bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-19 A PATIENT WITH ATYPICAL PARATHYROID ADENOMA
Authors: Karataş Aslı , Yavuz Di̇lek Gogas 
Published: January 2025

Abstract

Introduction
Primary hyperparathyroidism is most frequently caused by a parathyroid adenoma, occasionally by parathyroid hyperplasia, rarely by atypical parathyroid adenoma and parathyroid carcinoma. Here, we present a case diagnosed as PHPT pathology revealed atypical parathyroid adenoma.

Clinical Case
A 49-year-old male patient was referred to our endocrinology clinic because of hypercalcemia identified for the investigation of nephrolithiasis. The patient reported no hypercalcemia-related symptoms. His physical checkup was unremarkable.
The results of the laboratory investigations were as follows: calcium 10.9 mg/dL (8.8–10.6), albumin 4.2 g/dL (3.5–5.2), phosphorus 2.15 mg/dL (2.5–4.5), 25-OH vitamin D 13 μg/L, PTH 142 ng/L (15–65), creatinine 0.59 mg/dL (0–1.2), and 24-hour urine calcium 647.4 mg/day (0–300).
Neck ultrasonography revealed two hypoechoic nodules, the biggest measuring 13.5 x 9 mm in the right thyroid lobe. Parathyroid scintigraphy revealed no typical signs consistent with a parathyroid adenoma in the neck or mediastinum. Four-dimensional computed tomography of the neck revealed an 8 mm, well-circumscribed, bilobed lesion in the posterior-inferior region of the right thyroid lobe, that did not augment with intravenous contrast and was regarded as an exophytic thyroid nodule.
A fine-needle aspiration biopsy was done and the results were reported as follicular lesions of uncertain significance. A PTH washout test was performed on the same nodule, resulting in a value of almost 5000 ng/L. A choline PET/CT scan revealed a 13 mm soft tissue lesion with enhanced radiotracer uptake (SUV max: 5.39) posterior to the lower pole of the right thyroid lobe, indicating a parathyroid adenoma.
The patient underwent a right thyroid lobectomy and the right inferior pole parathyroid adenoma was excised. The surgical specimen's histopathological investigation revealed neoplastic parathyroid tissue with lack of reticulin architecture and fibrotic bands, abnormal lack of parafibromin staining indicating an atypical parathyroid adenoma.
The postoperative calcium level was 9.7 mg/dL, the phosphorus level was 2.8 mg/dL, and the PTH level was 65.2 ng/L.

Conclusion
Atypical parathyroid adenoma is very rare and hard to diagnose. Its prognosis is unclear, so regular surveillance is crucial. The patient is closely monitored for recurrence.
P-23 MANAGEMENT OF X-LINKED HYPOPHOSPHATEMIC RICKETS IN A YOUNG MALE PATIENT
Authors: Mohammed Adel Gassab , Al Waeli Dheyaa Kadhim 
Published: January 2025

Abstract

Introduction
X-linked hypophosphatemic rickets (XLH) is a rare genetic disorder characterized by phosphate wasting, leading to rickets in children and osteomalacia in adults. We present the case of a 21-year-old male diagnosed with XLH, highlighting the clinical features, diagnostic approach, and management strategies employed.
XLH is the most common form of heritable rickets, caused by mutations in the PHEX gene. It manifests as rickets in children and osteomalacia in adults, accompanied by bone pain, muscle weakness, and skeletal deformities. We discuss a case emphasizing the importance of early diagnosis and comprehensive management.

Clinical Case
Mr. AH, a 21-year-old single, non-smoking male, presented with bowing of the legs and was found to have elevated urine phosphate levels. Laboratory tests revealed a calcium level of 9.3 mg/dL, phosphate level of 2.19 mg/dL, parathyroid hormone (PTH) level of 20.98 pg/mL, and vitamin D was not evaluated at the time of presentation. His stature was notably short for his age, with a height of 130 cm and a weight of 50 kg. Blood pressure was recorded at 130/70 mmHg.
The patient's clinical presentation, alongside laboratory findings indicative of hypophosphatemia, elevated urine phosphate, and an inappropriately normal PTH level, led to the diagnosis of XLH. The diagnosis was further supported by the characteristic skeletal deformities observed.
Initially, the patient was managed with phosphate supplements and active vitamin D analogs. Specifically, he was prescribed Zoledronic acid (Zometa) 4mg injection, One Alpha (alfacalcidol) 0.25 mcg tab leo minepharma 2x2, and Diabase tab (calcitriol) 50000 IU weekly. This treatment regimen aimed to correct the hypophosphatemia, improve bone mineralization, and ameliorate the clinical symptoms.
Managing XLH necessitates a multidisciplinary approach, focusing on correcting phosphate levels, supplementing vitamin D, and addressing skeletal deformities. Zoledronic acid, an antiresorptive agent, along with phosphate and vitamin D supplementation, can effectively manage these aspects. However, monitoring for complications such as nephrocalcinosis is crucial.

