Explore the vast range of titles available.

Lymphatic malformation (LM) is the currently preferred term for what was previously known as lymphangioma. Retroperitoneal LMs are extremely rare, benign, cystic masses that arise from lymphatic vessels. They can be challenging to diagnose because they resemble other retroperitoneal cystic tumors. The development of treatment strategies for rare diseases, including retroperitoneal LM, requires the acquisition of new knowledge to enhance our understanding of the disease progression. Therefore, we present an update regarding fundamental and advanced issues associated with retroperitoneal LM. This review describes the epidemiology, histopathology, biomedicine, clinical manifestations, radiological features, differential diagnosis, and management of this lesion.

This study uses time series modeling approaches, notably Autoregressive Integrated Moving Average (ARIMA) and Holt-Winters models, to forecast Vietnam’s annual CO2 emissions. Historical emissions data were examined to find patterns and forecast future emissions over the following five years. The Holt-Winters seasonal model (α, β, γ = 0.995, 0.142, 0.001) offered marginally better accuracy with a Mean Absolute Percentage Error (MAPE) of 18.65%. In contrast, the ARIMA (p, d, q = 3, 3, 2) model successfully reproduced the historical trends with MAPE of almost 26%. According to both estimates, CO2 emissions would climb significantly, highlighting the urgent need for sustainable behaviors and efficient climate legislation to lessen the increasing environmental impact. Future research will use sophisticated modeling approaches and explanatory variables to improve forecast reliability.

This study focuses on extracting nanocellulose (NC) from durian husk and its application in biopolymer packaging. This study successfully extracted nanocellulose from durian husk, demonstrating its potential as a valuable source. The nanocellulose exhibited a granular structure with interwoven chains and a mixed structure of cellulose types I and II. Thermal analysis showed a 62.38% weight loss at 600°C, indicating thermal stability. When added to starch films, nanocellulose did not affect film formation or biodegradability but increased water absorption. It also influenced the solubility of the films, reinforcing them at lower concentrations (2-4%) and increasing solubility at higher concentrations (6-10%). The addition of nanocellulose deepened the color intensity but had minimal impact on color change at 2-4%. Moreover, nanocellulose enhanced the antibacterial properties of the films, showing its potential in food packaging and biodegradable materials.

Renal trauma occurring in patients with unilateral renal cystic disease (URCD) is extremely rare. Unilateral renal cystic disease is benign, nonprogressive, nonfamilial, nonencapsulated, and unrelated to cysts in other organs. It should be differentiated from autosomal dominant polycystic kidney disease (ADPKD) parenthesis, multicystic dysplastic kidney disease, multiple renal simple cysts, and cystic renal neoplasms. We report a case of a 15-year-old male with URCD admitted to the hospital sustaining blunt trauma to his right flank after a motor vehicle crash. Final diagnosis in this case was renal injury in a URCD patient. The patient was treated conservatively and subsequently discharged. Unilateral renal cystic disease can be diagnosed and followed by a combination of imaging methods and functional studies. The management of URCD is conservative. Although the disease is stable, nephrectomy may occasionally be indicated when there is a strong suspicion for malignancy.

Teprotumumab (Tepezza), an insulin-like growth factor type 1 receptor antagonist, was approved for treatment of thyroid eye disease in 2020. Teprotumumab is administered intravenously every 3 weeks for a total of eight doses. Common side effects include nausea, diarrhoea, muscle spasms, hearing impairment, dysgeusia, headaches, dry skin, infusion reactions and hyperglycaemia. We report here a 76-year-old man with Graves-related thyroid eye disease who developed a rapidly progressive cognitive decline after receiving four out of eight doses of teprotumumab (cumulative dose 4620 mg). He was admitted for workup and teprotumumab infusions were discontinued. Intravenous glucocorticoids and immunoglobulin were given which showed no improvement in clinical symptoms. He subsequently underwent plasmapheresis with resolution of his symptoms, suggesting a teprotumumab-induced encephalopathy. Further studies involving larger populations and longer durations are needed.

Abstract Disclosure: M.K. Shakir: None. C.M. Godar: None. R. Piech: None. T.D. Hoang: None. The efficacy of romosozumab for improving osteoporosis and preventing skeletal fractures is uncertain in patients with osteogenesis imperfecta (OI). In this case report we describe the beneficial effect of romosozumab on markers of bone turnover and bone density in a patient with OI. A 64-year-old man with OI was referred to endocrinology for evaluation of repeated fractures. The patient had a few fractures as a child (2 collar bones and wrist, oldest at age 14); and he recovered well. He reports that he has had a short stature and blue sclera but was otherwise asymptomatic. His son was also diagnosed with OI based on bone biopsy showing abnormalities suggestive of OI type II or IV. This son has had multiple fractures, 10 shoulder dislocations, and 2 hip replacements. He has another son with a history of multiple fractures but no formal diagnosis of OI. His third son has no findings. The patient’s brother has been diagnosed clinically with OI type 4, and had genetic testing showing a COL1A1 pathogenic variant (c. 976G>C, p.Gly326Arg) . Genetic testing in our patient revealed a COL1A1 pathogenic variant (c. 976G>C, p.Gly326Arg) confirming the diagnosis of OI type 4. 8 years ago, he was treated with alendronate for 12 months, which did not prevent recurrent fractures, and all therapies were discontinued. However, recently, the frequency of fractures involving multiple sites had increased. At presentation, his lumbar and bilateral total hip bone mineral density (BMD) values were severely decreased to 0.725 and 0.566 g/cm2, (T scores -3.3 and -3.1) respectively. Because of severe osteoporosis, he was treated with romosozumab 210 mg every month. After 12 months of treatment, his lumbar and total hip BMD increased by 28.3% and 7.2 % respectively. Additionally, bone formation markers increased, and bone resorption markers decreased at 12 months of therapy. He did not develop any fractures after treatment with romosumab. No severe adverse drug effects were observed. At the end of 12 months he received 5 mg zoledronic acid IV. This case revealed good responses of BMD and bone turnover markers to romosozumab treatment, which can be considered as an effective treatment option for osteoporotic OI patients. Studies involving large number of patients are required. Presentation: 6/2/2024

