM type 1; HbA1c 15%, C-peptide 0.08 nmol/l, IA2Ab of &gt;400 and GAD Ab &gt;250. Patient had an uneventful hospital course, she stayed in ICU for 3 days and then shifted to medical floor. She was discharged on basal bolus insulin regimen. In patients with uncontrolled DM/DKA, serum Na level is variable, reflecting the balance between the hyperglycaemia induced water movement out of the cells that lowers serum Na level, and the glycosuria induced osmotic diuresis, which tends to raise serum Na. When there is marked osmotic diuresis, DKA may present with a normal or even elevated serum Na concentration, despite a markedly elevated serum BG.
To best of our knowledge, this is the second case to report an unusual DKA presenting with hypernatremia in adult patient.
MON-925 A Wolf in Sheep’s Clothing: Intermittent Hypercalcemia from an Intrathyroidal Parathyroid Carcinoma
Authors: Trejo Jonathan , Hernandez Lyan Gondin , Wortham Joy , Sandoval Brenda , Armaiz-Pena Gustavo R , Bruder Jan M , Koops Maureen , Solis-Herrera Carolina , Granda-Rodriguez Ramona 
Published: May 2020

Abstract
Parathyroid carcinomas have an estimated prevalence of &lt;0.1% of all cancers and is found in &lt;1% of patients with primary hyperparathyroidism (PHPT). While they frequently present with PTH- mediated hypercalcemia, they are often distinguished by severe hypercalcemia and markedly elevated PTH levels compared to their benign counterparts. Parathyroid cancers most often arise from existing parathyroid glands, making them identifiable with standard imaging modalities such as parathyroid sestamibi scan, thyroid ultrasound, and 4-D CT scan. There are reports of non-functioning parathyroid carcinomas, including those that are intrathyroidal. Most of the reported cases are found de novo. We present a case of an intrathyroidal parathyroid carcinoma with intermittent hypercalcemia. A 72-year-old man with a history of Graves’ disease and RAI ablation in the 1970’s was found to have hypercalcemia up to 14.1 mg/dL (8.5 - 10.1) with a PTH level of 223 pg/mL (14 - 64). He denied any constipation, bone pain, fractures, renal stones, or changes in mental status. Thyroid ultrasound demonstrated a 3.9 cm R lobe complex nodule reported as TI-RADS 4, and a hypoechoic 1.0 cm nodule in the L lobe. No definitive parathyroid adenoma was reported. A parathyroid sestamibi scan showed persistent uptake in area of the L 1.0 cm nodule favoring a PTH adenoma while the R nodule had initial radiotracer uptake with delayed washout but no technetium uptake. Laboratory evaluation demonstrated a 24-hour urinary calcium of 338 mg/24hr, low 25-OH vitamin D, and normal vitamin D 1,25 levels. Osteoporosis was diagnosed by BMD with T-score of -3.2 at the femoral neck. Repeat serum corrected calcium level was 9.7 mg/dL and PTH was 93 pg/mL. FNA cytology of the R thyroid mass was reported as benign thyroid tissue. Due to size of the R thyroid nodule, the patient underwent a R hemithyroidectomy with L parathyroidectomy. Intraoperative PTH levels decreased from 154 to 120 pg/mL after removal of L parathyroid adenoma; PTH level decreased further to 12.9 pg/mL after R hemithyroidectomy. Surgical pathology revealed 4.5 cm R parathyroid carcinoma without thyroid tissue with positive margins, and a hypercellular L parathyroid gland. PHPT resolved. After review of all aspects of the case and discussion with patient, the decision was made to monitor his calcium and PTH levels and repeat BMD 1 year from resection. This is an uncommon presentation of a rare endocrine malignancy. To our knowledge, there are few case reports of non-functional parathyroid carcinomas that were initially reported as thyroid cancer or benign thyroid tissue after biopsy. This report underscores the importance in keeping this rare diagnosis in the evaluation of PTH-mediated hypercalcemia.
