bluuebunny/crossref_metadata_2025_split huggingface dataset:
Damage characterization and resilience optimization of reinforced concrete bridge piers under vehicle impact
Authors: Roy Suman , Unobe Ikwulono D. , Sorensen Andrew 
Published: November 2022

AbstractVehicle impact creates a dynamic loading condition at high strain rate exhibiting a unique interaction with the resisting structural members’ material properties. This interaction results in an increase in the material’s strength properties, a behavior captured in analysis via the computation of a strength factor known as the dynamic increase factor (DIF). In reinforced concrete (RC) bridge piers, the concrete cover receives the initial impact from the vehicle, causing damage to this exterior surface. This makes the DIF related to the concrete material (i.e., the compressive DIF) particularly important in this initial phase of the crash scenario; thus, requiring an in-depth analysis into its effect on the performance of the pier during and after the impact event. This study initiates an investigation into the influence of the compressive DIF on the performance of RC piers under impact from vehicles classes. Of particular interest is estimating a post impact residual capacity for the pier, while also determining concrete strength parameters (compressive strength) that offers a good tradeoff between the shear capacity which primarily resists the impact loads, and the axial capacity which controls the principal serviceability of the pier. The resulting analyses, using a representative test pier, show that an optimal compressive strength of concrete will minimize loss in the residual capacity of the pier. The effect of the compressive DIF on other important design parameters, i.e., bond strength and development length is also scrutinized. This study will aid forensic structural engineers in scrutinizing the post impact concrete behavior and serviceability.
A statistical mechanics approach to cultural evolution of structured behavior in non-human primates: From disorder to tetris-like structures
Authors: Vera Javier , Fuentealba Diego , Lopez Mario , Ponce Hector 
Published: November 2022

Abstract
This paper explores a statistical mechanics approach to cultural evolution of structured behavior in non-human primates. Previous works on cultural evolution have proposed Iterated Learning procedures, in which the behavioral output of one individual becomes the target behavior for the next individual in the chain. Within this line of research, previous work has suggested that even in non-human primates this paradigm shows that cultural transmission can lead to the progressive emergence of tetris-like structures. Our simulations are based on several interrelated statistical mechanics measurements, which quantify the way structures become closer to each other and the tendency to put activated cells together (understood by means of a number of measures and an energy-like function). With these tools, we suggested the hypothesis that the appearance of tetris-like structures might be an indirect consequence of the energy-like minimization. From this, it is plausible to think that the preference of the participants for tetris-like structures is strongly related to some kind of minimization towards simplicity in cognition.
Genotype-phenotype Description of Vitamin D–dependent Rickets 1A: CYP27B1 p.(Ala129Thr) Variant Induces a Milder Disease
Authors: Méaux Marie-Noëlle , Harambat Jérôme , Rothenbuhler Anya , Léger Juliane , Kamenicky Peter , Soskin Sylvie , Boyer Olivia , Boros Emese , D’Anella Pascal , Mignot Brigitte , Gebhart Maite , Vic Philippe , Richard Nicolas , Thivichon-Prince Béatrice , Francou Bruno , Linglart Agnès , Bacchetta Justine , Molin Arnaud 
Published: November 2022