Abstract Disclosure: A.J. Spiro: None. M.K. Shakir: None. T.D. Hoang: None. Stress fractures are overuse injuries that occur in people with normal bones in the absence of an acute injury. They tend to occur in individuals who are beginning new or more intense physical activity and affect military personnel at higher rates than the general population. These injuries negatively impact force readiness and may lead to serious injury or discharge from military service. Much of the existing literature has focused on basic training recruits, as this population is known to be susceptible to stress fractures. Few studies have examined military populations with many years of service to evaluate how fracture trends may change after the initial basic-training period. We aimed to characterize stress fracture patterns in military personnel over the full spectrum of career stages, from new recruit through late career, and identify whether stress fracture locations varied by career length. We performed a retrospective chart of review covering a 3-year period (from Jan 1, 2017 to Dec 31, 2019) of military patients in the National Capital Region who were diagnosed with a new stress fracture. Career length was defined at the time of diagnosis as: new recruit (<12 months’ time-in-service), early-career (1 to <5 years’ time-in-service), mid-career (5 to <14 years’ time-in-service), and late-career (≥14 years’ time-in-service). Stress fracture locations were defined as: tibia, fibula, foot, femoral neck, femoral shaft, and pelvis. Frequencies of fracture types and presence of multiple fractures were described and compared by career length group using Chi-square tests. Femoral neck (11.1% vs 3.6%), femoral shaft (8.1% vs 1.8%), and pelvis fractures (3.8% vs 0.7%) were more frequent in new recruits vs other career length groups (p≤0.03 for each). Foot fractures were less frequent (19.2% vs 34.3%) in new recruits vs other career length groups (p<0.001). The presence of multiple fractures (23.7% vs 10.1%) was more frequent in new recruits vs others (p=0.01). Frequencies of each fracture type and of presence of multiple fractures were qualitatively similar among early-career, mid-career, and late-career groups. In our military population, new recruits had higher frequency of femoral neck, femoral shaft, and pelvic fractures, but lower frequency of foot fractures when compared to other patient groups. New recruits also had multiple fractures more often than other patients groups at the time of presentation. Presentation: 6/1/2024

Abstract Disclosure: S.E. Park: None. T.D. Hoang: None. M.K. Shakir: None. A.J. Spiro: None. Background: Diagnosis of pheochromocytoma is based on characteristic findings on imaging and lab studies. CT and MRI are the primary imaging modalities used when evaluating adrenal lesions. Gadolinium-68(68Ga)-DOTATATE PET/CT is somatostatin receptor based form of imaging used in the evaluation of patients with neuroendocrine tumors, including pheochromocytomas and paragangliomas (PPGLs). 68Ga-DOTATATE PET/CT is reported to have high sensitivity for the detection of PPGLs. Clinical Case: A 50-year-old man was evaluated for a 1.7cm right adrenal nodule, incidentally found on spinal MRI. He had no significant medical history and was not taking medications. He was asymptomatic without paroxysms of headache, palpitations, or diaphoresis. He had no notable family history. His physical exam was unremarkable. A low-dose dexamethasone suppression test showed appropriate cortisol suppression. Aldosterone and renin were in the normal range. Plasma fractionated metanephrines showed normal metanephrine level with mildly elevated normetanephrines, 194 pg/mL (ref. 0-145 pg/mL). 24hr-fractionated urine metanephrines showed normal metanephrine and normetanephrine levels. Adrenal CT showed a 1.9 x 1.4 x 1.9cm right adrenal lesion with 38 HU on noncontrast imaging. 15-minute washout showed absolute and relative washout of -27.1% and -11.1% respectively. Adrenal MRI showed a T2-hyperintense/T1-hypointense lesion. Due to concern for an asymptomatic pheochromocytoma, 68Ga-DOTATATE PET/CT was performed, and the right-side nodule showed relative absence of uptake compared to the rest of the adrenal gland. The results were interpreted as reassuring that the lesion was unlikely to represent a pheochromocytoma. During follow-up, two years later, a repeat adrenal CT showed an increase in size of the lesion to 2.0 x 1.9 x 2.6cm, with similar HU and washout. Plasma fractionated metanephrines increased to 420 pg/mL (ref. 0-145 pg/mL) and urine fractionated metanephrines were elevated 822 mcg/24hr (ref. 156-729). A clonidine suppression test was performed. During the test, the normetanephrine levels did not suppress, consistent with a pheochromocytoma. He underwent laparoscopic adrenalectomy, with pathology confirming a 2.3cm pheochromocytoma. Labs checked one month after surgery showed normalization of serum and urine normetanephrines. Conclusion: 68Ga-DOTATATE PET/CT is reported to have high sensitivity for the detection of PPGLs. In our patient, 68Ga-DOTATATE PET/CT showed relative absence of uptake in the adrenal lesion, which led to decreased suspicion for pheochromocytoma. Diagnosis was eventually made during follow-up, based on CT imaging, biochemical testing, and clonidine suppression test. More research is needed to determine the utility of 68Ga-DOTATATE PET/CT in the evaluation of adrenal pheochromocytomas. Presentation: 6/1/2024

