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Queer Kinship and Family Change in Taiwan sheds light on the often overlooked intricacies of queerness within family life in Taiwan. This is a dissertation-turned-book and first monograph by sociol...

Background Normal male puberty begins after 9 years of age with a concurrent rise in luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These play distinct roles, with LH acting on Leydig cells to stimulate testosterone and secondary sex characteristics, while FSH promotes testicular growth by stimulating the maturation of seminiferous tubules. Clinical Case An 8-year 9-month-old male TV presented with a 1.5 year history of facial hair and 9 months of phallic growth, body odor and acne. Physical exam revealed phallic enlargement, Tanner stage I pubic hair and firm, borderline pubertal testes (4 cc bilaterally). Bone age was 9 years at a chronological age of 8 years 6 months. Laboratory evaluation was inconsistent with typical puberty – LH (9 mIU/mL, RR 0.0-0.3 mIU/mL) and testosterone (519 ng/dL, RR 2-8 ng/dL) were elevated while FSH was pre-pubertal ( Conclusions Normal male puberty follows a predictable sequence, beginning with testicular enlargement followed by body odor, pubic hair growth, phallic enlargement, voice change, and increased growth velocity. In TV, hypersecretion of LH led to testosterone production, causing secondary sex characteristics. However, his pre-pubertal FSH did not stimulate the testicular growth that typically heralds the onset of puberty. Digression from typical pubertal sequence and isolated high LH raised concern for a pathologic cause. Central precocious puberty (CPP) is most often idiopathic in females, although more commonly associated with CNS lesions in males. Rarely, precocious puberty results from a functioning gonadotroph adenoma. Less than 1% of these are hormonally active. If active, these more often secrete FSH or co-secrete FSH and LH, and typically require surgical resection given limited success of medical therapies. This case illustrates the distinct roles of FSH and LH in pubertal development. Departures from the typical sequence of development should expand one's differential to include etiologies resulting in nonconcurrent secretion of gonadotropins. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Background Limited information is available regarding baseline characteristics of children and adolescents with gender dysphoria (GD). The purpose of this retrospective study was to describe baseline characteristics of pediatric patients referred for GD. Methods A retrospective chart review of pediatric patients with GD referred to the pediatric endocrine clinic between 2002 and 2017 was conducted. Body mass index (BMI) percentiles and z-scores were calculated based on height and weight at the initial visit. Results Seventy-eight patients aged 14.9±2.37 years were identified. Of these, affirmed gender was more often male than female (63% vs. 37%, p=0.024). Although no difference was seen in average BMI z-scores between female to male (FTM) and male to female (MTF) patients, approximately 50% were overweight or obese. A higher incidence of anxiety was present in FTM compared with MTF youth (p=0.05). Fifty-six patients were referred in January 2014 or later, of whom 27% had a history of early expression of GD compared with 55% of those seen prior to 2014 (p=0.061). Conclusions The high prevalence of overweight in TG youth at baseline represents a potential risk for adverse health consequences. There appears to be a change in the age of first manifestation of GD over time.

Aims The Disposition Index (DI) is widely used in clinical studies of β-cell function. However, direct physiologic interpretation of the DI value and the inverse exponential slope relating insulin secretion and insulin sensitivity terms is difficult. We evaluated a linearization of the relationship that allows separate evaluation of the DI term and the slope. Methods Insulin secretion and sensitivity indices were derived from standardized oral glucose tolerance testing, including commonly used terms and model-derived terms. The population included participants with normoglycemia, dysglycemia or Type 2 diabetes. Logarithmic transformation of the DI equation to linearize the secretion-sensitivity relationship was performed, and the resulting secretion-sensitivity relationships were evaluated using standard linear regression methods. Results Simple logarithmic transformation linearized the secretion-sensitivity relationships available from a variety of OGTT-derived metrics. In normoglycemic subjects the slopes approximated −1 in insulin-basedsecretion-sensitivity pairs, and approximated −0.6 in C-peptide based secretion-sensitivity pairs. Group differences in DI terms were observed as expected. These analyses also revealed differing secretion-sensitivity slopes, with IGT and T2D demonstrating progressively impaired coupling. Conclusions Linearization of the secretion-sensitivity relationship provides simplified interpretation of the DI value and allows simple analysis and meaningful interpretation of the secretion-sensitivity slope. This linear relationship is amenable to standard statistical evaluations for comparisons of insulin secretion responses and of secretion-sensitivity coupling across groups.

