bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phishing website prediction using base and ensemble classifier techniques with cross-validation
Authors: Awasthi Anjaneya , Goel Noopur 
Published: November 2022

AbstractInternet or public internetwork has become a vulnerable place nowadays as there are so many threats available for the novice or careless users because there exist many types of tools and techniques being used by notorious people on it to victimize people somehow and gain access to their precious and personal data resulting in sometimes smaller. However, these victims suffer considerable losses in many instances due to their entrapment in such traps as hacking, cracking, data diddling, Trojan attacks, web jacking, salami attacks, and phishing. Therefore, despite the web users and the software and application developer's continuous effort to make and keep the IT infrastructure safe and secure using many techniques, including encryption, digital signatures, digital certificates, etc. this paper focuses on the problem of phishing to detect and predict phishing websites URLs, primary machine learning classifiers and new ensemble-based techniques are used on 2 distinct datasets. Again on a merged dataset, this study is conducted in 3 phases. First, they include classification using base classifiers, Ensemble classifiers, and then ensemble classifiers are tested with and without cross-validation. Finally, their performance is analyzed, and the results are presented at last to help others use this study for their upcoming research.
TMPRSS6 gene polymorphisms associated with iron deficiency anaemia among global population
Authors: Mohd Atan Farah Nur Elina , Wan Mohd Saman Wan Asmuni , Kamsani Yuhaniza Shafinie , Khalid Zalizah , Abdul Rahman Amirah 
Published: November 2022

AbstractIron deficiency anaemia (IDA) has been recognised as a common global health problem that affects more than 1.2 billion people worldwide, particularly in high-risk individuals such as young children, pre-menopausal women, and pregnant women. In most cases, IDA arises due to the prolonged effect of iron deficiency (ID). On the other hand, it has been estimated that iron deficiency without anaemia is more frequent nowadays. Apart from the lack of nutrients, infections and inflammatory diseases, genetic factors can also be another factor that drives iron instability in the blood, leading to IDA. Previous studies, including genome-wide association studies, have identified multipletransmembrane protease serine 6 (TMPRSS6)genetic variants associated with different iron parameters, especially variants contributing to an increase in hepcidin level, low blood, and iron status. Despite multiple studies onTMPRSS6gene polymorphisms, fewer studies are reported among the Asian population. Thus, further association studies ofTMPRSS6genetic polymorphisms between ID and IDA are warranted among the Asian population. This review provides a comprehensive summary of the causativeTMPRSS6genetic variants and their roles associated with iron deficiency among the global population.
Mammalian Target of Rapamycin Inhibition Decreases Angiotensin II-Induced Steroidogenesis in HAC15 Human Adrenocortical Carcinoma Cells
Authors: Ali Yusuf , Gomez-Sanchez Elise P , Gomez-Sanchez Celso E 
Published: November 2022

Abstract

Background
Mammalian target of rapamycin (mTOR) inhibitors suppress adrenal cortical carcinoma cell proliferation and cortisol production; the relationship between mTOR and aldosterone production has not been examined.

Methods
HAC15 cells were incubated with an mTOR activator and several inhibitors including AZD8055 (AZD) in the presence and absence of angiotensin II (AngII). The expression of rapamycin-sensitive adapter protein of mTOR (Raptor) and rapamycin-insensitive companion of mTOR (Rictor), adaptor proteins of mTOR complex 1 and 2, respectively, were studied in the HAC15 cells and deleted by CRISPR/gRNA.

Results
The mTOR inhibitors decreased aldosterone induced by AngII. Inhibition of mTOR by AZD significantly suppressed AngII-induced aldosterone and cortisol formation in a dose-dependent manner, whereas the mTOR activator MHY had no effect. AZD did not alter forskolin-induced aldosterone production showing that it is specific to the AngII signaling pathway. AngII-mediated ERK and mTOR activation were suppressed by AZD, along with a concomitant dose-dependent reduction of AngII-induced steroidogenic enzymes including steroidogenic acute regulatory protein, 3β-hydroxysteroid dehydrogenase-type 2, CYP17A1, and aldosterone synthase protein. Furthermore, mTOR components ribosomal protein S6 kinase (P70S6K) and protein kinase B phosphorylation levels were decreased by AZD. As mTOR exerts its main effects by forming complexes with adaptor proteins Raptor and Rictor, the roles of these individual complexes were studied. We found an increase in the phosphorylation of Raptor and Rictor by AngII and that their CRISPR/gRNA-mediated knockdown significantly attenuated AngII-induced aldosterone and cortisol production.

