bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUN-689 Treatment of Hepatitis C Has Time-Dependent Relationship with Type 2 Diabetes Progress
Authors: Liu Luna , Ding Yi , Liu Hong-Biao 
Published: May 2020

Abstract
Introduction
Hepatitis C virus (HCV) is not only related to hepatic impairment but also associated with metabolic complications, such as glucose intolerance and lipid dis-regulation. In addition, HCV can affect pancreatic Beta-cells function. There are multiple controversial reports regarding the relationship between antiviral treatment and diabetes mellitus (DM) development. We performed continuous observation of a long-term nursing home facility DM patient treated with HCV.
Case Presentation
52 y/o white male nursing home patient history of hepatitis C and type 2 diabetes mellitus was treated with ledipasvir/sofosbuvir (90 mg - 400 mg) for 12 weeks. Prior to HCV treatment patient DM control was treated with oral medications (metformin and glipizide) with fast glucose level fluctuating 143±44 mg/dl; 2 hours postprandial level 205±57mg/dl; HbA1c 7.0%. There was no significant change of finger sticks during the 12 weeks of HCV treatment fast glucose 121 ±27 mg/dl and 2 hours postprandial level 176±62 mg/dl.DM management remained the same treatment plan. In the first three months after HCV treatment course patient DM was progressively getting worse with fast glucose level 221±56mg/dl; 2 hours postprandial levels 300±71 mg/dl. HbA1c 8.7% (3 months after HCV treatment). Oral DM medications were doubled dosages and maximum dosage of pioglitazone was added on. In addition, insulin sliding scale and long acting insulin accumulated daily dosage around 120 units. Starting from four months after HCV treatment patient DM was gradually improving evidenced by fast glucose levels 92±10mg/dl and 2 hours postprandial levels 117±30 mg/dl; HbA1c 5.6% with the same management strategies. Seven months after HCV treatment patient DM was stable with fast glucose levels 91±8 mg/dl and 2 hours postprandial levels 115±29 mg/dl; HbA1c 4.8% and insulin sliding scale and glipizide were discontinued. Long acting insulin dosage was decreased to 74 units daily. Eighteen months after HCV treatment patient fast glucose levels and 2 hours postprandial levels were in normal range and HbA1c 5.6%.
Discussion
Based on our observation there are four phases of DM development related to the HCV treatment: phase I silence stage (during 3 month HCV treatment) DM is stable; phase II deterioration stage (First 3 month after HCV treatment) DM is progressively getting worse; phase III recovery stage (4 to 6 month after HCV treatment) DM is gradually improving; phase IV stabilization stage (6 month after HCV treatment) DM is stabilized and improved.
Conclusion
Anti-viral treatment of HCV has possible intrinsic time-dependent relationship with DM development.
SAT-515 Anorexia and Severe Hypothyroidism Driving Persistent Ascites and Liver Injury
Authors: Gugger Aristea Sideri , Viana Gracia , Stamatiades George Alexiades , Majumdar Sachin K 
Published: May 2020

Abstract
Background Unintentional weight loss, ascites, and altered mental status typically raise concerns for hepatologic-cardiac-oncologic disease. Herein we present a case that after exhaustive workup the etiology of the aforementioned findings was attributed to a combination of anorexia and severe hypothyroidism, states where slowed metabolism and altered nutritional status can interact synergistically. Clinical Case A 71 y/o lady with a history of hypothyroidism after RAI for Graves’ disease, anxiety, depression, presented with 20-30 lbs unintentional weight loss over 5 months. She had poor appetite, nausea, constipation, increased abdominal girth, anasarca, fatigue, weakness, and altered mental status. On exam she had bradycardia, hypotension and hypothermia (BP 97/51, HR 54, RR 18, Temp 94, BMI 15.8). Labs revealed a TSH of 36, FT4 0.98, Tbili 0.3, alk phos 491, AST 435, ALT 651, gGT 151, albumin 2.3, prealbumin 14.7, INR 1.03, and pancytopenia. Treatment with IV levothyroxine resulted in mental status improvement. Over the next few months extensive testing revealed mild element deficiencies (zinc 44- nl range 60 - 130 mcg/dL, vit A 32- nl range 38 - 98 mcg/dL), no evident infectious/hematologic or inflammatory disease. Despite 3 paracenteses, 2 liver biopsies, multiple imaging studies (abdominal U/S, ECHO, XRs, CT chest/abdomen/pelvis, MRI abdomen/pelvis, enterography, MRI brain, PET scan), EGD/colonoscopy, bone marrow bx, and explorative laparoscopic abdominal surgery, no clear explanation was found. During the workup her liver enzymes remained elevated, TSH and fT4 normalized, but T3 remained low at 50 (76 - 181 ng/dL). Psychiatric evaluation revealed mild cognitive impairment, presumed to be secondary to depression and underlying disease. By exclusion, she was diagnosed with anorexia with a possible component of persistent hypothyroidism. She was fed through NG tube and followed closely by nutrition with a personalized high protein and calorie meal plan. Eight months later she had gained 5 lbs, her liver enzymes/electrolytes and CBC normalized, and most of her symptoms resolved. Conclusion Hypothyroidism can cause LFT abnormalities, and though rare, there are &gt;50 cases of hypothyroidism induced ascites reported. Usually LFTs and ascites normalize promptly with hormone supplementation. However, our patient’s case was complicated by severe anorexia, with nutritional status essentially equivalent to kwashiorkor sufferers. Though extremely rare in the developed world and in adults, kwashiorkor like physiology has been described in patients with anorexia, with impressive liver abnormalities, presumed to be due to autophagy. Though certainly this is a rare diagnosis, it does point to the fact that in our test driven culture, it is worth pausing, re-evaluating history and physical and thinking outside the box prior to subjecting our patients to countless tests and procedures.
