bluuebunny/crossref_metadata_2025_split huggingface dataset:
MON-353 Tumor-Induced Osteomalacia from a Hypervascular Thoracic Paraspinal Mass: Challenges in Diagnosis and Management
Authors: Perez Paola M , Fu Polly , Folick Andrew , Ku Gregory Michael , Shoback Dolores M , Lee Janet Yi Man 
Published: May 2020

Abstract
Background: Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome driven by ectopic production of fibroblast growth factor 23 (FGF23), resulting in renal phosphate wasting, hypophosphatemia, and bone demineralization. Successful therapy requires complete resection of the tumor, which is often challenging to localize. Clinical Case: A bedridden 37-year-old woman presented to Endocrine Clinic after 9 years of progressive pain and weakness in her back, hips, and extremities. She had previously been diagnosed with a neurodegenerative disease, though an MRI from 5 years ago showed bilateral subacute sacral ala fractures. CT scan on presentation showed generalized osteopenia and numerous subacute to chronic atraumatic fractures (involving ribs, scapula, pubic rami, and right femoral shaft) concerning for osteomalacia. On exam, she had profound lower extremity weakness. Laboratory testing was notable for serum phosphorus 0.6 mg/dL (normal (nl) 2.5-4.9), calcium 8.4 mg/dL (nl 8.5-10.5), PTH 216 pg/mL (nl 13-85), 25-OH vitamin D 26 ng/mL (nl 30-100), alkaline phosphatase 345 U/L (nl 45-130), 1,25-(OH)2 vitamin D 28 pg/mL (nl 18-72), renal tubular phosphorus reabsorption TmP/GFR 0.53 mg/dL (nl 2.97-4.45), and inappropriately normal FGF23 level 170 RU/mL (nl&lt;180). Phosphate salts, calcitriol, and cinacalcet were initiated. Octreotide scan was negative, but 18F-FDG PET/CT showed mild hypermetabolic activity in the lower thoracic paraspinal area correlating with a 3.4 cm hypervascular mass near the left 8th rib head and two adjacent nodules on MRI. Due to bleeding risk, biopsy was deferred and further confirmatory studies were pursued. Genetic testing for hereditary forms of hypophosphatemia (FGF23, CLCN5, DMP1, ENPP1, FGFR1, PHEX) was negative. 68Ga-DOTATATE PET/CT was not available, but selective venous sampling for FGF23 revealed a 3:1 ratio between venous drainage of the tumor bed and general circulation. Based on this localization, surgical resection was performed. Pathology was consistent with a phosphaturic mesenchymal tumor, but clear margins could not be confirmed due to intraoperative tumor fragmentation. Three months of medical management with phosphate salts and calcitriol normalized her phosphorus levels (2.5-3.3 mg/dL), and she underwent surgical repair of her femoral fracture. Although MRI revealed only postsurgical changes in the spine, her continued requirement for phosphate supplementation and persistently elevated FGF23 levels (258 RU/mL) are concerning for residual tumor. Conclusion: This case illustrates the challenges of TIO due to a hypervascular mass in a rare paraspinal site localized by selective venous sampling for the first time at our institution. The patient’s continued FGF23 elevation underscores the importance of advancing medical therapies, such as burosumab, in patients with TIO that are not amenable to complete surgical resection.
OR33-05 Amino Acid Signature of Abdominal Obesity in the TwinsUK Cohort
Authors: Maltais-Payette Ina , Vijay Jinchu , Grunberg Elin , Tchernof Andre 
Published: May 2020