Conclusion
mTOR signaling has a critical role in transducing the AngII signal initiating aldosterone and cortisol synthesis in HAC15 cells and that inhibition of mTOR could be a therapeutic option for conditions associated with excessive renin–angiotensin system-mediated steroid synthesis.
ODP017 A case of an infected pheochromocytoma presenting as an acute abdomen: case report.
Authors: Sutharsan Shamila , Singarayar Dr Carolina , Foo Dr Siew Hui 
Published: November 2022

Abstract
This is a case of a 41 years old gentleman who had presented with a 3 day history of severe left sided abdominal pain associated with vomiting 6 years prior in 2015. He had a CT abdomen at that time which showed acute cholecystitis and a left adrenal lesion arising from the lateral limb with a size of 2.8×2.9cm with a HU of 139 and less than 60% washout. He was treated with antibiotics for 3 days however he took an AOR discharge once he felt better. A 24 hour urine cathecolamines were sent during that admission. Subsequently he had defaulted his follow up and presented again 6 years later in May 2021 to another hospital with severe sharp left hypochondriac pain of 2 weeks duration with a pain score of 6/10 associated with vomiting. He was hypertensive at 190/100mmHg, tachycardic at 117 beats/min, febrile at 40 degrees Celcius and had associated hyperglycemia with a blood glucose of 28mmol/L with no metabolic acidosis. His blood investigations revealed a raised white cell count of14.7×10 9 /L with a normal renal and liver profile. He was started on a intravenous antibiotics, variable rate insulin infusion and kept nil by mouth. An urgent CT abdomen done showed a large mass of 9.8×10.1×12.5cm with a mean HU of 25 suggestive of solid cystic mass arising from the left adrenal. His previous cathecolamines from year 2015 was traced and the epinephrine level was 2x elevated at 46mcg/day. He was started on oral Phenoxybenzamine 10mg BD and further titrated to 10mg TDS. Propanolol 40mg BD was given as well. He was only given oral Phenoxybenzamine for 3 days (usually needing 1 week) as an emergency left adrenalectomy was done due to worsening pain not relieved by analgesics and ileus. He had an open left adrenalectomy, splenectomy and distal pancreatectomy. Intraoperative findings weregeneralized pus contamination, stomach, small and large bowel grossly dilated without any perforation, infected left adrenal tumour 10×8cm with no clear plane with distal pancreas including splenic vein due to desmoplastic reaction. During surgery his blood pressure was ranging between 110-140mmHg (systolic) and 60-80mmHg (diastolic). Intra – op, his blood pressure was supported by a low dose noradrenaline which was discontinued within a few hours post surgery. Histopathalogy examination showed neutrophilic infiltrates forming microabscesses with necrosis amounting 60% of the total tumour. The ragged area of the adrenal gland shows mainly inflammation and fibrosis with no evidence of tumour. A final diagnosis of infected pheochromocytoma was given. After surgery, he recovered well and did not need antihypertensives and was discharged with oral glucose lowering agents.
Presentation: No date and time listed
ODP020 A Challenging Case of Poorly Differentiated Carcinoma with Neuroendocrine Differentiation and Adrenal Mass
Authors: Mosquera Jorge , Oo Yin , Milburn Joseph 
Published: November 2022

Abstract

Background
Neuroendocrine tumors (NETs) account for about 0.5% of all newly diagnosed malignancies. The most frequent primary sites are the gastrointestinal tract or pancreatic (62%-67%) and the lung (22%-27%). All poorly differentiated NETs have a Ki-67 index of greater than 20% and WHO grade of 3. The determination of the site of origin can be challenging in widely metastatic poorly differentiated NETs.

