bluuebunny/crossref_metadata_2025_split huggingface dataset:
Partial arch replacement of type A aortic dissection after thoracic endovascular aortic repair for type B dissection
Authors: Nakajima Tomohiro , Iba Yutaka , Ogura Keishi , Kawaharada Nobuyoshi 
Published: October 2023

Abstract
Background
Stent graft-induced new entry (SINE), defined as the stent graft-induced formation of a new entry point for blood to enter an area, is increasingly being observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection worldwide. We herein describe a case of Stanford type A aortic dissection due to proximal SINE after TEVAR for Stanford type B dissection.

Case presentation
This case involved a 58-year-old man with type A aortic dissection due to SINE. Six years previously, he had developed severe back pain and was diagnosed with type B aortic dissection after computed tomography examination. Because the primary entry was positioned at the descending aorta, we conducted TEVAR for exclusion of the entry with a GORE TAG conformable thoracic aortic graft. He was thereafter followed by our hospital. Six years later, he developed jaw pain and was examined at another hospital. He was transferred to our hospital because of the possibility of type A dissection. Computed tomography revealed type A aortic dissection with proximal site SINE. Emergency partial arch replacement was conducted, and he was discharged on postoperative day 27. Because the entry was at the lesser curve of the arch, we excluded the entry and conducted partial arch replacement.

Conclusions
In this case, proximal SINE occurred 6 years after TEVAR. Because SINE may occur even in the long term after TEVAR, careful follow-up is necessary.
Influence of different Wastewater Treatment Processes on the rate and characteristics of MPs released from WWTPs in Fiji, South Pacific
Authors: Rokomatu Malelili Naulivou , Bhagwat-Russell Geetika , Panneerselvan Logeshwaran , Raju Subash , Savou Viliame , Waqainabete Timaima , Palanisami Thavamani 
Published: October 2023

AbstractThe global effects of MP (MP) pollution on the environment are concerning, and they are exacerbated by the multiple sources of pollution in aquatic environments such as urban runoff, waste mismanagement, industrial pollution, and so on. South pacific islands host a large diversity of aquatic flora and fauna and given its ecological significance it is necessary to identify the sources of MP pollution in the region. To date, very little attention has been given to identify whether effluents from wastewater treatment plants (WWTP) are acting as a significant source of MP in the South Pacific region and its countries. Therefore, the present study analyzed and compared the treatment methods and fate of MPs in the country’s two main WWTPs: 1) the Kinoya WWTP (simple secondary clarifier and trickling filter) and 2) Natabua WWTP (secondary pond treatment system). Sampling locations were based on the different treatment stages, and samples were collected from each stage of treatment before effluents were released into the ocean. Kinoya WWTP had an average of 3.45 ± 0.3 particles/L in the inlet stage and released an average of 0.3 ± 0.26 particles/L of MP through the outlet with 91% removal efficiency (RE) with an output equivalent of 4500 particles per day. The initial stage of treatment from the anaerobic pond outlet at Natabua had an average of 2.9 ± 1.05 particles/L, and the maturation outlet had an average of 0.53 ± 0.42 particles/L, a removal efficiency of 81% and thus an output equivalent of 4558 particles/L of MP. Polymer analysis under FTIR confirmed that cellophane or semi-synthetic cellulose and polypropylene were common polymers in the final effluent in Kinoya WWTP, and Natabua plant has cellophane or semi-synthetic cellulose, polypropylene and polyethylene were observed as common polymers. Although there are numerous study that have compared wastewater treatment processes, this is the first study in Fiji that investigates the efficiency of the two methods of water treatment process in the context of microplastic pollution and emphasizes the effectiveness of the treatment stages in determining the concentration of MP released into the ocean.
Burnout in mental health services in Ireland during the COVID-19 pandemic
Authors: Adamis Dimitrios , Minihan Elisha , Hannan Noel , Doherty Anne M. , McNicholas Fiona 
Published: October 2023

Background
Burnout is a consequence of chronic occupational stress. Specific work-related factors may contribute to burnout experienced by those working in mental health services (MHS), many of which have increased since the COVID-19 pandemic.

Aims
To examine personal, work- and patient-related burnout among MHS staff in Ireland during the COVID-19 pandemic, and explore the impact of work-related conditions on burnout.