Conclusion
This case underscores the complexities of diagnosing and managing XLH. Early intervention and a tailored therapeutic strategy are pivotal in improving patient outcomes, highlighting the necessity for awareness and understanding of this rare condition among clinicians.
P-29 HONEYMOON IN LATE PREGNANCY
Authors: Duran İffet Dağdelen 
Published: January 2025

Abstract

Introduction
During pregnancy there is a partial decrease in the function of immune system which would end with suppression of autoimmune diseases, even type 1 diabetes (T1DM) (1-2). We report a pregnant women with T1DM who was suffering from severe hypoglycemia even with very low insulin dosages in her third trimester.

Clinical Case
A 27 year old young lady was referred to our clinic with HbA1c level of 12.7%. She had no symptom other than slight nausea and dry mouth. Her β-HCG level was 55 mIU/ml and her plasma glucose level was 435 mg/dl. She was diagnosed with T1DM about one year ago, was started with intensive insulin regimen about 80 IU/day totally, which she did not use ever since. We hospitalized her and started intravenous (IV) hydration and IV insulin, which we switched to subcutaneous insulin. She was educated by our dietitian and by our diabetes-clinic nurse. As the insulin dosages increased, it was detected that she was pregnant. She was offered for therapeutic abortus but did not accept. Her blood glucose measurements improved and she was discharged with morning: 12 IU, afternoon:8 IU, evening:15 IU insulin aspart and night:18 IU insulin detemir dosages. In the follow up, her Hba1c level decreased to 8.7 % in the 2nd month and to 6.7% at the 20th week. Her fasting blood glucose levels were between 87-102 mg/dl and 1st hour postprandial levels were between 110-137 mg/dl. She dropped from the follow up by her own decision. At her 30th pregnancy week, she came with hypoglycemia and she had decreased her insulin dosages to morning: 2 IU, afternoon: 2IU, evening: 3IU insulin aspart and no insulin detemir. Her plasma cortisol level was 18 mcg/dl, alanine aminotransferase (ALT): 12 IU/L, gamma glutamyl transferase (GGT): 28 IU/L, creatinine (Cre):0.8 mg/dl, and Hba1c:5.3%. Her abdominal ultrasonography (USG) was normal. She was diagnosed with honeymoon period in T1DM and was informed about strict blood glucose measurement.

Conclusion
T1DM would disappear for a long while or regress greatly in some pregnant women even in the late years of their disease (2). Insulin -free period after the pregnancy would last even two and a half years or huge reduction in insulin dosage during pregnany period would even start after 20 years of T1DM (2). In our case, the patient started to use very low insulin dosages at around 30th pregnancy week and after one and half year of her diagnosis of T1DM.
P-43 OUR OBJECTIVE WAS TO PRESENT A CASE WITH FUNCTIONING GONADOTROPH ADENOMA
Authors: Soltanova Lala , Sahin Serdar , Kadıoğlu Pınar 
Published: January 2025

Abstract
Clinical Case
A 36-year-old woman was admitted to the Gynecology department with menstrual irregularity (oligomenorrhea) for 3 months. Pelvic ultrasound detected multiseptated cysts of variable size in both ovaries. Prolactin value was 3 times elevated (63 ng/ml) and 13 mm macroadenoma was detected on pituitary MRI. The patient was initiated on cabergoline treatment 2 days a week. Following 2.5 years of treatment, the patient's menstrual irregularities remained intermittent. The estrogen value in the follicular phase was 3007 pg/ml. Breast USG was normal and endometrial thickness was increased and curettage was performed. The pathology confirmed polyps and estrogen level decreased to 1207 pg/ml after curettage however increased again after 3 months. The patient was referred to the endocrinology department.
The patient with menstrual irregularities continued to have laboratory findings in accordance with hypergonotropic hypergonadism and control sellar MRI was performed. (Figure-1)
A macroadenoma measuring 18x17x15 mm (CCxLMxAP), hyperdense on T1, isodense on T2, mildly deviating the optic chiasm superiorly was operated by the neurosurgery team. Histopathological examination revealed LH and FSH positive gonadotropic pituitary neuroendocrine tumor.
The patient's menstrual cycle improved in the 6-month postoperative follow-up. Control sellar MRI showed no residual mass.
Functional gonadotroph adenomas (FGA) were detected in our patient. Menstrual irregularity was originally considered as hyperprolactinemia. However, while hypogonadotropic hypogonadism is expected in prolactinoma, the presence of hypergonadotropic hypergonadism in our patient is an important distinguishing sign from prolactinoma.Figure 1: Table 1:
O-14 A RARE CASE OF PULMONARY SARCOIDOSIS IN PATIENT WITH FOLLICULAR THYROID CANCER
Authors: Gabidzashvili Nino , Arabuli Bakur , Vinogradskaya Olga , Nakaidze Nana , Mikaberidze Ana , Dophidze Elene , Ambriashvili Kristi , Tsiskarishvili Nino , Jangavadze Mikheil 
Published: January 2025