Clinical Case
A 51-year man with a history of hypertension and type 2 diabetes mellitus presented with angioedema while on lisinopril for years. Apart from a month's history of bilateral flank pain, he denied diarrhea, flushing, stridor, or shortness of breath. CT abdomen showed an 8.2×8. 0×7.9 cm right adrenal mass with a few punctate calcifications, hepatomegaly with multiple liver metastases, multiple retroperitoneal, hepatoduodenal, retrocrural adenopathy, and T4 metastatic lesion. CT chest showed bulky mediastinal and supraclavicular lymph nodes with trachea narrowing. All those lesions were FDG avid on PET/CT scan. Core biopsy of right supraclavicular lymph node revealed a poorly differentiated carcinoma with neuroendocrine differentiation and high proliferative index (25-50%). On cell block, it was negative for (AE1/AE3 (-), CAM5.2 (-), CK7, CK20, vimentin, desmin, CEA, EMA, CD45, CD20, and TTF-1 but positive for CK903 (focal +), synaptophysin (+), chromogranin (+), calretinin (focally +), inhibin (focally +). Based on the immunohistochemical stain, it was concluded as a metastatic small cell carcinoma of unknown origin. He was treated with carboplatin, etoposide, and atezolizumab and received 5 cycles. Endocrine was consulted two months after his initial presentation. Urine normetanephrine was &gt; 4-fold elevated. Blood pressure was controlled on Doxazosin at 4 mg bid. The 10 gene-panel for hereditary pheochromocytoma and Paraganglioma (PGL) was negative. There was a progression of mediastinal adenopathy while on treatment with narrowing of proximal intrathoracic trachea requiring elective tracheostomy. Based on imaging findings and elevated normetanephrine, we believe he has metastatic pheochromocytoma and PGL. His chemo regimen was switched to Cyclophosphamide, Vincristine, and Dacarbazine (CVD). He finished 8 cycles of CVD with an overall reduction in the size of lymph nodes (both above and below the diaphragm) and right adrenal mass. His plasma normetanephrine level was also significantly improved.
Presentation: No date and time listed
ODP603 Impact of CME at Improving Knowledge, Competence and Confidence Related to Management of Cushing Disease
Authors: Larkin Amy , Maeglin John 
Published: November 2022

Abstract

Introduction
We sought to determine if an online continuing medical education (CME) activity could improve knowledge, competence and confidence of primary care physicians (PCPs) and endocrinologists (endos) related to management of patients with Cushing disease (CD).

Methods
Educational design included a "test, then teach" approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. A repeated pairs pre-/post-assessment study design was used and McNemar's test (5% significance level, P .8 large). The activity posted June 22, 2021, and data were collected through August 27, 2021.

Results
Overall, 74% of PCP learners (N=468, Cohen's d=.96) and 75% of endo learners (N=81, Cohen's d=1.14) improved their knowledge/competence(both P
Presentation: No date and time listed
PMON154 Cardiovascular Complications in Acromegaly-A National Inpatient Sample Analysis
Authors: Thota Geethika , Raj Kavin , Dewan Sandesh 
Published: November 2022

Abstract

Introduction
Cardiovascular complications are the frequent cause of death in Acromegaly. Most of the prior studies on the epidemiology of cardiovascular complications in Acromegaly had a small sample size due to the rarity of Acromegaly. We wanted to investigate the prevalence of cardiovascular risk factors and cardiovascular diseases in patients with Acromegaly in a large sample size using the NIS (National inpatient sample)

Methods
We utilized the National inpatient sample (NIS) 2016, 2017, and 2018 for our analysis. All patients with Acromegaly were included. The frequency of different cardiovascular risk factors and cardiovascular diseases was estimated.

Results
A total of weighted 5654 weighted hospitalizations (95% CI 5220-6089) with Acromegaly were included. Out of these, 15% had heart failure, 20% had cardiac arrhythmias, 7% had valvular diseases, 3% had pulmonary circulation disorders, 6.9% had peripheral vascular diseases. 42.1% had hypertension with no complications, 13.9% had hypertension with complications, 2% had paralysis, 17.7% had Diabetes mellitus without complications, 15.2% had Diabetes mellitus with complications, 20.9% had obesity, 33% had dyslipidemia, 11.6% had nicotine dependence, and 4.7% had a family history of myocardial infarction. The mean elixhauser comorbidity score was 2.9. A total of 33% of patients had pituitary surgery at the time of hospitalization.