AbstractIntroductionVitamin D–dependent rickets type 1A (VDDR1A) is a rare genetic disease associated with loss-of-function variations in the gene encoding the vitamin D–activating enzyme 1α-hydroxylase (CYP27B1). Phenotype-genotype correlation is unclear. Long-term outcome data are lacking. The objective of this study was to describe characteristics and outcomes to search for a phenotype-genotype correlation.MethodsWe retrospectively collected clinical data, genetic features, and outcomes from 24 genetically confirmed cases from 10 French centers; results are presented as median (min–max).ResultsClinical symptoms at diagnosis (age, 1.5 [0.5-8.7] years) were mainly bone and neurological abnormalities, and laboratory data showed hypocalcemia (1.97 [1.40-2.40] mmol/L), hypophosphatemia (−3.4 [−13.4 to (−)0.2] SD score for age), low 25OHD and low 1,25(OH)2D3, secondary hyperparathyroidism with PTH at 6.6 (1.3-13.7) times the upper limit for normal (ULN; PTH expressed as ULN to homogenize data presentation), and increased alkaline phosphatase (1968 [521-7000] IU/L). Bone radiographs were abnormal in 83% of patients. We identified 17 variations (11 missense, 3 frameshift, 2 truncating, and 1 acceptor splice site variations) in 19 families (homozygous state in 58% [11/19]). The partial loss-of-function variation p.(Ala129Thr) was associated with a milder phenotype: older age at diagnosis, higher serum calcium (2.26 vs 1.85 mmol/L), lower PTH (4.7 vs 7.5 ULN), and lower alkaline phosphatase (759 vs 2082 IU/L). Patients were treated with alfacalcidol. Clinical (skeletal, neurological), biochemical, and radiological outcomes were satisfactory, and complications occurred if there was bad adherence.ConclusionOverall, our findings highlight good outcomes under substitutive treatment and the need of a closer follow-up of eyes, teeth, kidneys, and blood pressure in VDDR1A.
ODP611 Combination Of Seated Saline Suppression Test And Computed Tomography In Predicting Subtype Diagnosis Of Primary Aldosteronism In Chinese Population
Authors: Zhang Dan , Zhang Tingting , Chen Tao , Li Yuanmel , Mo Dan , Tian Haoming , Ren Yan 
Published: November 2022

Abstract

Objective
The study aimed to evaluate the accuracy of the seated saline suppression test (SSST) combined with adrenal computed tomography (CT) in determining the primary aldosteronism (PA) subtypes.

Methods
Each patient underwent a SSST and adrenal CT. Logistic diagnostic model (CT finding + post-SSST plasma aldosterone concentration (PAC)) were built, which evaluated the accuracy of the SSST combined with adrenal CT for a subtype classification of PA. Subtype diagnosis of PA was determined by adrenal venous sampling (AVS), pathology and clinical outcomes (primary aldosteronism surgical outcome(PASO)).

Results
A total of 72 patients with PA were classified into two groups, including 45 aldosterone-producing adenoma (APA) and 27 idiopathic hyperaldosteronism (IHA) patients. By binary logistic regression analysis, adrenal CT (odds ratio (OR)=16.28, 95% confidence interval (CI) 4.18-63.42, P&lt;0. 05) and 4-hours PAC after SSST (OR =1.13, 95% CI 1. 03 to 1.23, P&lt;0. 05) were significantly independent predictors of APA patients. We have successfully developed a diagnostic model based on logistic regression that is able to predict the probability of APA. The area under the receiver operating characteristic (ROC) curve of logistic diagnostic models(AUC=0.907, 95% CI 0.815 to 0.963) was significantly greater either than that for the adrenal CT (AUC=0.807,95% CI 0.696 to 0.890,respectively,P&lt;0. 05) or SSST (AUC=0.799,95% CI 0.688 to 0.884,respectively,P&lt;0. 05). Positive CT finding combined with a post-SSST PAC≥18.2 ng/dL provided sensitivity of 88.89%,specificity of 74. 07%,and positive predictive value (PPV) of 93.9%(31/33) for predicting APA, that determined patients who required AVS prior to surgery.

Conclusion
The model combining CT finding with post-SSST PAC has superior accuracy in subtype diagnosis of PA compared with SSST or adrenal CT alone. The current study was the first study to investigate the accuracy of the new method on the subtype classification of PA. We are fortunate to find it may be a safe, convenient, sensitive and noninvasive approach in predicting subtype diagnosis of PA in Chinese individuals, especially in primary care where AVS may be unavailable. The results require further confirmation by RCT clinical trials.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
LBSAT61 Pure Aldosterone-secreting Adrenocortical Carcinoma Causing Resistant Hypertension In A Patient With Previously Controlled Longstanding Hypertension: A Case Report
Authors: Alnahas Zeinab , Horani Mohamed 
Published: November 2022

Abstract

Introduction
Adrenocortical carcinoma is a rare endocrine malignancy that could be classified into functioning or non-functioning, depending on the tumor's ability to secret adrenocortical hormones. Pure aldosterone-secreting adrenocortical carcinoma is extremely rare, accounting for &lt;7% of all functioning tumors that could present with primary aldosteronism and secondary hypertension.