Abstract
Background and aim: Metabolomic studies have shown that circulating amino acid levels are altered in the context of obesity. The branched-chain amino acids (BCAAs, namely leucine, isoleucine and valine) have been the most studied because of their consistent positive association with adiposity and their ability to prospectively predict type 2 diabetes and cardiovascular diseases (1). Circulating glutamate has been much less investigated, but some have shown that its specific association with central fat accumulation was stronger than that of BCAAs (2). This study aimed to evaluate the relationship between circulating glutamate and abdominal obesity and the impact of genetic factors on this association. Methods: In the TwinsUK cohort, we selected individuals for whom both metabolomics and DXA trunk fat measurements were available (n=4 665). We used linear regression to assess the correlation between glutamate level and trunk fat. Those with a trunk fat mass greater than 15 kg were considered abdominally obese. We compared the odds of presenting abdominal obesity in each circulating glutamate quintile with logistic regression models. Monozygotic twin pairs discordant for trunk fat were selected to identify analyte differences driven by non-genetic factors. All analyses were also performed with BCAAs for comparison. Results: Circulating glutamate was positively and significantly associated with trunk fat (β: 0.28, 95%CI: 0.26-0.31). Individuals in the highest circulating glutamate quintile had a more than 8-fold higher risk of being characterized by abdominal obesity compared to those in the lowest quintile (OR: 8.44, 95%CI: 6.17-11.55). In the 54 monozygotic twin pairs discordant for trunk fat, the heavier twin had significantly higher glutamate level compared to the leaner co-twin (p-value: 4.05e-07). In all these analyses, the results for glutamate were more significant than with any of the BCAAs. Conclusion: There is a positive relationship between circulating glutamate and trunk fat that is partially independent of genetic background. This often-overlooked metabolite might represent an interesting biomarker of abdominal obesity. References: (1) Newgard (2017). Metabolomics and Metabolic Diseases: Where Do We Stand? Cell Metab, 25(1), 43-56, (2) Kimberly et al. (2017). Metabolite profiling identifies anandamide as a biomarker of nonalcoholic steatohepatitis. JCI Insight, 2(9).
MON-342 Severe Hypocalcemia and Psuedotumor Cerebri: Old, Still Not so Well Known Relationship
Authors: Patil Madhuri , Butler Valerie , Cameron Benjamin , Jamil Nadia , Egbe Tiffany 
Published: May 2020

Abstract
Introduction:
Severe headaches with nonspecific characteristics raise concern for idiopathic intracranial hypertension (IIH) in a young adult female patient. Clinical features of severe headache, vision loss, and papilledema; normal neuroimaging and elevated opening pressure on lumbar puncture are diagnostic of IIH or pseudotumor cerebri. Etiology is often attributed to obesity in young female patients. We present a rare case of Pseudotumor cerebri in a non-obese female patient with severe hypocalcemia.
Case:
A 26 year old Hispanic female patient with past medical history of hypocalcemia, but off her medications, presented to ER for worsening headache for over a month. Without any specific triggers, she began having headaches in her bitemporal region. The pain was continuous, pressure-type, and 9/10 intensity at its worst. It was associated with nausea and blurring of vision and was refractory to ibuprofen. Patient endorsed severe muscle cramps on review of systems. Physical examination demonstrated mild distress due to the headache, positive Trousseau’s sign, and bilateral papilledema. Laboratory studies revealed serum total calcium level of 4.8 mg/dL, albumin 3.5 g/dL, ionized calcium 0.71 mmol/L, serum phosphate 5.3 mg/dL, intact PTH 300.1 pg/mL, 25-OH Vitamin D 14.3 ng/mL and 1, 25-Dihydoxy Vitamin D 14.1 pg/mL, alkaline phosphatase 131 IU/L, 24-hour urinary calcium 48mg/d and 24 hour urinary calcium/creatinine ratio 50 mg/g. Her MRI brain and MR venogram were unremarkable. Lumbar puncture had elevated opening pressure of 46 cm of H2O. The patient was started on Acetazolamide, oral calcium, and calcitriol without resolution of headaches and hypocalcemia. Acetazolamide was discontinued when she developed severe hypokalemia. With diagnosis of pseudohypoparathyroidism, the dose of elemental calcium was doubled and calcitriol dose increased to 1 mcg BID with improvement of serum calcium, symptoms, and papilledema.
Discussion:
While IIH could be associated with certain medications and systemic conditions, obesity or recent weight gain are the most commonly cited causes of IIH. Severe hypocalcemia is a rare and less known etiology of IIH. Cases of adult patients are reported with a variety of etiologies of severe hypocalcemia. Severe hypocalcemia leading to hypersecretion of cerebrospinal fluid is postulated as a possible mechanism but evidence is lacking in literature. Chronic, rather than acute, severe hypocalcemia is likely to precipitate IIH. Visual symptoms, headache and papilledema are difficult to resolve with conventional medical therapy without correction of underlying severe hypocalcemia. We conclude that before considering surgical interventions for cases which are refractory to medical therapy, rare underlying conditions like severe hypocalcemia must be investigated and treated optimally.
SUN-513 Severe Hyperthyroidism in a Complete Molar Pregnancy
Authors: Proudan Nikoletta , Andre Kersthine 
Published: May 2020