Discussion
Cardiovascular risk factors and cardiovascular diseases remain a significant issue in acromegaly patients. Hypertension was the most common cardiovascular risk factor, and cardiac arrhythmias were the most common cardiovascular disease. Acromegaly patients have a higher risk for mortality than the general population due to cardiovascular complications. This is directly correlated with increased IGF-1 levels which can be eliminated with surgery. However, 80-90% of patients do not cure despite surgery. Hence, aggressive control of the cardiovascular risk factors and strict biochemical control is necessary to reduce cardiovascular mortality in acromegaly patients. Acromegaly patients should be regularly screened for cardiovascular risk factors, and they should receive guideline-directed management of these conditions. Potential limitations of our study include the retrospective nature, lack of documentation of pituitary resection, and the exact treatment received in the outpatient for Acromegaly in NIS.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON157 Evidence For Locally Produced Cortisol in Pituitary Tissue
Authors: Tsai Karen , Bergsneider Marvin , Vinters Harry , Wang Marilene , Zhang Dongyun , Heaney Anthony 
Published: November 2022

Abstract
Double or multiple pituitary adenomas are rare and account for only 1.6-3.3% of all corticotroph tumors. We describe 2 distinct pituitary corticotroph adenomas in a 43-year-old female presenting with ACTH-dependent Cushing disease (CD). Although pre-operative pituitary MRI noted a single 8×6mm left sided pituitary microadenoma, which was confirmed at trans-nasal trans-sphenoidal surgery, she was found to an additional 7mm right sided microadenoma. Histopathology confirmed 2 separate corticotroph adenomas and she exhibited immediate remission of her CD with nadir cortisol of 1mcg/dL. Whole exome sequencing demonstrated a somatic mutation in the 21-alpha-hydroxylase (CYP21A2) gene in both tumors. CYP21A2 transcript and protein expression were absent in the index case but both CYP21A2 transcript and protein were demonstrated in a series of 9 other pituitary corticotroph adenomas and 12 normal pituitary tissues. This unusual case which prompted us to examine CYP21A2 expression in the pituitary allows us to describe for the first time evidence of locally generated pituitary-derived cortisol and indicate this could play a paracrine role on the corticotroph and may contribute to growth of ACTH pituitary adenomas in some instances.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON71 Evaluation of a new transition organization for young adults with endocrine or metabolic diseases
Authors: Roux Enora L , Touraine Pr Philippe 
Published: November 2022

Abstract

Objective
To evaluate the effect of a new care organisation on outcomes of transition success Design. Non-randomized controlled trial in a French University Hospital.

Methods
Patients transferred to adult care during the control period (04/2014-08/2016) and the intervention period (09/2016-06/2018) were included. The intervention is based on case management involving liaising with pediatric services, personalising care pathways, and liaising with structures outside hospital (general practitioner, educational and social sector).

Results
202 patients were included (101 per period), the most represented pathologies were congenital and non-congenital hypopituitarism (respectively n=34 (17%) and n=45 (22%)) and thyroid diseases (n=21, 10%). Patients were aged 22.5 in median at 24 months post transfer where 12 were lost to follow up in the control group versus 9 with the intervention (p=0.49). The percentage of honoured consultation among those planned during 24 months was higher with intervention (p=0.0065). Patient satisfaction, physician trust, transfer delay did not differ between the groups. The incremental cost-effectiveness ratio was €179 per patient not lost to follow-up.

Conclusions
At 24 months post transfer the rate of lost to follow-up does not differ significantly, but indicators of a steadier follow-up are increased and the intervention appears to be cost-effective.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON89 Nephrogenic Diabetes Insipidus in a Patient on Temozolomide
Authors: Moll Teresa , Lott David , Wright Virginia , Lien Lillian , Subauste Jose 
Published: November 2022