Case Presentation
A 48-year-old man had a past medical history of longstanding hypertension that recently became resistant to multiple antihypertensive medications (thiazide, angiotensin receptor inhibitor, calcium channel blocker, hydralazine) despite medications compliance. He presented to the ER with left flank pain that was not associated with dysuria, nausea, or vomiting. On admission, his blood pressure was 223/135 mmHg. CT scan of the abdomen and pelvis showed mild left-sided hydronephrosis, hydroureter with a 2mm stone at the left ureterovesical junction, and a 7. 0×7. 0×6.4 cm left heterogeneous adrenal mass that was highly suspicious for malignancy. His laboratory workup revealed low serum potassium of 2.9 mmol/L (reference value 3.5-5.1 mmol/L), serum creatinine of 1.38 mg/dL (reference value 0.7-1.3 mg/dL), random cortisol of 21.8 mcg/dL (reference value 5-25 mcg/dL), ACTH of 5 pmol/L (reference value 10-60 pmol/L), serum levels of normetanephrine of 0.67 nmol/L (reference range 0-0.89 nmol/L), metanephrines of &lt;0.10 nmol/L (reference range 0-0.49 nmol/L), and chromogranin A of 45 ng/mL (reference range 0-95 ng/mL). Further investigations showed high serum aldosterone of 28 ng/dL (reference range 2-9 ng/dL) and low plasma renin activity of 0.1 ng/mL per h (reference range 0.5-2.5 ng/mL per h) supported the diagnosis of primary aldosteronism. The patient underwent left adrenalectomy, and the diagnosis of pure aldosterone-secreting adrenocortical carcinoma was confirmed by histological examination.

Conclusion
Pure aldosterone-secreting adrenocortical carcinoma is an extremely rare adrenal tumor that could cause resistant hypertension. Re-evaluation of secondary causes of hypertension is essential in patients with a previously controlled longstanding hypertension, developing uncontrolled or resistant hypertension.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
ODP019 A Case Study of the Association of Autoimmune Polyglandular Syndrome and Pulmonary Artery Hypertension
Authors: Lambert Peter , Baker Mary 
Published: November 2022

Abstract
We report a patient with combined pulmonary arterial hypertension (PAH) and autoimmune polyglandular syndrome (APS) type 2. A 41 y/o woman with hypothyroidism presented for right heart (RHC) in the work up of PAH. Pt had a medical history of PAH diagnosed by transthoracic echocardiogram (TTE) and hypothyroidism. She reported symptoms of fatigue, shortness of breath with increased pigmentation of her skin progressive for several years. Preadmission lab found hyponatremia of 126 and potassium of 6.6. She was admitted and treated with IV insulin with D50, kayexalate, IV fluids. A random 11 AM cortisol was 0.57 mcg/dl N: AM: 6. 0–30. 0 mcg/dl; PM: 3. 0–16. 0 mcg/dl. Acosyntropin test was ordered. Pt failed the stimulation test (baseline 0.39, 30 min 0.49, 60 min 0.50, with an ACTH at baseline of 1423 pg/ml N: 7.2-63.3). Pt was started on hydrocortisone 20 mg AM/10 mg PM with fludrocortisone 0.1mg. On follow up at 2 weeks, her energy, mood, appetite and breathing tolerance had improved. Follow up RHC in 4 weeks found normalization of right heart pressures. APS is a collection of autoimmune diseases. Type I APS, caused by a defect in the autoimmune regulator (AIRE) gene, is diagnosed with two of three conditions, chronic mucocutaneous candidiasis, hypoparathyroidism, and adrenal cortical insufficiency. Type II APS (formally "Schmidt's Syndrome"), associated with HLA haplotypes DR3 (DQB*0201) and DR4 (DQB1*0302), is diagnosed with chronic autoimmune adrenal insufficiency with either Type 1 DM or chronic autoimmune thyroid disease (commonly Hashimotos but can be Graves). It typically presents later in life compared to APS I, age 30-40s. The association between PAH is rare but has been noted in several case studies. It has been associated with APS I in Korniszewski et al. and Bhansali et al. For APS II, the first association was reported by Barrou et al. of a patient with hypothyroidism, hypogonadism, and adrenal insufficiency who later developed PAH. Two cases reported by García-Hernández et al found PAH with positive adrenal antibodies without adrenal insufficiency. In 2009 Walid R. et al. reported a case of severe adrenal insufficiency (hypotension, hypokalemia) with PAH. She improved with steroids, but her PAH was present on TTE four years after treatment started. Pt in that case declined RHC. The patient in this case study proceeded with a RHC which did show normalization of right heart pressures, the first reported case to document normalization of PAH with replacement steroid treatment.
Presentation: No date and time listed
ODP624 A case of Cushing disease demonstrated rapid deterioration of clinical findings and marked hypercortisolemia
Authors: Hashimoto Makiko , Kajio Hiroshi , Uchihara Masaki , Tanabe Akiyo 
Published: November 2022