Abstract

Introduction
As a rule, follicular thyroid cancer is a mildly aggressive type of cancer. However, follow-up after radical treatment consists of assessing the achievement of structural and biochemical remission. If a metastatic process is suspected, additional examination is carried out. Rarely, it is possible to detect a second malignant tumor in the same patient or granulomatous diseases, which complicates differential diagnostics.

Clinical Case
A 53-year-old patient was diagnosed with multinodular goiter a long time ago. She contacted the clinic to determine follow-up based on the results of a biopsy of the left lobe nodule of the thyroid gland which corresponded to BSRTC IV (follicular neoplasm). Left hemi-thyroidectomy was indicated. Intraoperative pathology corresponded to follicular cancer so total thyroidectomy was performed. Postoperative histological examination confirmed follicular cancer 2.2x2.0 cm pT2N0. Radioactive iodine therapy (80 mCi) was performed. After therapy, a whole body scan revealed a focus of retention in the neck, centrally and paramedianly on the left. She received LT4 suppressive therapy. At the first control after combined therapy: TG - 14.7 ng/mL, Anti-TG - normal. After 4 months suppressive therapy: TG - 5.52 ng/mL, Anti-TG - normal. Thyroid ultrasound revealed the lymph nodes with suspicion ultrasound characteristic in the left III and IV zones. Cytological examination showed a picture of hyperplastic lymphadenitis, malignant cells were not detected. CT scan of the chest detected sharply enlarged mediastinal lymph nodes. Thoracoscopy with excision of the paraaortic lymph nodes was performed. Histological examination showed granulomatous lymphadenitis (sarcoidosis). Methylprednisolone therapy was initiated, LT4 suppressive therapy is ongoing.

Conclusion
Our case demonstrates the complexity of differential diagnosis in suspected metastases of follicular thyroid cancer.
Long-term Outcomes of Feminizing Genitoplasty in DSD: Genital Morphology, Sensitivity, Sexual Function, and Satisfaction
Authors: Bag Min Jeong , Inacio Marlene , Bachega Tânia Aparecida Sartori Sanchez , Batista Rafael Loch , Madureira Guiomar , Costa Elaine Maria Frade , Domenice Sorahia , Mendonca Berenice Bilharinho , Dénes Francisco Tibor , Sircili Maria Helena Palma 
Published: January 2025

Abstract

Context
Understanding long-term outcomes and patient satisfaction with feminizing genitoplasty (FG) in patients with differences of sexual development (DSD) is crucial for optimizing treatment protocols.

Objective
To evaluate long-term morphological and functional results and patients’ satisfaction in a cohort of DSD patients submitted to FG.

Design
Cross-sectional and retrospective cohort study conducted from 1965 to 2016 with follow-up assessments.

Setting
Tertiary care center.

Patients or Other Participants
Sixty DSD female patients, including 36 with congenital adrenal hyperplasia (CAH) and 24 with non-CAH DSD etiology, who underwent FG.

Intervention(s)
FG procedures were performed, and results were analyzed based on age at surgery and surgical techniques used.

Main Outcome Measure(s)
Surgical results, genital sensitivity, sexual function, and patient satisfaction.

Results
Ninety-one percent of patients had normal clitoral size, and 85% had separated perineal orifices. Three patients with persistent urogenital sinus did not report symptoms. Genital sensitivity to mechanical and vibratory stimuli was similar to control groups. No CAH patients experienced overall sexual dysfunction, while 3 non-CAH patients and 4 control women reported reduced sexual desire and arousal. Eighty-nine percent of patients preferred surgery during childhood, and 97% were satisfied with their surgical outcomes.