Abstract
Hydatidiform mole (HM), a type of gestational trophoblastic disease (GTD), is a rare cause of clinical hyperthyroidism. The development of hyperthyroidism requires an elevation of HCG &gt;100,000 mlU/mL for several weeks. Complete mole has a marked HCG elevation compared to partial mole thus presents with a higher incidence of thyrotoxicosis. Surgical uterine evacuation is the treatment of choice for HM. However, untreated hyperthyroidism can pose a risk for the development of thyroid storm and high-output cardiac failure in the perioperative period. To our knowledge, there are no specific guidelines for management at this time. We present a case of hyperthyroidism secondary to complete molar pregnancy successfully treated with propylthiouracil (PTU), potassium iodide (SSKI), and atenolol in the preoperative period.
A 42-year-old female with history of migraines presented to her gynecologist with a 3-week history of lower abdominal cramping, vomiting, loss of appetite, and abnormal vaginal bleeding. She also endorsed a 6-pound weight loss, intermittent tachycardia, exertional dyspnea, and increased anxiety. Pregnancy test was positive, and ultrasound was concerning for GTD. Laboratory work up was significant for HCG 797,747 mIU/mL (&lt; 5mlU/mL), TSH &lt;0.005 mIU/mL (0.4-4.0 mlU/mL), Free T4 3.09 ng/dL (0.9-1.9 ng/dL), and Free T3 11.48 pg/dL (1.76-3.78 pg/dL). The patient was admitted to the hospital and started on PTU 100 mg Q6H, SSKI 200 mg TID following the first dose of PTU, and atenolol 25 mg daily. She underwent an uncomplicated D & C the next day. On post-op day 1, HCG decreased to 195,338 mIU/mL and Free T4 to 2.39 ng/dL. The patient was discharged on the aforementioned doses of PTU and atenolol. One-week follow-up labs showed HCG 8,917 mIU/mL and Free T4 1.22 ng/dL. Surgical pathology confirmed a complete hydatidiform mole. PTU was decreased to 50 mg TID. On post-op day 14, HCG had risen to 15,395 mIU/mL with onset of nausea and vomiting. Repeat Free T4 remained within reference range. Patient was taken back to surgery for a laparoscopic total hysterectomy with bilateral salpingectomy. Pathology confirmed an invasive hydatidiform mole. Two-week follow-up lab work showed HCG 155 mIU/mL, TSH 1.5 mIU/mL, and Free T4 1.19 ng/dL. PTU and atenolol were then discontinued.
The development of hyperthyroidism in molar pregnancy is largely influenced by the level of HCG and usually resolves with treatment of GTD (1). However, it’s crucial to control thyrotoxicosis to avoid perioperative complications. This case also highlights the importance of monitoring HCG levels following a complete molar pregnancy due to an increased risk for invasive neoplasm.
1. Walkington, L et al. “Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.” British journal of cancer vol. 104,11 (2011): 1665-9. doi:10.1038/bjc.2011.139
From Heritage to Refugee Heritage
Authors: Hochberg Gil 
Published: May 2020

Abstract
As a contemporary concept, heritage bridges legal discourse and ethical discourse, national affiliations and a global imaginary, colonial pasts and neocolonial presents. The term often circulates beliefs in cultural authenticity, collective memory, and historical merit under the logic of neoliberal markets and legitimate capital gain, hence the tight connections between cultural heritage, industry, and tourism. While the concept developed as early as the nineteenth century in postrevolutionary France, its expansive political, juridical, and symbolic use has matured only after the Second World War, primarily as a reaction to the mass destruction experienced in European cities. Managing “heritage” in the context of the global political imagination created after the war, UNESCO has become the key player, lead actor, and sole orchestrator of all things/sites/memories—tangible and intangible—defined as World Cultural Heritage. This article looks at recent critical engagement with heritage, and with UNESCO's role in identifying heritage sites, by exploring Refugee Heritage, a recent project of DAAR (Decolonizing Architecture Art Residency).
Introduction
Authors: Schäfers Marlene , Düzel Esin 
Published: May 2020