Renal volume has the potential to serve as a robust biomarker for tracking the onset and progression of renal diseases and also for quantifying renal function. We propose a method to estimate renal volumes using freehand ultrasound scans at the point of care. A conventional ultrasound probe was augmented with an Intel RealSense D435 i camera. Visual inertial simultaneous localization and mapping was used to localize the probe in free space. The acquired 2-D ultrasound images, segmented by trained clinicians, were combined with the estimated poses of the probe to yield accurate volumes. The method was tested on two ex vivo sheep kidneys embedded in gelatin phantoms. Four different scanning protocols were tested: transverse linear, transverse fan, longitudinal linear and longitudinal fan. The estimated renal volumes were compared with those obtained using the water displacement method, the ellipsoidal method and computed tomography imaging. The water displacement method yielded mean volumes of 66.00 and 66.20 mL for kidneys 1 and 2, respectively (ground truth). Freehand ultrasound scans produced mean volumes of 64.08 mL (2.90% error) and 65.25 mL (1.40% error); the ellipsoidal method yielded volumes of 57.49 mL (12.90% error) and 60.15 mL (9.13% error); and computed tomography yielded a volume of 63.00 mL (4.54% error).

Increased diagnosis of type 1 diabetes in sub-Saharan Africa has produced a need for quality specialty care to improve outcomes, but this specialty care is scarce. Rwanda has 42 district hospitals, each with 2 nurses in non-communicable disease (NCD) who provide diabetic care with limited glucose checks. Sustainable training is difficult due to limited in-country expertise and the cost-prohibitive nature of bringing in specialists. This study compares the efficacy of live conference-style training to online educational modules using interactive problem sets to teach NCD nurses. The ability to recommend insulin adjustments and feasibility of intervention were measured as outcomes. Rwandan district hospitals were randomized into 2 groups of 21. NCD nurses from Group 1 facilities attended a 1.5-day conference on the practical care of type 1 diabetics, with breakout sessions to practice insulin adjustments. Group 2 participants received conference materials online with interactive e-modules to practice insulin adjustments. Participants completed a 10-question assessment before and after their learning intervention and surveys to assess demographics, medical experience, practice location, and perceived efficacy of their training. Descriptive statistics (mean ± SD, counts and percentages) were used to compare group characteristics, while pre- and post-assessment increments were compared by paired t-tests and group differences by unpaired t-tests or Fisher’s exact test. The following comprise initial results with planned reassessments over 1 year. Overall, 41 nurses in Group 1 (47% male, 9.3 ±6.1 years in practice, 2.6 ± 1.6 years in the NCD role) and 35 nurses in Group 2 (47% male, 7.9 ±4.2 years in practice, 3.1 ± 0.9 years in the NCD role) were enrolled. There were no group differences in regards to gender, time in practice, or time in NCD role. 90.7% of providers described their practice as based in a ‘small town’ or ‘rural area’. Pre- and post-assessments were completed by 85% (35/41) of Group 1 and 74% (26/35) of Group 2. Both groups improved on their post-assessment with no significant difference between groups (Group 1 increment +2.0 ± 2.0 vs Group 2 +1.5 ± 3.1, p=0.24). Of 43 nurses invited to complete online education, only 35 (80%) successfully enrolled in the online course and only 26 (60%) completed the requested online activities. A large majority of participants felt confident making insulin adjustments at the conclusion of their education (Group 1=83%, Group 2=100%, p=0.17) and that the training was applicable to their practice (Group 1=92%, Group 2=100%, p=0.55). Though completion rate was low for online education, participant performance was comparable between the live and online instruction modalities. Thus, online education is a feasible option for specialty care training. Studies to reduce barriers in online education in resource-limited settings may narrow the expertise gap. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Background We aimed to determine the extent of post-treatment weight gain that occurs in pediatric patients in the first year following radioactive iodine (RAI) therapy for Graves disease (GD) and its relationship to clinical characteristics. Methods A retrospective chart review of patients receiving RAI therapy for GD between 1998–2015 was performed. Change in BMI SDS (∆BMI SDS) from baseline to one year after treatment was determined. We also investigated whether individual clinical and/or biochemical factors were associated with the weight trajectory in these patients. Results One hundred fifty seven patients aged 12.7 ± 3 years (80% girls) were included in the analysis. Average ∆BMI SDS was 0.70 ± 0.71 (p