Abstract

Introduction
In cases of ACTH-dependent Cushing syndrome, the differentiation between Cushing disease and the ectopic ACTH syndrome (EAS) can sometimes be challenging. Herein we report on a case of Cushing disease who showed clinical features resembled EAS caused by malignant neoplasms and required a detour for the diagnosis.

Clinical case
A 49-year-old Japanese woman presented a rapid exacerbation of muscle weakness of her limbs, leg edema and moon face from two months ago. She did not have any past medical history, hypertension, diabetes mellitus, or osteoporosis. Her serum K was 2.6 mEq/L, ACTH level was 151 pg/mL, serum cortisol level was 36.6 μg/dL, and urinary free cortisol (UFC) level was 4250 μg/day. Serum cortisol after 1 mg dexamethasone suppression test (DST) showed 41.9 μg/dL and that after 8 mg DST was 14.1 μg/dL. A pituitary MRI demonstrated a poor enhancement area with a clear margin of 10 mm in diameter in her dorsal side of the pituitary gland. She was diagnosed with ACTH-dependent Cushing syndrome and metyrapone was initiated. Soon she developed severe cough with infiltrative shadows on her lungs two days later. Her respiratory condition deteriorated rapidly, and she was urgently transferred to our hospital and intubated one week later. She had complicated pneumocystis carinii, nocardia pneumonia, and severe respiratory failure based on immunodeficiency due to hypercortisolemia. She was treated with systemic management in the intensive care unit, infection treatment and dose adjustment of metyrapone. Her condition improved and she was extubated on the 8th day. Although she had the pituitary tumor, EAS caused by a malignant neoplasm was suspected because of a combination of rapid clinical deterioration, marked hypercortisolemia and hypokalemia. However gastrointestinal tract survey, 18F-PET/CT and somatostatin receptor scintigraphy did not show any significant lesions. Finally, selective inferior petrosal sinus sampling (IPSS) demonstrated over secretion of ACTH from the pituitary gland. ACTH decreased to an undetectable level and hydrocortisone was supplemented after transsphenoidal surgery. No recurrence was observed in 1 year of follow-up. Pathological findings showed a densely granulated type of ACTH-producing adenoma without Crooke's change. KI-67 index were 4.7%, which was higher than that in general ACTH producing pituitary adenomas.

Conclusion
We experienced Cushing disease with the rare clinical course. This case suggests that although a step-by-step approach is often adopted to make a differential diagnosis of patients with ACTH-dependent Cushing's syndrome, ultimately IPSS is required. Because her KI-67 index showed 3 or higher despite the gentle tumor behavior, careful follow-up is required.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON101 Fluctuating Insulin Requirements in Untreated Acromegaly: From 200-to-0
Authors: Bellavia Lauren , Goldstein Michael , Klek Stanislaw 
Published: November 2022

Abstract

Introduction
Acromegaly is a clinical disorder that occurs from autonomous production of growth hormone (GH). Diabetic ketoacidosis (DKA) is an uncommon and late complication of acromegaly. Acromegaly presenting in DKA prognosticates glycemic management with insulin-based regimens. Cessation of insulin therapy, however, can be achieved in patients with acromegaly after proper medical and/or surgical interventions. Our case highlights a unique outcome in a patient with newly-diagnosed acromegaly that initially presented in DKA with very high insulin requirements and was ultimately de-escalated off all anti-hyperglycemic therapy with significant glycemic improvement prior to any treatment for acromegaly.