Abstract
A 54-year-old female admitted for nausea and vomiting found to have hypernatremia. Four months prior to this admission, patient had undergone emergent craniotomy for an intraparenchymal hemorrhage. Found to have a 7.8 cm hemorrhagic and partially necrotic mass. Pathology consistent with anaplastic oligodendroglioma. She began radiation and temozolomide 2 months after surgery. On this admission for nausea and vomiting, sodium noted to be elevated at 154 mmol/L (136-145 mmol/L). Initially thought to be due to dehydration and started on intravenous fluids. Urine output noted to increase to 2-3 liters/day with persistently elevated sodium. Urine studies and labs collected while sodium 155 mmol/L significant for urine osmolality 128 mOsm/kg (50-1200 mOsm/kg), serum osmolality 330 mOsm/kg (280-295), and urine sodium 34 mmol/L. Given patient's history of prior craniotomy, radiation, and temozolomide, suspected central diabetes insipidus but DDAVP challenge with 4 mcg did not result in a lower urine output and urine osmolality remained &lt;300 mOsm/kg. Repeat DDAVP challenge produced similar results. Evaluation of other central axis deficiencies revealed normal Free T4 (1.21 ng/dL). Unable to assess for adrenal insufficiency due to patient already on high-dose steroids for malignancy. Workup was turned to potential nephrogenic etiology as patient had been started on pantoprazole during her initial diagnosis 4 months prior. Co-peptin while sodium 148 mmol/L returned at 27.6 pmol/L (&lt;13.1 pmol/L), indicative for nephrogenic diabetes insipidus. Patient was started on amiloride 5 mg twice a day and hydrochlorothiazide 25 mg twice a day with improvement noted in both sodium and urine output. Did discuss renal biopsy to rule-out interstitial nephritis from pantoprazole but given patient was on anti-coagulation for sub-massive pulmonary embolism, biopsy was deferred. Ultimately patient was discharged on amiloride 10 mg and hydrochlorothiazide 25 mg daily with sodium 142 mmol/L. She continued to receive temozolomide but eventually both amiloride and hydrochlorothiazide were held during a subsequent admission about a month later due to hyponatremia from poor oral intake. Sodium remained stable for about 5 months off medication at which time patient was re-started on amiloride for hypernatremia. Unfortunately patient passed due to complications from thrombosis. Review of PubMed revealed only 1 additional case report of a patient on temozolomide who developed nephrogenic diabetes insipidus but that patient was also on sulfamethoxazole-trimethoprim which was most likely the cause.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
PMON91 Late Presentation of Pituitary Apoplexy Following Gonadotropin-Releasing Hormone Agonist for Prostate Cancer Treatment
Authors: Raj Rishi , Elshimy Ghada , Owen Douglas 
Published: November 2022

Abstract

Background
Pituitary apoplexy (PA) is characterized by sudden increase in pituitary gland volume secondary to ischemia and/or necrosis. Certain predisposing factors can result in PA and use of gonadotropin-releasing hormone (GnRH) agonist for prostate cancer (PCa) is one such condition. We present a case of 59-year-old male who had insidious onset of PA following leuprolide administration, resulting in late presentation of PA.

Case Presentation
A 59-years old male was referred to the endocrinology clinic for evaluation of pituitary enlargement found on MRI brain in June 2021. He complained of fatigue, anorexia, unintentional weight loss, diplopia, and blurry vision, which developed insidiously and gradually worsened over six months. In 2014, he was diagnosed with stage 4 PCa (Gleason Score=8) with metastasis to the lymph nodes, ribs, and pelvic bones and underwent palliative radiation for bone metastasis and androgen deprivation with intramuscular leuprolide 22.5 mg every 3 months between July 2014 till July 2020. On presentation, he was hemodynamically stable and visual field testing was negative. Anterior pituitary hormone evaluation revealed panhypopituitarism with low serum ACTH 5 pg/ml (7.2-63.3 pg/ml), cortisol 2.9 mcg/dl (5-15 mcg/dl), TSH 0.53 mclIU/ml (0.6-4.7 mclIU/ml), Free T4 0.27 ng/dl (0.58-1.76 ng/dl), IGF-1 58 ng/ml (54-258 ng/ml), LH 0.3 mIU/ml (1.5-9.3 mIU/ml), FSH 1 mIU/ml (1.4-18 mIU/ml) and testosterone &lt; 3 ng/dl (1.5-9.3 ng/dl). Pituitary MRI July 2021 demonstrated subacute hemorrhage inside the pituitary gland which was not present in prior MRI in September 2020. Based on laboratory work up showing secondary adrenal insufficiency and central hypothyroidism, as well as pituitary imaging confirming apoplectic event, he was diagnosed with PA secondary to GnRH agonist use. He was initially treated with stress dose of steroids followed by prednisone 5 mg daily and levothyroxine 75 mcg daily. He had significant improvement of symptoms over next few weeks including near complete resolution of visual symptoms.

Conclusion
Given high prevalence of PCa and increased use of GnRH agonists, more patients will develop PA, which was once thought to be extremely rare. Furthermore, it is critical that patients receiving GnRH agonists should be evaluated for possible PA, even in the absence of acute symptoms, which is classically seen in PA.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.