Kidney volume is a predictor of kidney function or the number of surviving nephrons; as such, it is a valuable biomarker in tracking the onset and progression of chronic kidney disease (CKD). Existing techniques to measure renal volumes [CT, MRI, three-dimensional (3D) ultrasound] are limited by high cost, long scan times, and low portability. To overcome these limitations, we propose a real-time, low-cost solution for estimating renal volumes using free-hand ultrasound scans. The method involves an Intel RealSense D415 camera mounted on a conventional one-dimensional ultrasound probe; RGB-D SLAM is used to localize the probe in free space. The acquired two-dimensional images are manually segmented by trained clinicians and combined with their corresponding poses to form a 3D volume. The method was tested on ex vivo sheep kidneys embedded in gelatin phantoms. Three different scanning protocols were tested: transverse linear scan (TL), transverse fan scan (TF), and longitudinal fan scan (LF). Ultrasound measured renal volumes were compared to those obtained using the water displacement (WD) method; TL = 66.2 ml, LF = 58.3 ml, TF = 53.3 ml, and WD = 66.6 ml. Further investigation includes automating kidney segmentation, accounting for patient motion, and in vivo validation.

Our Pediatric Endocrinology Clinic has seen a sharp increase in referrals for gender dysphoria (GD) during recent years. However, the frequency and characteristics of referrals have not been objectively examined.A retrospective chart review of referrals for GD during the past 13 years was performed. Variables analyzed included numbers of referrals per year, patient characteristics, comorbid conditions, and hormonal therapy. Timing of referral and eligibility for treatment were measured against established recommendations.Of 38 patients, 74% were referred during the last 3 years. Most patients presented late in puberty before a GD-specific psychological evaluation and few were eligible for hormonal treatment at baseline. Over half had psychiatric and/or developmental comorbidities.A dramatic increase in referrals for GD since 2002 was confirmed. Enhanced provider education and outreach regarding care of patients with GD are needed.

Using a newly synthesized gibberellin analog containing an acetoxymethyl group (GA(3)-AM) and its binding proteins, we developed an efficient chemically inducible dimerization (CID) system that is completely orthogonal to existing rapamycin-mediated protein dimerization. Combining the two systems should allow applications that have been difficult or impossible with only one CID system. By using both chemical inputs (rapamycin and GA(3)-AM), we designed and synthesized Boolean logic gates in living mammalian cells. These gates produced output signals such as fluorescence and membrane ruffling on a timescale of seconds, substantially faster than earlier intracellular logic gates. The use of two orthogonal dimerization systems in the same cell also allows for finer modulation of protein perturbations than is possible with a single dimerizer.

Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. Most cases of CPP are seen in girls, in whom it is usually idiopathic. In contrast, ∼50 % of boys with CPP have an identifiable cause. The diagnosis of CPP relies on clinical, biochemical, and radiographic features. Untreated, CPP has the potential to result in early epiphyseal fusion and a significant compromise in adult height. Thus, the main goal of therapy is preservation of height potential. The gold-standard treatment for CPP is go-nadotropin-releasing hormone (GnRH) analogs (GnRHa). Numerous preparations with a range of delivery systems and durations of action are commercially available. While the outcomes of patients treated for CPP have generally been favorable, more research about the psychological aspects, optimal monitoring, and long-term effects of all forms of GnRHa treatment is needed. Several potential therapeutic alternatives to GnRHa exist and await additional investigation.