Clinical Case
A 32 year-old male with a past medical history of colorectal cancer and no known history of diabetes presented to the emergency department for evaluation of generalized weakness, epigastric pain, nausea, and vomiting and was admitted for DKA. Hemoglobin A1c was 11.6% (reference range &lt; 5.7%), confirming the diagnosis of newly-diagnosed diabetes. C-peptide was 1.4 ng/mL (reference range 0.5-3.3 ng/mL) and anti-glutamic acid decarboxylase, anti-islet cell, and anti-zinc transporter 8 antibodies were all negative. He was initiated on intravenous insulin infusion, with rates achieving &gt; 200 units of insulin per day. Given severe insulin resistance in conjunction with acromegalic features on physical exam and a unique history of colorectal cancer at a young age without any family history, evaluation for acromegaly was initiated. Human GH level was 68.60 ng/mL (reference range 0.05-3.00 ng/mL) and insulin-like growth factor-1 (IGF-1) level was 1,036 ng/mL (reference range 82-242 ng/mL). MRI brain revealed a hypoenhancing 1.3 cm lesion enlarging the left lateral pituitary gland. Diagnosis of acromegaly due to a GH-secreting macroadenoma was established. The patient was discharged on a high-dose insulin regimen in addition to metformin therapy with de-escalation off of all anti-glycemic therapy within a few weeks of diagnosis; at his 3 month follow-up visit, his repeat hemoglobin A1c was 6.1 with repeat GH level of 28.8 ng/mL and IGF-1 level of 1602 ng/mL, despite not yet undergoing any treatment for the underlying condition.

Conclusion
DKA as an initial presentation of acromegaly has been previously reported in literature, however, not with a concomitant history of colon cancer. Moreover, no previous cases of acromegaly have reported glycemic normalization off of anti-hyperglycemic therapy prior to any treatment for acromegaly. Our case highlights that evaluation for secondary causes, including acromegaly, should be considered in patients with severe insulin resistance and emphasizes the dramatic range of insulin requirements that patients with acromegaly may have.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON116 Central Diabetes Insipidus in a patient with Pituitary Macroadenoma status post Trans-sphenoidal Resection, complicated by Nephrogenic Diabetes Insipidus due to Chronic Lithium use
Authors: Akula Monika , Chalasani Krishna , Cheng Jennifer , Figueroa Jonathan , Hu Katherine , Ong Raquel , Zin Khin , Patel Nikunjkumar , Holland Soemiwati 
Published: November 2022

Abstract
59-year-old female with PMH of Bipolar disorder and Pituitary macroadenoma presented to the ER yesterday for worsening Headache associated with nausea, vomiting and double vision. Detailed imaging of the pituitary gland demonstrated a hypo enhancing sellar and suprasellar mass extending asymmetric to the right, appears to fill and expand the right cavernous sinus. This was associated with T2 hypo intensity. The hypo enhancing mass measured around 2.9 cm AP by 2.7 cm transverse by 3.5 cm CC, previously 2.9×2.4×3.1 cm. Of note, she was found to have this pituitary macroadenoma non-functional on prior testing. Important to note that she had history of bipolar disorder and it was refractory to many medications and was started on Lithium 10 months prior to this presentation. She underwent Image Guided Endoscopic Trans nasal Transsphenoidal Resection of Pituitary Tumor with reconstruction with Nasoseptal Flap, Lumbar Drain Placement, and Injection of Intrathecal Fluorescein Dye. Her postoperative course was complicated by Central DI and was started on DDAVP treatment. Eventually she developed Panhypopituitarism and needed Levothyroxine and Hydrocortisone replacement therapy. She had a prolonged hospital course due to post-surgical meningitis resulting in fever and encephalopathy. She had persistent hypernatremia and lithium was discontinued given the fact she was found to be in Nephrogenic DI and her hypernatremia requiring intravenous D5 water fluid treatment for a brief period.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.