SUN-686 Diabetic Retinopathy in Latinos with Type 2 Diabetes: Temperance Is Protective
Authors: Fukunaga Alex , Genter Pauline , Ipp Eli 
Published: May 2020

Abstract
Diabetic retinopathy (DR) is a duration-dependent complication of diabetes (DM). Yet some people with DM do not develop DR despite long disease duration. We evaluated such a group in search of novel factors that might signal protection from DR, using a large cohort of Latinos with type 2 DM and readable retinal images in the GOLDR study (n=614). Participants were phenotyped and 7-field retinal images were evaluated using Airlie House criteria. We identified 90 participants with DM&gt;10y without evidence for DR (NoDR). We compared this group of patients with another group more susceptible to DR with evidence for earlier onset DR, in DM &lt;10y duration (EoDR, n=103). Duration of diabetes in NoDR was [x+SEM] 14.2+ 0.6y, and in EoDR, 4.3+ 2.9 y (p&lt;0.001), a 10-y spread. We found that most of the typical DR-associated risk factors could not explain DR protection in NoDR, including age, sex, age at DM onset, systolic blood pressure (SBP), percent insulin users, duration of hypertension, fasting plasma glucose, A1C, urine albumin/creatinine ratio and estimate glomerular filtration rate; these parameters were not significantly different in the two groups. Protective factors that did emerge were female sex (p=0.02), lower diastolic BP 69.1+0.9 vs. 72.5+0.9 (p&lt;0.01) and lower alcohol intake 3.1+0.8 vs. 7.8+2 de/w (14g drink equivalents/week; p=0.025). In a sensitivity analysis to determine whether sex accounted for the apparent effect of alcohol on DR, we evaluated the men in the study, who were more likely to be drinkers. Alcohol consumption was compared in men with DR who reported drinking alcohol (n=93) compared to men without DR who also reported drinking (n=53). Men without DR reported significantly less alcohol intake, 14.8+2.4 vs. 25.9 +3.3 de/w in those with DR (P&lt;0.01), suggesting that a possible protective benefit of lower alcohol consumption observed in NoDR was not likely to be mediated by the presence of fewer men in that cohort. In summary, type 2 diabetic patients with no evidence of DR after 10y were more likely to be women, have a lower diastolic BP, and who imbibed less alcohol when compared with a more accelerated DR subgroup with &lt;10yrs duration of DM. We conclude that in type 2 DM Latino patients, a focus on alcohol intake may be a useful management strategy in addition to traditional medication-based BP control and renal protection, as well as a pathophysiological pathway for DR worthy of investigation.
MON-513 Suppressing the Growth of Human Medullary Thyroid Cancer Cells Using FDA-Approved Drug
Authors: Ramachandran Ilangovan , Ramadoss Sivakumar , Nathan Lauren , Kumaran R Ileng , Chaudhuri Gautam 
Published: May 2020

Abstract
Medullary thyroid carcinoma (MTC) is a solid tumor of the parafollicular cells in the thyroid gland. MTC has worse prognosis, when compared with other differentiated thyroid cancers, and MTC patients with distant metastases have a low survival rate unless thyroidectomy is performed at an early stage. Furthermore, conventional treatments have only marginal benefits. Therefore, there is a need to develop novel therapeutics for MTC. Several drugs that are developed and tested in preclinical trials fail in clinical trials. Therefore, repurposing the already US Food and Drug Administration (FDA)-approved drugs towards the treatment of cancers may have potential benefits, like saving the lives of cancer patients and lowering the investment cost of drug development. Here, we explored a novel precision treatment for thyroid cancers by repurposing the FDA-approved small molecule anti-parasitic drug Nitazoxanide (NTZ). In our study, we examined the anticancer effects of NTZ on human MTC cells using the TT cell line. We treated the TT cells with different concentrations of NTZ and assessed the cell proliferation by water-soluble tetrazolium salt (WST-1) assay and oxygen consumption rate (OCR) by Seahorse extracellular flux analysis (Seahorse XFe24 Analyzer). Additionally, we determined the effects of NTZ on the protein expression of key signaling molecules that regulate MTC cell growth by western blot analysis. Our results indicated that NTZ significantly suppressed the growth of TT cells at 24 h treatment. Very importantly, NTZ reduced the basal OCR demonstrating the inhibition of mitochondrial respiration. Moreover, protein expression studies revealed that NTZ markedly reduced the key Hippo signaling pathway effector molecule TAZ and the oncogene c-myc. Interestingly, NTZ decreased the expression of epidermal growth factor receptor (EGFR) that plays an important role for RET activation in MTC. Importantly, NTZ increased the expression of p53 upregulated modulator of apoptosis (Puma). Taken together, our findings demonstrate for the first time that NTZ inhibits the growth of MTC cells and decreases the cancer cell metabolism. The mechanisms by which NTZ targets the MTC cells involve the suppression of key oncogenic proteins and upregulation of tumor suppressor molecule. Thus, our study highlights that repurposing this FDA-approved currently used drug may have a greater advantage of being tested in preclinical models of MTC, and therefore, for the rapid consideration of NTZ as a potential therapeutic drug to treat MTC patients in the near future.