MON-072 A 2 -Year Old Girl with Turner Syndrome and Neurofibromatosis Type 1
Authors: Dermitzaki Eleni , Manolakos Emmanouil , Tagalakis Panagiotis , Kleanthous Kleanthis , Papadimitriou Dimitrios T 
Published: May 2020

Abstract
Introduction: Turner syndrome (TS) occurs due to loss of either all or part of the X chromosome, in some or all the cells of the body. The most consistent features of TS are short stature and premature ovarian failure. Neurofibromatosis type 1 (NF1) is an inheritable in an autosomal dominant manner tumor predisposition syndrome and is caused by loss-of-function mutations in the tumor suppressor NF1 gene (neurofibromin 1). Literature review indicated rare cases with NF1 and TS (1). We report the sixth girl with mosaic TS and NF1 who presented with optic nerve glioma.
Case report: A 2-year-old female presented to us due to short stature. Her height was 2,5 SD lower than the mean parental height curve, and her bone age was delayed only by 3 months. She already had a normal (46XX) peripheral blood karyotype (70 mitoses). She had abnormal body proportions and with short limbs with unremarkable café au lait spots. Additionally, to the short stature laboratory investigation we ordered a gene panel to exclude hypochondroplasia, and a Karyotype in fibroblasts culture from oral cavity sample. The results revealed low IGF-1 and mosaic TS in 14%. We preformed 2 provocative tests which revealed low growth hormone peak &lt; 5 ng/ml. A brain and pituitary MRI to exclude pituitary lesions or structural abnormalities revealed gliomas of the optic chiasma and the right optic nerve with characteristic NF1 “spots” (regions of signal abnormality in T2 sequences) involving the basal ganglia, cerebellum and the right temporal lobe. DNA sequencing targeted to a gene panel related to NF1 and NF2 revealed a novel de novo heterozygous NF1 gene mutation in exon 28 [3764Α&gt;G];[=]p.[Gln1255Arg].
Discussion: NF1- Gliomas are most commonly seen in young children, (mean 4.5 years). Only 1/3 of affected children will require therapeutic intervention. However early diagnosis, of optic gliomas is important. Our patient was completely asymptomatic by the time of diagnosis and no other symptom or sign of NF1 was apparent. Ophthalmologic examination was normal, but visual electrophysiologic testing was abnormal as far the right optic nerve is concerned. The oncology team decided to preform chemotherapy. In TS impaired growth is related to resistance in GH. Some studies suggested that there could be a relationship between GHD and NF1 even in the absence of an organic pituitary damage. In our patient it has been decided not to treat with GH and closely track the patient’s growth.
Conclusion: Coexistence of NF1 with TS is rare. Awareness is needed as early identification and treatment of CNS gliomas can prevent visual loss and severe co-morbidities.
1.
Rare Presentation of Neurofibromatosis and Turner Syndrome in a Pediatric Patient. Pediatr Rep. 2017 Jun 26; 9(2): 6810
SAT-639 Is the Freestyle Libre Flash Glucose Monitor Accurate in the Critically Ill?