Method
We conducted a cross-sectional survey of three MHS across Ireland utilising a study-specific questionnaire, the Copenhagen Burnout Inventory and the Effort–Reward Imbalance scale.

Results
Of 396 participants, 270 (70.6%) were female. Moderate and high personal burnout was experienced by 244 (64.1%) participants; work-related burnout by 231 (58.5%) participants and patient-related burnout by 83 (21.5%) participants. Risk factors for both personal and work-related burnout were female gender, urban service, time spent outside main responsibilities, overcommitment, high score on the Effort–Reward Imbalance scale and intention to change job. Being younger, with high workload and deterioration of personal mental health during the pandemic was associated with higher personal burnout, whereas a lack of opportunity to talk about work-related stress contributed to work-related burnout. Fewer factors were associated with patient-related burnout, namely overcommitment, working in urban services and poorer physical and mental health during the COVID-19 pandemic.

Conclusions
High levels of personal and work-related burnout were found among mental health workers. The weak association with COVID-19-related factors suggest levels of burnout predated the pandemic. This has implications for MHS given the recognised additional work burden created by COVID-19.
Effect of Radioactive Iodine Therapy on Cancer-Specific Survival of Papillary Thyroid Cancer Tall Cell Variant
Authors: Dai Ping , Zhao Wanjun , Zheng Xun , Luo Han , Wang Xiaofei 
Published: October 2023

Abstract

Context
Radioactive iodine (RAI) therapy is often used as an adjuvant treatment to reduce the risk of recurrence in patients with papillary thyroid cancer (PTC). However, the effect of RAI therapy on cancer-specific survival (CSS) in patients with tall cell variant (TCV) remains controversial.

Objective
This study aimed to investigate the impact of RAI therapy on CSS in patients with TCV-PTC by analyzing data from the Surveillance, Epidemiology, and End Results database.

Methods
We identified 1281 patients with TCV-PTC in the SEER database who underwent total thyroidectomy between 2004 and 2019. Of these, 866 (67.6%) patients received RAI therapy and 415 (32.4%) did not. Propensity score matching was conducted to balance the baseline characteristics between the 2 groups. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% CI for the effect of RAI therapy on CSS.

Results
After propensity score matching, 373 pairs of patients were included in the analysis. The results showed no significant difference in CSS between the RAI therapy group and the non-RAI therapy group (HR 0.54, 95% CI 0.25-1.17, P = .120). Subgroup analyses indicated similar results.

Conclusion
RAI therapy may not improve CSS in patients with TCV-PTC after total thyroidectomy. Future studies with larger sample sizes, longer follow-up periods, and better study designs are needed to confirm or refine our research findings.
FRI074 Rise In Fasting Ghrelin Level In Response To Weight Loss Predicts Future Weight Regain In The POUNDS LOST Trial
Authors: Tong Jenny , Heianza Yoriko , Schur Ellen Anne , Sacks Frank , Qi Lu , Boyko Edward J 
Published: October 2023

Abstract
Disclosure: J. Tong: None. Y. Heianza: None. E.A. Schur: None. F. Sacks: None. L. Qi: None. E.J. Boyko: None.
Weight loss maintenance is a challenging problem commonly encountered in obesity management. The biological mechanism for weight regain following diet-induced weight loss is not well understood. The orexigenic gut hormone ghrelin increases appetite and food intake and promote positive energy balance. We aim to investigate whether weight-loss induced fasting ghrelin changes predict subsequent weight regain in the POUNDS LOST trial. Methods: This study included 244 overweight or obese adults (age: 52.9±8.8 yr; 66% female; BMI 32.4±3.9 kg/m2 [mean ± SD]) randomly assigned to 1 of 4 weight-loss diets varying in macronutrient intake who had fasting plasma total ghrelin levels measured at baseline, 6 and 24 months after the intervention. We examined associations between fasting ghrelin levels changes between baseline and 6-months (weight change: -7.1±5.3 kg) and body weight change between 12 and 24 months (3.2±3.9 kg). Results: Fasting plasma ghrelin level increased significantly at 6 months (from 487.3±251.1 to 574.0±274.5 pg/mL) and remained elevated at 24 months despite weight regain (684.0±411.0 pg/mL). Increases in ghrelin level from baseline to 6 months (86.7±167.4 pg/mL) were correlated with weight regain from 12 to 24 months (p=0.018). The association was unchanged after adjustment for age, sex, race, and diet assignment at baseline; fat and carbohydrate craving scores, hunger and fullness ratings, dietary restraint and disinhibition scores measured at 6 months, prior to onset of weight regain. Conclusions: Fasting ghrelin levels rose in response to diet-induced weight loss and persisted for 2 years despite weight regain. Ghrelin change during the weight loss phase predicts subsequent weight regain independent of appetite and craving measures. Understanding the mechanistic connection between ghrelin action and weight regain may shed light on novel approaches to weight loss maintenance.
Presentation: Friday, June 16, 2023
THU030 Evaluation Of Combined CRH And HDDST Test Performance
Authors: Elenius Henrik , McGlotten Raven , Nieman Lynnette K 
Published: October 2023