MON-511 Are Thyroid Nodule Fine Needle Aspiration Washings an Acceptable Alternative to Dedicated Fine Needle Aspirates When Obtaining Tissue Samples for Genetic Expression Classifier Analysis?
Authors: Carrillo Maritza Elide , Rodriguez Renil 
Published: May 2020

Abstract
The Bethesda System for Reporting Thyroid Cytopathology stratifies thyroid nodules by risk associations. Approximately 15-30% of fine needle aspirations (FNA) fall into an indeterminate criteria, and two thirds are found to be surgically benign leading to unnecessary surgeries (1). Veracyte Inc. developed the Afirma gene expression classifier (GEC) to identify whether an indeterminate nodule had benign expression, with a NPV of 95% for AUS/FLUS (Atypia of undetermined significance/ follicular lesion of undetermined significance) nodules making it an excellent way to rule out malignancy (2). The goal of testing for thyroid cytology includes avoiding unnecessary surgery in benign nodules and identifying high risk from low risk lesions. The Afirma validation landmark study aided in the commercial approval for use in clinical practice after showing a 95.1% sample sufficiency when 2 dedicated samples were obtained in addition to the 3-5 FNA samples for cytology, but our institutional practice habits may suggest other techniques may be valid as well (2). We aimed to assess the rate of sufficient sample for GEC based on FNA washings at our institution, without using dedicated FNA for GEC. Data was gathered from all indeterminate nodule FNA washings referred for Afirma GEC from January 2015 through December 2017. Samples were determined on Afirma report as benign, suspicious, or insufficient and rate of insufficiency was determined. 95 indeterminate nodule FNA washings were sent for Afirma GEC. 93 (97.9%) samples were sufficient for RNA, with 47 (49.5%) reported as suspicious and 46 (48.4%) reported as benign, 2 (2.1%) samples were insufficient for RNA. 97.9% of our samples were sufficient when using FNA washings alone. Our experience suggests that the technique used at our clinical practice is an acceptable alternative to using an additional 2 passes for dedicated samples in collecting RNA for Afirma GEC. This method decreases need for call back for a second biopsy, is less time consuming, and potentially more cost effective. Limitations in our study are a small sample size limited to a single institution, differing number of FNA washings per total passes among practitioners, and variability of experience between providers. In conclusion thyroid nodule FNA washings are an acceptable alternative to dedicated FNA when obtaining tissue samples for genetic expression classifier analysis. Further studies with a larger sample size across different institutions are necessary.
1.Prathima S, Thyroid Research and Practice, January-April 2016; Vol 13: Issue 1; p 9-14
Yang SE et al, Cancer Cytopathology, February 2016, p 100-109
2. Alexander EK. Kennedy GC. Baloch ZW.et al. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med. 2012;367(8):705–715.
MON-107 Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children from a Large Centre (Hangzhou, China)
Authors: Peng Wei , Jin Binghan , Yuan Jinna , Dong Guanping , Lin Hu , Huang Ke , Wu Wei , Derraik José G B , Fu Junfen 
Published: May 2020

Abstract
Objective: To review the clinical symptoms and biochemical parameters associated with diabetic ketoacidosis (DKA) in children newly diagnosed with type 1 diabetes (T1D) in our single medical centre over 10 years. Methods: Participants were children aged &lt;16 years diagnosed with T1D between 1 January 2009 and 31 December 2018 at the Children’s Hospital, at Zhejiang University School of Medicine (Hangzhou, China). DKA occurrence was assessed by blood gases using pH and bicarbonate. The severity of DKA was categorized according to ISPAD 2014 guidelines, as mild, moderate, or severe. The child’s history prior to diagnosis was recorded, and patients underwent a number of clinical assessments, including anthropometry, biochemical parameters, and OGTT. The demographic and clinical characteristics of children with and without DKA were compared. Results: 681 patients (314 boys and 367 girls) were diagnosed with T1D over the study period. 341 (50.1%) had DKA at diagnosis, with yearly rates ranging from 45.0% to 56.8%. Eight cases had missing data on severity, but 120 had mild (36.0%), 100 moderate (30.0%), and 113 severe (33.9%) DKA. Children with DKA were younger than those without DKA (7.2 vs 8.2 years, respectively; p=0.001), and were more likely to report vomiting (13.2% vs 1.5%; p&lt;0.001), loss of appetite (3.2% vs 0.9%; p=0.031), fatigue (39.3% vs 5.6%; p&lt;0.001), and abdominal pain (9.1% vs 1.5%; p&lt;0.001) prior to T1D diagnosis. The classical symptoms of diabetes were similar in children with and without DKA, such as polyuria (86.8% vs 90.3%, respectively; p=0.153), polydipsia (90.6% vs 91.5%; p=0.696), polyphagia (26.4% vs 30.3%; p=0.259), and weight loss (50.7% vs 50.6%; p=0.970). Children with DKA had higher blood lipids and fasting insulin levels at presentation, but displayed similar HbA1c levels. Conclusions: We report a high incidence of DKA at our centre (50%) among children diagnosed with T1D. As most children displayed classical symptoms of diabetes, it is important to increase community awareness of the disease to ensure an early diagnosis and lower the risk of children presenting with DKA.