Conclusion
FG outcomes in this cohort were satisfactory, with no significant impact on genital sensitivity or sexual function. Most patients preferred early surgery and reported high satisfaction with the results. Further studies are needed to confirm these findings in broader populations.
Dissecting Tumor Size Underestimation in Pancreatic Cancer: A Comparative Analysis of Preoperative Treatments
Authors: Kobayashi Kazuki , Kishi Yoji , Tsunenari Takazumi , Yonamine Naoto , Takao Mikiya , Einama Takahiro , Tsujimoto Hironori , Ueno Hideki 
Published: January 2025

Abstract

Background
Tumor size (TS) in pancreatic ductal adenocarcinoma (PDAC) is one of the most important prognostic factors. However, discrepancies between TS on preoperative images (TSi) and pathological specimens (TSp) have been reported. This study aims to evaluate the factors associated with the differences between TSi and TSp.

Patients and Methods
We retrospectively analyzed patients with PDAC who underwent surgery at our institution between January 2010 and November 2023. TS discrepancy (TSD[%]) was defined as ([TSp − TSi]/TSp) × 100. Using logistic regression, we generated a receiver operating characteristic (ROC) curve to define the cutoff for TSi underestimation predicting clinical tumor (T) stage migration. Univariate and multivariate analyses were performed to evaluate predictors of TSi underestimation.

Results
Of the 231 patients, 99 (42%) patients received preoperative chemotherapy. The ROC curve determined a TSD underestimation cutoff of 25.9%. The number of TSp > TSi cases was 185 (80%), and TSi underestimation was present in 117 (51%) patients. T stage migration rates were 76%, 26%, and 50% in clinical stage (c) T1, cT2, cT3, respectively, among the patients with chemotherapy, and 93%, 33%, and 14%, respectively, in those without chemotherapy. Multivariate analyses revealed that independent predictors of TSi underestimation were posterior surface invasion in the patients with preoperative chemotherapy and anterior surface invasion in those without chemotherapy.

Conclusions
TS was more commonly underestimated than overestimated, and cT1 rarely corresponded to pathological (p)T1. The factors contributing to TSi underestimation differed between patients with and without preoperative chemotherapy. Therefore, these two groups should be considered separately for accurate TSi evaluation.
Prag, Holz und die Johanniter in der zweiten Hälfte des 14. Jahrhunderts
Authors: Jan Libor 
Published: January 2025

Prague, wood and the Hospitaller in the second half of the 14th century

This article emphasizes the role of wood for many areas of human activity in the Middle Ages. Of course, this is also connected with the timber trade and its transport, for which waterways were primarily used. On the basis of two sources, namely a visitation of the Hospitaller commanderies in the Prague archdiocese from 1373 and a torso of the accounts of the same religious house from the 1480s, the author shows the mechanisms of these activities, which were carried out under the direction of the Prague commanderies. For the Prague Hospitallers, the enclave to the south upstream of the Vltava River was important, where they owned several villages as well as adjacent forests. The centre was the farmstead (curia) in Varvažov, whose administrator was one of the knightly members of the Prague Convent. The transport by boat of the timber assembled into rafts was carried out mainly by the serfs from Varvažov, Nevězice and Zbonín, who were burdened with only small financial contributions. With the price of one raft between costing 12‒32 Prague groats, the Order was able to earn almost 100 three-scores (i.e. 6,000 groats) annually, which was divided in half between the Prague Commander and the administrator from Varvažov. However, the order’s witnesses, Commander Pesslin and Prior Nicholas, did not mention the timber trade at all in their visitations.
Neuerungen in Herstellung und Verwaltung von Schriftgut im ordenszeitlichen Preußen bis zum Beginn des 13-jährigen Krieges
Authors: Heckmann Dieter 
Published: January 2025

Innovations in the production and administration of documents in Prussia during the Teutonic Order’s time until the beginning of the Thirteen Years’ War

If innovations in the administration of records may be regarded as the results stemming from impulses either beyond the specific reasons for writing, or beyond the need to improve clarity, then at least four of them can be recognized for the Prussian period of the Teutonic Order. These were the registration of letters in full text, the “official” translation, the recording of the pound customs receipts and the creation of collections of formulas adapted to the needs of writers, which contributed to the standardization of the administrative and legal area in Prussia. This article argues that these changes can usually be associated with the increasing employment of public notaries in the sovereign or municipal administrations of late medieval Prussia.
Play it Again, Sam? Reference-Point Formation and Product Differentiation in the Music Industry
Authors: Deshmane Abhishek , Martínez-de-Albéniz Victor 
Published: January 2025