Abstract
Disclosure: H. Elenius: None. R. McGlotten: None. L.K. Nieman: None.
Introduction: Determining the etiology of ACTH-dependent Cushing’s Syndrome (CS) is frequently a diagnostic challenge. Non-invasive tests to distinguish Cushing’s Disease (CD) from Ectopic ACTH Syndrome (EAS) are the CRH stimulation test and the 8 mg overnight high dose dexamethasone suppression test (HDDST). The CRH test is more accurate (sensitivity (Se) 83-93%, specificity (Sp) 85-100%) than the HDDST (Se 56-95%, Sp 67-100%), depending on the type of CRH and criteria used. We retrospectively reviewed the results of each test at our institution between 2005-2019 to evaluate the tests' performance at established cut offs, identify optimal response criteria and to see whether combining the two tests provided additional diagnostic accuracy. Methods: CD or EAS was confirmed by either surgical pathology or biochemical cure after tumor resection or imputed from IPSS results (n=7). We identified 100 patients with CD and 34 with EAS. Two EAS patients with cyclic CS each underwent tests with or without active hypercortisolism. Test criteria to identify CD were ≥50% suppression of cortisol for the HDDST and a ≥35% increase in mean ACTH at 15-30 minutes or a ≥20% increase in mean cortisol at 30-45 minutes for the ovine CRH test. Results: The HDDST had a Se of 81%, Sp of 81% and diagnostic accuracy (DA) of 81%, while the CRH test had Se 95%, Sp 75% and DA 90%. Each test improved with modified response criteria. Using a HDDST suppression criterion of ≥63% gave Se 78%, Sp 89% and DA 81%. Using CRH test response criteria of ≥39% increase in ACTH or ≥30% increase in cortisol gave Se 94%, Sp 92% and DA 93%. Performance improved further by combining the two tests, using the optimized criteria (≥63% for HDDST and ≥39% or ≥30% for the CRH test). Test results were concordant in 80%, giving a Se of 96%, Sp 97% and DA 96%. Among EAS patients, this approach only misidentified one subject with cyclic CS who was tested while hypocortisolemic. Removing this test improved combined test performance to Se 96%, Sp 100% and DA 97%. Among the 26 patients with discordant results (CD = 22, EAS = 4), the HDDST result was likelier to be correct in EAS vs CD (50% vs 14%, PPV 60%), while the CRH test was more often correct in CD vs EAS (86% vs 50%, PPV 90%). Conclusions: Based on this series that included a large proportion of EAS patients, the CRH test performed better than the HDDST, in line with earlier data. In cyclic CS, tests performed better in hypercortisolemic patients. The optimal response criteria were ≥63% cortisol suppression for HDDST and ≥39% ACTH or ≥30% cortisol increase for the CRH test. In the 81% of hypercortisolemic cases with concordant test results, these combined optimized cut offs provided the best diagnostic performance, improving it to Se 96%, Sp 100%, DA 97%. When results were discordant, the CRH test worked better to identify patients with CD.
Presentation: Thursday, June 15, 2023
THU078 The Definition And Epidemiology Of Giant Pituitary GH-Secreting Adenomas Based On Clinical, Imaging, And Hormonal Parameters: A Pilot Study
Authors: Del Corso Leticia Marinho , Marcela Cunha da Silva , Kusma Fidalski Solena Ziemer , Boguszewski Cesar Luiz 
Published: October 2023