Authors: Johnson-Rabbett Brianna , Hashmi Hiba , Lyerla Ryan , Lafave Laura 
Published: May 2020

Abstract
The FreeStyle Libre flash glucose monitor (FGM) has made the use of continuous glucose monitors more accessible to the typical diabetes patient in an outpatient setting given the significantly lower cost and ease of use of FGM as compared to other systems. However, FGM is not labeled for use in a critically ill population. The critical care department at our institution queried the endocrine department about studying the use of FGM in critically ill patients. The interest of the critical care department was due to the potential of decrease in patient discomfort and decrease in time and effort of nursing and support staff related to the performance of fingerstick capillary glucoses if FGM was an adequate replacement measure.
As of yet, there has been only minimal study of flash glucose monitoring in critically ill patients. One Australian study evaluated 8 patients in an ICU setting and determined that as compared with arterial blood glucose monitoring, flash glucose monitoring provided acceptable numerical and clinical accuracy.1 A Swedish study evaluated a total of 26 patients undergoing cardiac surgery and compared the use of FGM to use of a microdialysis intravascular system and concluded that the microdialysis system was more accurate, though in this study, only 25% of patients had diabetes. 2
To further investigate use of FGM in a critically ill population, we plan to undertake a single center, prospective, single arm study enrolling at least 20 and up to 40 patients. Inclusion criteria include a known diagnosis of type 1 or type 2 diabetes, age of 18 or older, and admission to the medical intensive care unit (MICU) with expected MICU stay of at least 48 hours.
Participating subjects will have a sensor applied by a study investigator. After confirmation that the sensor is operational, the investigator will place opaque tape over the monitor to blind the monitor data. Nurses or medical assistants will conduct the standard of care fingerstick glucose monitoring per hospital protocol but will also have been notified of request to also pass FGM reader over the sensor at time of fingerstick glucose data collection.
The primary objectives are to determine numerical accuracy in a critical care setting using the mean absolute relative difference and to determine clinical accuracy in a critical care setting using the surveillance error grid and the clarke error grid analyses. Preliminary data should be available by March, 2020.
1.
Ancona P, Eastwood GM, Lucchetta L, Ekinci EI, Bellomo R, Martensson J. The performance of flash glucose monitoring in critically ill patients with diabetes. Crit Care Resusc 2017; 19: 167-174, June 2017.
2.
Schierenbeck F, Franco-Cereceda A, Liska J. Accuracy of 2 Different Continuous Glucose Monitoring Systems in Patients Undergoing Cardiac Surgery: Intravascular Microdialysis Versus Subcutaneous Tissue Monitoring. Journal of Diabetes Science and Technology 2017, Vol. 11(1) 108–116
SAT-126 Breast Adipose Tissue Extracellular Vesicles from Obese Women Increase Breast Cancer Aggressiveness - a Novel Mechanism for the Obesity-Breast Cancer Link
Authors: Benito-Martin Alberto , Paik Paul , Mushannen Malik , Bhardwaj Priya , Oshchepkova Sonya , Spector Jason , Brown Kristy A 
Published: May 2020

Abstract
Background and Objectives: Breast cancer is among the most common cancer in women with 2.1 million new cases detected each year. Numerous studies have demonstrated a connection between body mass index (BMI) and cancer incidence, with obesity (BMI ≥ 30) being responsible for the development of at least 13 types of cancer, and 15% to 20% of total cancer-related mortality. The effects of extracellular vesicles (EVs) derived from the obese adipose tissue microenvironment on breast cancer have not yet been clearly elucidated.
Methods: EVs were obtained from media conditioned with human breast adipose tissue from reduction mammoplasty (n=31). Women were healthy at the time of surgery and had no history of breast cancer. Patient samples were stratified based on their body mass index (BMI), with a BMI &lt; 25 considered healthy and a BMI ≥ 25 considered overweight/obese. Breast adipose tissue-derived EVs (AT-EVs) were characterized (Quantitative Mass Spectrometry) and used to treat human breast cancer cell lines, including the ER+ MCF7 and triple negative breast cancer (TNBC) MDA-MB-231. Effects on cell proliferation and migration in vitro, and on tumor growth in a mouse xenograft model, were examined after long-term education with EVs. RNA sequencing was performed to investigate potential reprogramming induced by AT-EVs.
Results: We found a positive correlation between protein amount per AT-EV and BMI. Quantitative proteomics of AT-EVs revealed 46 proteins that were significantly higher and 54 proteins that were significantly lower in specimens from women with a BMI ≥ 25 compared to women with a BMI &lt; 25. AT-EVs from patients with a BMI ≥ 25 induced proliferation of MCF7 cells compared to AT-EVs from patients with a BMI &lt; 25. Obese EVs induced a more aggressive phenotype in MDA-MB-231 cells, increasing their invasiveness in vitro. Obese EVs also increased the growth of MCF7 and MDA-MB-231 cells in vivo. Ingenuity pathway analysis of RNA-Seq data identified significant differences in mTOR signaling and canonical pathways associated with altered mitochondrial function.