Uterine leiomyoma, also referred to as fibroid or myoma, is a prevalent benign tumor that can present with a range of clinical manifestations. The symptoms, which vary based on the tumor’s location, size, and number, include pain, constipation, urinary disturbances, and abnormal menstrual bleeding. Certain types of uterine leiomyomas, such as pedunculated subserosal myomas or large degenerating cystic myomas, may closely mimic ovarian tumors, leading to significant diagnostic and management challenges. In this report, we present the case of a 47-year-old woman who experienced severe dyspnea and abdominal distension. Comprehensive radiological evaluation revealed a massive lesion, with both solid and cystic components, occupying the entire abdominopelvic cavity. Histological analysis confirmed the diagnosis of cellular leiomyoma. This case underscores the importance of considering degenerative cystic myoma in the differential diagnosis of large, cystic intra-abdominal tumors of unknown origin, to avoid misdiagnosis and ensure appropriate management.

Abstract Disclosure: H. Babu: None. A. Nawaz: None. A.J. Spiro: None. T.D. Hoang: None. M.K. Shakir: None. The overnight 1 mg dexamethasone suppression test (DST) is widely used to screen for Cushing’s Syndrome (CS), especially due to its low incidence of false negative results. Serum cortisol concentrations <1.8 µg/dL suggests adequate HPA axis suppression and usually excludes CS. Concentrations >1.8 µg/dL should be verified with a second test. However, the lack of suppression on DST has been documented previously in 1.46% to 15% of obese patients without CS. Previous studies have suggested simultaneous measurements of serum cortisol, ACTH, and dexamethasone levels after DST to ensure adequate suppression. In this retrospective analysis, we compared the plasma levels of ACTH, dexamethasone, and cortisol levels after 1 mg and 2 mg DST in healthy obese (class III) subjects. The study involved 6 subjects (2 males, 4 females, age 37.5 ± 8.79 years, BMI 43.65 ± 3.12 (kg/m2) who were referred for evaluation of abnormal weight gain. Exclusion criteria for these subjects included diabetes mellitus, pregnancy, history of CS, psychiatric disorders, chronic liver disease, chronic renal failure, malabsorption disorders and nephrotic syndrome. The exclusion of CS was done by history and physical examination showing the lack of specific clinical features of CS. Additionally, none of the subjects were taking drugs that interfered with CYP3A4 or oral contraceptives within 3 months preceding the study. None of the participants reported alcohol consumption of more than 30 g per day. Screening tests for CS involved 1 mg, 2 mg DST, LNSC and 24-hour urine cortisol levels. Results: Following 1 mg DST in 5 subjects, the mean serum cortisol levels were 1.35 ± 0.13 mcg/dL and the mean serum dexamethasone levels, and ACTH levels were 282 ± 44 ng/dL and 5.92 ± 1.56 pg/mL, respectively. However, in one subject (BMI 43.5) the post-DST cortisol level was 2.96 mcg/dL with corresponding dexamethasone level of 138 ng/dL and ACTH level of 21 pg/mL. However, following 2 mg DST in all 6 subjects the serum cortisol levels were less than 1.8 mcg/dL (1.21± 0.22 mcg/dL) with ACTH levels (3.87 ± 0.70 pg/mL) and dexamethasone levels of 482 ± 80 ng/dL. The LNSC levels were normal in 4 subjects (0.010 ± 0.005 mcg/dL), whereas in 2 subjects these were minimally elevated. 24-hour urine cortisol levels were normal in 5 subjects (29.4 ± 3.74 mcg) and in one subject this was mildly elevated (67 mcg). Long term follow-up of all subjects confirmed normal cortisol status. Previous studies have demonstrated that routine CS screening of patients affected by severe obesity is not indicated. However, other investigations have shown CS may occur in a small percentage of severe obese patients. In conclusion, 2 mg DST is a preferred test in obese patients suspected to have CS although 1 mg DST generally can be used as an initial screening test. Additionally, serum dexamethasone and ACTH measurements may still be useful in patients who are suspected to have a false-positive DST. Presentation: 6/1/2024