Newly released music is never assessed in isolation by audiences, who tend to compare objective (sonic attributes) and subjective (genre affiliations) elements of its identity with the previous musical catalog of the corresponding artist, his or her musically proximal peers, and the most successful releases in the market. In this paper, we provide a general framework that disentangles the objective and subjective identities of new musical releases and evaluates how differentiation affects audience reactions. We posit that radio stations, who seek commercial success, have different preferences toward differentiation in comparison with critics, who grant cultural legitimacy in the industry. Combining play numbers, reviews, and music description data from different sources, we find that radio stations prefer consistency in the musical style of successive releases by the focal artist and especially favor albums that sound similar to chart toppers. Critics, however, exhibit opposite preferences, preferring novelty compared with past works of the artist, while remaining uninfluenced by contemporaneous music dynamics. Our moderation checks reveal that decisions around genre affiliations and scheduling of new releases aid music producers to effectively manage audience expectations. This suggests that data-driven decision support systems can help artists to strategically release new products that cater to heterogeneous tastes. This paper was accepted by David Simchi-Levi, entrepreneurship and innovation. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.03319 .
Cost-effective pulsed laser diode transmitter for efficient laser power transfer
Authors: Yigit Hayri , Boynuegri Ali Rifat 
Published: January 2025

Laser power transfer (LPT) technology is an emerging wireless power transfer technology that offers a promising way to transfer energy over long distances. The transmitter section, being a pivotal component of LPT systems, has conventionally employed continuous mode (CM) lasers. However, pulsed mode (PM) lasers have gained increasing attention due to their economic, flexible, and efficient designs. In this study, an economical and modular transmitter system is proposed for LPT applications. Through the utilization of 10 PM laser diodes, an uninterrupted power transfer capability was achieved. The results of the study showed an efficiency rate of 7.62% and a significant cost saving of $293.
Spectrum and trends of cancer among HIV patients in Southwestern Uganda
Authors: Atwine Raymond , Yekosani Mitala , Birungi Abraham , Ssenkumba Brian , Tuhamize Barbra , Ezinga Richard , Male Keneth , Kabanda Taseera 
Published: January 2025

Background
Antiretroviral therapy (ART) restores cellular immunity, significantly reducing AIDS-related mortality and morbidity thus improving the quality of life among People living with HIV (PLHIV). Studies done in several countries show a decline in AIDS defining cancers (ADCs) with the introduction of ART however the increased longevity has led to the increase of Non-AIDS defining cancers (NADCs). The study was aimed at studying the changing spectrum and trends of cancer among Human Immunodeficiency Virus (HIV) patients in southwestern Uganda.

Methods
The study was a retrospective chart review of records of HIV-positive patients attending/receiving care from the Oncology clinic and ISS clinic of Mbarara Regional Referral Hospital (MRRH) who were, diagnosed with cancer for the past 10 years (January 2012–2021). Data were statistically analyzed using STATA version 17 (Stata Corp, Texas, US) at P <  0.05.

Results
Males were more common at 64.5% while the median age was 37 years (IQR 29–47 years). ADCs were seen in 77.5% of the population while participants with NADCs were older (p < 0.001). The majority 73.3% (283/386) were in later stages (3 and 4). Having either ADCs or NADCs was different across HIV stages (p < 0.001). The median baseline CD4 count was 205 cells/μl (IQR: 90–400 cells/μl). The median duration on ART was 15 months (IQR 3–65 months). Participants with ADCs had been on ART for a shorter duration of time (p < 0.001). Only the outcome of patients with ADCs were available. The outcome varied with sex (p < 0.036), baseline CD4 (p < 0.048), and HIV stage (p < 0.002). Males were more likely to die (30/38 or 78.95%) and lost to follow-up (26/41 or 60.98%). Participants with baseline CD4 cell count > 200 cells/μl were more than twice likely to be active in care. The Commonest ADC was Kaposi Sarcoma (KS) while the commonest NADC was Squamous cell carcinoma, Not otherwise specified. Age above 50 years was associated with a significantly reduced risk of ADCs (OR: 0.11; 95% CI: 0.03–0.43; p value: 0.002). The risk of ADCs increased from stage 2 (OR: 0.46, p-value: 0.03; 95% CI: 0.23–0.91) to stage 3 (OR: 1.13; p-value: 0.66; 95% CI: 0.65–1.97) but this was not statistically significant. The risk of ADCs decreased with increasing ART duration (P value < 0.05).

Conclusion
ADCs are still a major health challenge in Southwestern Uganda despite the increasing the coverage and uptake of ART in region. These have mostly affected the young people, people who have been on HAART for a shorter period and those with lower CD4 cell count at initiation of ART.