Abstract
Disclosure: L.M. Del Corso: None. M.C. Silva: None. S.Z. Fidalski: None. C.L. Boguszewski: None.
Acromegaly is a chronic disease, caused by a GH-secreting pituitary adenoma in most cases. At diagnosis, around 75% of patients have a macroadenoma, which constitute a heterogeneous group with variable biological behavior, therapeutic response, and prognosis. Giant adenomas (GA) have been defined as those which are more than 40 mm at their largest in diameter, but this is an arbitrary definition lacking comparative studies to investigate tumor size at diagnosis with clinical presentation, response to treatment and the evolution of acromegaly patients. Thus, the aim of our study was to compare the aforementioned variables according to the tumor size at diagnosis and review the diagnostic criteria for giant GH-secreting adenomas. In this observational, retrospective, single-centre pilot study, we have retrieved data from 161 medical records and evaluated age, sex, duration of symptoms, GH levels, presence of type 2 diabetes mellitus (T2DM), hypertension and hypopituitarism, imaging characteristics, and the need for adjuvant therapy with somatostatin receptor ligands (SRL) or other drugs. Study population was classified into four groups according to tumor size at diagnosis: (I) &lt;10 mm (microadenomas; n=14); (II) 10-29 mm (n=84); (III) 30-39 mm (n=10); (IV) 40 mm or more (n=9). The final study group consisted of 117 individuals (49% men; mean age 43 ± 13 yrs). Hypopituitarism was significantly more frequent in groups III and IV compared to groups I and II (p=0.004), with no difference between groups III and IV (p=0,3). There was a higher proportion of invasive adenomas when the lesions ≥ 30 mm were compared to groups I and II (p=0.008), but with no difference between groups III and IV (p=0.62). Sixty percent of patients in group III (n=6) and 44% of patients in group IV (n=4) needed other drug therapy than SRL (cabergoline and/or pegvisomant), a higher proportion compared to those of groups I (n=1; 7%) and II (n=25; 30%) (p=0.04), again without difference between groups III and IV (p=0,7). Regarding the initial levels of GH, a significant difference was observed between groups I and IV (p=0.04), but this difference was not observed in the other groups. There were no statistical differences in relation to sex, duration of symptoms, need for SRL therapy, prevalence of hypertension and T2DM between study groups. Our study raises the hypothesis that giant adenomas should be defined as tumors larger than 30 mm, as the clinical behavior of tumors above this cutoff point seems to be similar in comparison with tumors larger than 40 mm but different from those of smaller sizes.
Presentation: Thursday, June 15, 2023
SAT673 Novel Mutation Of TBX3 Associated With Morbid Obesity In Human
Authors: Alkaissi Hussam R , Ji Beisi , McFarlane Samy 
Published: October 2023