Conclusion: Our studies identify a novel mechanism to explain the obesity-breast cancer link in older women. Namely, that in obesity, the breast microenvironment produces EVs capable of reprogramming breast cancer cells to grow faster and be more aggressive. Identifying which cargo in breast AT-EV mediates these effects may provide new targets for intervention.
SUN-428 Rural India Embracing Advanced Techniques in MIS:- A Series of 20 Cases of Thyroid Surgeries by Transoral Endoscopic Thyroidectomy-Vestibular Approach (TOETVA) Technique with Respect to Acceptance of Progressive Surgeries Using Advanced Technologies, Techniques by Rural Patients and it’s Safety & Feasibility in Small Setup Hospital in Rural India
Authors: Lohokare Narendra Vijay , Velankar Aditi C 
Published: May 2020

Abstract
Aims & Objectives
Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) an alternative surgical technique for thyroid surgery is slowly gaining widespread popularity.
Majority of TOETVA surgeries are performed in Tertiary Care institutes. It’s safety & Feasibility in small setup hospitals has not been reported until now. The key challenges in Indian Rural healthcare sector are Lack of Quality Infrastructure, Dearth of qualified medical functionaries and NonAccess to basic medicines and medical facilities thwarts its reach to population in rural India. Indian Health Care sector is a self-pay market. Lack of awareness & affordability being a challenge with patients they remain apprehensive in acceptance of Advanced Technology or newer Techniques.
This series is an attempt to study A shift in acceptance of progressive surgeries using Advanced Technologies & Techniques by Rural Patients and its Safety & Feasibility in Smaller operative setups in rural India.
Methods
Proper patient selection along with proper instrumentation & OT setup helped complete the procedures without any major complication.
Advanced Instrumentation along with essential Operation Theatre setup were utilised for performing Total of 20 TOETVA procedures.
For successful execution of TOETVA surgeries extensive Training Programs were furnished to equip stakeholder teams with respective Skill, Knowledge & Attitude sets.
Organisational SWOT Analysis & Competency mapping contributed to strategise a helping approach to Educate & Influence stakeholders.
Results
Total 20 patients were operated by TransOral Endoscopic Thyroidectomy - Vestibular (TOETVA) Technique from May 2018 till September 2019.
Three SubTotal Thyroidectomies & 16 Hemithyroidectomies were performed. One patient was operated for Thyroglossal cyst.
Increased awareness about a need to Improve on competence of Empathy & Accountability, Pursuit of Quality Care & Inculcating Cost-Effective use of the results of relevant research in regular functions.
Conclusions
There is a noticeable paradigm Shift in acceptance of rural patients as well as of rural paramedical staff that these surgeries which require Advanced Technology & Innovative Techniques are easily Accessible & Executable without undue cost burden with utmost safety at their own vicinity even in the small setup hospitals.
This study aids to recommend Feasibility & Safety of TOETVA even for small setup of hospitals in Rural India.
SAT-644 A Case of the Use of the Eversense Continuous Glucose Monitor with Repeated Same-Pocket Insertion
Authors: Lee Warren , Wright Lorena Alarcon Casas 
Published: May 2020

Abstract
Introduction:The Eversense continuous glucose monitoring (ECGM) system is a 90-day implantable, subcutaneous device approved for patients with diabetes. The manufacturer recommends alternating arms for each subsequent insertion site to allow for appropriate healing. To date, there is few data describing use of the same subcutaneous pocket for all subsequent ECGM devices. We present the experience of a patient’ s first year use of ECGM with 4 out of 5 device placements within the same subcutaneous pocket. The patient uses an insulin pump and is a concomitant user of Dexcom G5 continuous glucose monitor, allowing us to compare data from his two CGM systems.