Abstract
How are resistance movements able to sustain political commitment and morale amid ongoing state violence? How do conflicts over sovereignty find articulation in contestations over affective belonging and moral values, thereby shaping intimate lives and gendered subjectivities? The five articles gathered in this special section take up these questions by ethnographically considering the complex internal dynamics of resistance movements in Kurdistan, Kashmir, and Western Sahara. They explore how these movements' struggles for alternative sovereignties and against colonial occupation and dispossession are translated into gendered expectations of loyalty, accusations of betrayal, and practices of critique. Investigating how Kurdish, Sahrawi, and Kashmiri militants, activists, and followers of resistance movements navigate the binary logics of loyalty and critique that violent conflict and occupation have rendered central to their lives, this special section shines new light on the morality of resistance and the gender of militancy.
Walking a Fine Line
Authors: Schäfers Marlene 
Published: May 2020

AbstractThe Kurdish resistance movement, one often hears in Kurdistan, Turkey, and beyond, has brought momentous change to a deeply patriarchal society and in this way paved the way for the empowerment of Kurdish women. Instead of discussing whether such empowerment has “actually” materialized, this article seeks to investigate what moral expectations, normative standards, and gendered subjectivities this narrative generates. The Kurdish case reveals how narratives of empowerment form a crucial part of the moral and gendered bargains that sustain and legitimate resistance movements. As they tie personal lives to political projects of resistance and liberation through notions like sacrifice, gift, and debt, such narratives shape political belonging and render critique a perilous undertaking. Tracing how Kurdish women seek to reconcile the dilemmas that arise as a result, the article reflects on the ways in which the political comes to be refracted in intimate realms of kinship and family. It contends that familial and personal relationships are crucial sites where expectations of political loyalty and allegiance take on shape and substance but are also negotiated and contested.
Beauty for Harmony
Authors: Düzel Esin 
Published: May 2020

Abstract
Beauty can be a source of self-making within a political community, and that self can display moral autonomy via publicly visible and invisible practices while still adhering to a community. At a time of transition during the early 2000s from militarized resistance to urban civil politics, radical democracy, and gender ideals, older militarized notions of the Kurdish self, body, and beauty were changing. In a context of heightened visibility within the movement, women active in the Kurdish movement responded by recrafting their femininities, using beautification practices as a modern, urban, and empowering political tool. But beautification of the new self also entailed often sticky negotiations over the moral boundaries between the self and the movement, producing anxieties over what and who should constitute the moral. As women's actions, public roles, and visibilities became important indicators of the Kurdish movement's political success, their beauty practices and beautiful visibilities came to be viewed through the urgent need for moral unity. Central to Kurdish women activists' experience of and response to the political and social transformations going on around them, the integration of beauty practices into their politics placed moral autonomy at the center of the construction of new models of Kurdish femininity.
The Coherence of Contradiction
Authors: Sseremba Yahya 
Published: May 2020

Abstract
Shahab Ahmed shows that the magnitude of contradiction in Islam is far greater than modern analysts realize. Yet there is, he says, something in this contradiction that makes it coherent—something for which whoever seeks to understand Islam in its multifaceted entirety should look at. I propose that the insights of the book should be utilized to study the unity of conflicting traditions even in non-Muslim societies of Africa before colonialism downsized custom.
Phase-shift laser range finder technique based on optical carrier phase modulation
Authors: He Hongyu , Sun Jianfeng , Lu Zhiyong , Xu Mengmeng , Lao Chenzhe , Han Ronglei , Cai Xinyu , Li Yuexin 
Published: May 2020

A coherent laser range finder based on optical phase modulation and phase shift measurement is presented. In the proposed laser range finder, the emitted laser is modulated by an electro-optic phase modulator using a 20 MHz sine signal, and the received laser is mixed with a local oscillator using a 90° optical hybrid. Compared with traditional laser phase shift range finders, the proposed laser range finder can measure the velocity and range at high precision simultaneously. An algorithm to calculate the range and velocity is deduced. Our preliminary experiments on moving targets indicate that when the measurement rate is 100 kHz, the root mean square errors of range and velocity, respectively, are

9.35
×

10

−
4

m

and

4.74
×

10

−
4

m

/

s

.
Lasing in a medium with the properties of a Christiansen filter
Authors: Burdukova Olga , Petukhov Vladimir , Senatsky Yuri 
Published: May 2020