Abstract
Disclosure: H.R. Alkaissi: None. B. Ji: None. S. McFarlane: None.
Background: TBX3 is a transcription involved in the development of the heart conduction system, apocrine and mammary glands, limbs, and lung development and maturation, with variable oncogenic roles. Recently, the role of TBX3 and body weight control has been demonstrated in animal models, showing an essential role for TBX3 in hypothalamic arcuate neuronal maturation, function, and identity [1]. Case: 26-year-old woman referred for the management of morbid obesity and menstrual irregularities. The patient weighed 330 lbs, with a BMI of 55 kg/m2, with hypertension T2DM. The patient had a normal development until age five, after which she experienced regression in milestones and lost the ability to communicate, and was diagnosed with autism. She had a history of food-seeking behavior, leading to progressive weight gain, which was managed by blocking access to food, such as locking the fridge. The patient's weight fluctuated from 290 lbs to 330 lbs. Family history of T2DM in her maternal relatives. She was diagnosed with T2DM at the age of 18, with HbA1c level of 9.4%. Autoantibody testing was negative for glutamic acid decarboxylase (GAD), islet cell antibody (ICA), and zinc transporter 8 (ZnT8). The fasting C-peptide level was detectable at 1.87 ng/mL. T2DM was well controlled with an HbA1C range of 6.0-6.7% with the use of short and long-acting insulin regimen. However, with improved glycemic control, short-acting insulin was stopped and she was started on liraglutide. Syndromic obesity was suspected due to early-onset of the disease and the developmental regression. Testing for Prader-Willi syndrome was negative, based on a normal chromosome 15 methylation study. Leptin levels were elevated at 66 ng/mL, prompting further testing for obesity-related genetic mutations. Next-generation sequencing and targeted Sanger sequencing for 79 genes associated with obesity in human and animal models was performed. A novel mutation was identified in TBX3 activation domain, c. C1513T (p.P505S). UniProt peptide sequence alignment analyzed for sequence conservation. ClinVar, HGMD and GWAS Catalogue databases screened for similar variants. Discussion: We present the first case in human, where novel TBX3 mutation results in hypothalamic dysfunction, leptin resistance manifesting as morbid obesity, hyperphagia, and menstrual irregularities. The reported mutation in the activation domain (A) of TBX3. In silico analysis showed high evolutionary conservation of the mutated domain (across vertebrate species), indicating the mutation is likely pathogenic. References:1. Quarta C, Fisette A, Xu Y, et al. Functional identity of hypothalamic melanocortin neurons depends on Tbx3. Nat Metab. 2019 Feb;1(2):222-235. doi: 10.1038/s42255-018-0028-1. Epub 2019 Jan 28. PMID: 32694784; PMCID: PMC8291379.
Presentation: Saturday, June 17, 2023
FRI275 Glutamate Receptor Agonists Stimulate Kisspeptin Neurons In The Arcuate Nucleus Of The Hypothalamus
Authors: Bearss Robin , Piet Richard 
Published: October 2023

Abstract
Disclosure: R. Bearss: None. R. Piet: None.
KNDy neurons co-express kisspeptin, neurokinin B (NKB), dynorphin A (Dyn A), and glutamate. These neurons, located in the arcuate nucleus of the hypothalamus, drive pulsatile gonadotropin releasing hormone (GnRH) secretion. This eventually promotes pulsatile gonadotropin hormone release from the anterior pituitary, important for fertility in both sexes. The current hypothesized mechanism for pulse generation involves KNDy neuron interconnectivity and reciprocal regulation through the combined actions of NKB, DynA and glutamate to coordinate KNDy neuron activity. There is evidence that KNDy neurons express NKB, Dyn A and glutamate receptors and that NKB stimulates KNDy neuron electrical activity while Dyn A suppresses it. There is also evidence that ionotropic glutamate receptor antagonists can inhibit KNDy neuron coordinated activity and pulsatile gonadotropin hormone release, indicating that glutamatergic neurotransmission plays a significant role in activity coordination. The purpose of the following experiments was to investigate the response of KNDy neurons to varied glutamate receptor activation. We used calcium imaging to monitor the activity of KNDy neurons in brain slices. We crossed Kiss1-Cre mice—expressing Cre recombinase (Cre) in kisspeptin neurons—with Cre-dependent GCaMP6f mice to generate Kiss1-Cre x GCaMP6f mice that express GCaMP6f in kisspeptin neurons. GCaMP6f fluorescence increases when binding to intracellular calcium and can, thus, be used as an inferential marker of electrical activity. Coronal brain slices (200 µm thickness) obtained from male Kiss1-cre x GCaMP6f mice and containing the arcuate nucleus were placed in a recording chamber under an epifluorescence microscope. KNDy neurons were exposed for 2 minutes to a bath application of either the ionotropic glutamate receptor agonist α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA, 10µM), the ionotropic glutamate receptor agonist N-methyl-D-aspartate (NMDA, 50µM), or the group 1 metabotropic glutamate receptor (mGluR) agonist (S)-3,5-dihydroxyphenylglycine (DHPG, 50µM). AMPA, NMDA, and DHPG increased KNDy neuron fluorescence by 7.8±0.5% (n=113 in 7 slices from 6 mice), 7.5±0.5% (n=154 in 6 slices from 5 mice), and 6.1±0.7% (n=159 in 7 slices from 5 mice) respectively. All cells that were excited by NMDA or DHPG were also excited by AMPA. These experiments provide evidence that activation of ionotropic AMPA and NMDA receptors as well as group 1 mGluRs stimulate KNDy neuron activity. Further investigation into the precise role of individual glutamate receptor subtypes on KNDy neuron coordinated activity is needed.
Presentation: Friday, June 16, 2023