Clinical Case:42-year-old male with a 14-year history of type 1 diabetes, user of the ECGM from July 2018 to date. The first device was placed in his right arm; his second ECGM was placed in his left arm with all subsequent implant replacements in the same pocket, a total of 5 devices, four in the same pocket. Patient baseline glucometric data obtained from his first ECGM device (period 1 [P1]) indicated an estimated HbA1c (A1c [%]) of 7.06, average glucose (AG [mg/dL]) 156±61, coefficient of variation (CV) 39.1, time in range (TIR [%]) 66.73, time below range (TBR [%]) 2.59, time in serious low (SH [%]) 0.41, time above 180 mg/dL (TA180 [%]) 21.38, and time in serious high, above 250 mg/dL (TA250 [%]) 8.72. Data obtained from subsequent device insertions is described by periods of data time: period 2, 3 and 4 (P2, P3, P4). Glucometric data was as follows for the 3 time periods. A1c was 6.9, 6.9 and 7.1; AG 152±65, 153±64, 157±68; CV 42.7, 41.8, 43.3; TIR 65.7, 65.72, 64; TBR 3.81, 4.13, 3.68; SH 0.93, 0.7, 0.92; TA180 20.1, 20.2, 20.2; TA250 9.3, 9.1, 10.7 respectively for P2, P3 and P4. All four ECGM devices were replaced successfully within the same subcutaneous pocket with minimal bleeding and discomfort. There were no complications, and all devices functioned well, with excellent and constant transmitter signal and longevity. A 1-month overlapping Dexcom CGM data at the end of P2, start of P3 demonstrated A1c of 6.8; AG 144±64; TIR 67.2; TBR 7.5; SH 1.9;TA180 25.3 and TA250 8.2. ECGM data of the same time frame showed A1c of 7.3, TIR of 59.5, TBR 3.6, SH 1.09, TA180 22.1, and TA250 13.5.
Conclusions:Our experience with the ECGM over repeated insertions within the same pocket shows that using this technique is a feasible method for subsequent device implantation. We present one of our patients, user of ECGM, with the longest use of same insertion pocket, demonstrating adequate and constant signal and no complications. The ECGM procedure itself has minimal risk for bleeding, pain, and infection. The use of the same pocket further decreases this risk, by decreasing the number of punctures and procedure time. Consideration for same pocket insertion is proposed to be discussed with the patient, limiting the same pocket insertion to a maximum of one year, based on our clinical experience.
MON-217 New Methods for Primary Aldosteronism Screening by Exploring the Values of Different Indicators and in Combination with Predictive Model
Authors: Li Yuanmei , Wang Wen , Li Qianrui , Chen Tao , Mo Dan , Zhang Tingting , Zhou Fangli , Ren Yan , Tian Haoming 
Published: May 2020

Abstract
Background: Primary Aldosteronism (PA) is the most common cause of secondary hypertension. The endocrine society guidelines recommend case detection of PA by determining the aldosterone-renin ratio (ARR) under standard conditions, but the cut-off value of upright ARR varies greatly. In addition, as with all other biochemical tests, there are false positives and false negatives for upright ARR. In order to avoid false negative, some researchers have proposed plasma renin activity (PRA) &lt; 1.0 ng/ml/h as a screening indicator. In order to avoid false positive caused by low PRA, Professor Young of the Mayo Clinic have proposed that the ARR combined with the plasma aldosterone concentration (PAC) &gt; 15 ng / dL for PA screening. In 2019, Professor Young proposed PA screening positive when PAC≥10ng/dL and PRA&lt;1.0 ng/ml/h. In addition, angiotensin II (AT-II) directly stimulates the synthesis of aldosterone. Compared with renin, the decrease of AT-II level and the increase of aldosterone to AT-II ratio (AA2R) may reflect the aldosterone autonomy secretion. However, whether these screening indicators are superior to upright ARR remains to be further verified. Therefore, either exploring the diagnostic efficacy of PAC, PRA, or AA2R as a screening indicator or even better developing a clinical prediction model combined with multiple indicators may provide a more accurate method for PA screening. Objective: To explore the value of different indicators and the logistic regression model (nomogram) for primary aldosteronism screening. Methods: The clinical data of 499 patients with PA and 479 patients with essential hypertension (EH) diagnosed by West China Hospital from 2009 to 2018 were retrospectively analyzed. The diagnostic performance of different screening methods was compared by plotting receiver operating characteristic curves (ROC). Results: The proportion of low potassium in PA group was higher than that in the EH group (86.20% vs. 36.50% P&lt;0.001). The area under the ROC curve (AUC) of upright ARR was greater than that of upright AA2R, upright PRA, upright PAC, supine ARR, and lowest blood potassium (P&lt;0.05); The AUC of logistic regression model (nomogram) [which consists of the upright PAC, the upright PRA, and the lowest blood potassium] was greater than that of upright ARR (96.3% vs. 94.6%, P&lt;0.05). Conclusion: The upright ARR is the best single screening indicator; AA2R (radioimmunoassay) is not recommended for PA screening. Ultimately, the logistic regression model (nomogram) is superior to the upright ARR.