OR24-02 Identification of Membrane Proteins That Enhance the Responsiveness of the Ghrelin Receptor
Authors: Prins Karina , Visser Jenny A , Huisman Martin , Mies Rosinda , Neggers Sebastian J C M M , der Lely Aart Jan Van , Delhanty Patric J 
Published: May 2020

Abstract
Ghrelin, a 28-amino acid peptide gut hormone, occurs in acylated (AG) and unacylated (UAG) variants. AG is a GH secretagogue as well as being orexigenic and diabetogenic, acting via the growth hormone secretagogue receptor (GHSR1a) in the hypothalamus and pituitary. UAG counteracts these metabolic effects through unknown mechanisms. While screening for potential UAG receptor(s) we discovered previously uncharacterised interactions of AG and UAG with five cell membrane proteins (MPs), three of which are known to modulate metabolism. Here, we studied if two of these MPs (MP1 & 2) could modulate GHSR1a signalling by expressing their transgenes in HEK293 cells. As GHSR1a is coupled with calcium signalling via Gq proteins, aequorin luminescence was used to evaluate Ca2+ influx into the cells. Transfected cells were treated with either AG, UAG, or soluble parts of the MPs, or combinations thereof.
MP2 markedly enhanced the efficacy (~5.5-fold), but not the potency, of AG-induced Ca2+ influx, whereas MP1 had no effect on Ca2+ influx. Neither MP1 nor MP2 overexpression altered cellular GHSR1a levels. In the absence of GHSR1a, MP2 was unable to stimulate an AG-induced Ca2+ influx. UAG treatment (100nM) had no effect on GHSR1a-mediated Ca2+ influx in the presence or absence of MP2. MP2 is post-translationally modified and we suspected this to be important for its activity. However, removal or blockade of these modifications had no effect on the ability of MP2 to enhance GHSR1a signalling. Moreover, incubating the cells with soluble ectodomain of MP2 did not alter its effect on GHSR1a signalling. Nevertheless, induction of ectodomain shedding with PMA (0.4-1µM) dose-dependently reduced the AG-induced Ca2+ response to 0.5-0.2 of control levels (DMSO) in MP2-GHSR1a co-transfected cells. Unlike MP2, which has a transmembrane and intracellular domain, MP1 is attached to the plasma membrane via a glycosylphosphatidylinositol (GPI) anchor and lacks an intracellular domain. Since MP1 is otherwise structurally similar to MP2, we suspected that the intracellular domain of MP2 may be important for its function. Therefore, we expressed chimeras of MP2 and MP1 in which the GPI linkage site and the transmembrane/intracellular domains were exchanged. The MP2 ectodomain with a GPI-anchor had similar stimulatory effects on GHSR1a signalling as full-length MP2, whereas the MP1 ectodomain with MP2 transmembrane and intracellular domain only enhanced GHSR1a signalling by approximately 3-fold.
In conclusion, we have identified a membrane protein as a novel component of the ghrelin signalling pathway that markedly enhances the response of the ghrelin receptor to AG. Our current data suggest its ectodomain is important in mediating this effect. Studies are ongoing to fully delineate the mode of interaction and to determine the role of MP2 in ghrelin signalling in vivo.