Dye lasing in a dense slurry-like mixture, similar to the optical medium of the Christiansen filter, is first reported. A cuvette with lithium fluoride (LiF) crystal particles and an immersion liquid containing pyrromethene 567 dye was placed in a two plane mirror resonator and pumped by pulses of the second harmonic of the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Twenty nanosecond pulses at 545–570 nm wavelengths with energies up to 0.6 mJ were obtained at the output of this slurry laser. The central part of the laser beam with a divergence of 6 mrad was usually accompanied by a ring structure of scattered radiation. The conditions of the generation development and formation of the output beam profile in a slurry laser as well as its possible applications are discussed.
Incorporating Fecal Calprotectin Into Clinical Practice for Patients With Moderate-to-Severely Active Ulcerative Colitis Treated With Biologics or Small-Molecule Inhibitors
Authors: Dulai Parambir S. , Battat Robert , Barsky Maria , Nguyen Nghia H. , Ma Christopher , Narula Neeraj , Mosli Mahmoud , Vande Casteele Niels , Boland Brigid S. , Prokop Larry , Murad M. Hassan , D'Haens Geert , Feagan Brian G. , Sandborn William J. , Jairath Vipul , Singh Siddharth 
Published: May 2020

INTRODUCTION:
We applied the Grading of Recommendations, Assessment, Development, and Evaluation framework to evaluate the performance of fecal calprotectin (FC) as an alternative to endoscopy in patients with moderate-to-severe ulcerative colitis (UC) treated with a biologic agent or tofacitinib.

METHODS:
Individual participant data from the trials of infliximab, golimumab, vedolizumab, and tofacitinib for UC were pooled to generate prevalence of endoscopic activity (Mayo endoscopy score) across different combinations of the rectal bleeding score (RBS) and stool frequency score (SFS). These estimates were then combined with the data from an updated systematic review of the operating properties of FC to generate clinical scenario–specific assessments of the performance of FC as a predictor of endoscopic disease activity. A prespecified threshold of acceptability for false-negative (FN) and false-positive (FP) test results was set at 5%.

RESULTS:
For patients with UC achieving RBS 0 + SFS 0/1, FC ≤ 50 μg/g may avoid endoscopy in 50% patients with a FN rate <5%. Similarly, for patients with RBS 2/3 + SFS 2/3, FC ≥ 250 μg/g potentially avoids endoscopy in approximately 50% patients with an FP rate <5%. The greatest uncertainty in the diagnostic performance for FC was observed in patients with UC achieving RBS 0 but having SFS 2/3, where FN and FP rates were consistently >10%, and endoscopic evaluation may be warranted.

DISCUSSION:
Two clinical scenarios were identified where FC can be used with confidence for monitoring treatment response to biologics or tofacitinib in patients with UC without the requirement for endoscopy.
Importância do monitoramento e disponibilização de dados hidrológicos para a gestão integrada dos recursos hídricos
Authors: Figueiredo Pereira Marco Alésio , Lippo Barbieiro Bruno , Muller de Quevedo Daniela 
Published: May 2020

A conservação do meio ambiente, com a implementação de práticas visando o desenvolvimento sustentável e abordando a gestão integrada dos recursos naturais, é essencial para a manutenção do meio e da sociedade. Nesse sentido, este trabalho teve por objetivo avaliar a possibilidade de implementar a Gestão Integrada de Recursos Hídricos - GIRH, a partir de dados hidrológicos disponibilizados no endereço eletrônico do Sistema Nacional de Informações sobre Recursos Hídricos (SNIRH) sob a responsabilidade da Agência Nacional de Águas – ANA. Para isso, o estudo apresenta as condições do monitoramento hidrométrico da bacia hidrográfica do Rio dos Sinos – RS e discutindo a importância da disponibilização de dados hidrológicos para a GIRH. A partir de informações disponibilizadas no SNIRH, fez-se uma pesquisa sobre as séries históricas de estações pluviométricas, fluviométricas e de qualidade da água instaladas na respectiva bacia, sendo avaliado se, a partir do monitoramento hidrométrico realizado, é possível a implementação da GIRH. Foi possível identificar que, a partir dos dados existentes, a implementação e a manutenção de uma GIRH fica comprometida. Constata-se que existem diversas entidades que monitoram os recursos hídricos na bacia, no entanto, quando disponibilizados, os dados observados por tais entidades são armazenados em sites específicos de cada instituição ou nem mesmo são disponibilizados, o que acarreta dificuldade de aquisição de dados para os usuários finais. Além disso, verifica-se a necessidade da ampliação da rede de monitoramento e a implantação de uma rede automática e telemétrica de monitoramento na bacia.