Search

Hypoplastic left heart syndrome (HLHS) is a congenital diagnosis that necessitates immediate intervention at the beginning of life to ensure survival past infancy and to optimize left-side cardiac function. Often, these required procedures can lead to deleterious side effects and resultant complications. In this case report, we present a 15-month-old patient with HLHS who underwent multiple procedures, including two aortic arch surgeries. After the interventions, the patient experienced left main pulmonary bronchus compression along with pulmonary artery stenosis. In this case, we outline an approach to performing vascular dilation without compromise of airway patency.

Squamous cell carcinoma predominates as the most common malignant lesion of the oropharynx with human papilloma virus-associated disease now predominant over tobacco-related oropharynx cancer. Other rare malignant pathologies can manifest as visible neoplasms in these anatomic sites with varying degrees of symptoms such as dysphagia, odynophagia, otalgia, aspiration, hemorrhage, weight loss and dyspnea. We present a case of a rarely encountered primary oropharyngeal sarcoma managed by single-port transoral robotic resection and a selective cervical lymph node dissection followed by adjuvant radiotherapy.

The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by T H 2 and TH 17 cell predominant immune responses, the production of IgE antibody, and atypical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection,recognized as an essential driving factor in at least severe subsets of allergic airway diseases. In this review, we consider recent progress made in understanding the immune mechanisms that drive airway mycosis-related diseases, improvements in immune-based diagnostic strategies, and therapeutic approaches that target key immune pathways.

Although the vast majority of pediatric neck masses are benign, pediatric malignancies commonly present in the supraclavicular region. We present the case of a 4-year-old male who presented with a mass in the trapezius muscle with accompanying lymphadenopathy. An extensive work-up was performed to exclude malignancy, and the patient was ultimately diagnosed with a benign monocytic mass, which surgically excised. He has been doing well since surgery with no evidence of recurrence. A review of the literature revealed this case to be the first of its kind to be reported.

Machine learning is a rapidly growing subset of artificial intelligence (AI) which involves computer algorithms that automatically build mathematical models based on sample data. Systems can be taught to learn from patterns in existing data in order to make similar conclusions from new data. The use of AI in facial emotion recognition (FER) has become an area of increasing interest for providers who wish to quantify facial emotion before and after interventions such as facial reanimation surgery. While FER deep learning algorithms are less subjective when compared to layperson assessments, the databases used to train them can greatly alter their outputs. There are currently many well-established modalities for assessing facial paralysis, but there is also increasing interest in a more objective and universal measurement system to allow for consistent assessments between practitioners. The purpose of this article is to review the development of AI, examine its existing uses in facial paralysis assessment, and discuss the future directions of its implications.

To determine the effects of the COVID-19 pandemic on Adenotonsillectomies (TA), Tonsil Related Cases (TC), and Peritonsillar Abscess (PTA) Trends.Retrospective Cohort Study.This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 51 children's hospitals. Regions were defined according to PHIS rules with at least five children's hospitals per region. We compared monthly total TA, TC, TC as a proportion of all hospital visits, and PTA from all encounters at each hospital from January 1, 2019, through December 31, 2021.Compared to 2019, April 2020 saw mean TC drop significantly from 371.62 to 68.37 (p 0.001). Interestingly, June, September, and December 2020 had significantly higher mean TC compared to 2019. TC as a proportion of all hospital visits decreased significantly throughout the majority of 2021. Similarly, TA significantly decreased during 2020 and 2021 across all regions in the US, starting in March 2020 and this reduction in TA extended through the end of 2021 without any signs of recovery. PTA rates did not change significantly over the three years.The pandemic-plagued 2020 saw a noticeable decrease in overall TC and TA but then rebounded quickly to even higher than pre-pandemic levels. However, this rebound halted for the majority of 2021 and subsequently decreased to lower than pre-pandemic levels, which differs from other communicable pathologies such as otitis media which decreased initially then recovered to pre-pandemic levels by Summer of 2021.

To investigate the discrepancy rate in classification of newly diagnosed aortic dissection (AD) between radiologists and surgeons and explore patient management. 3255 CTs performed for AD from June 2013 to June 2018 at our institution were retrospectively identified. CT reports and charts were reviewed to identify newly diagnosed AD or intramural hematoma (IMH). Radiology reports and electronic health records were reviewed for Stanford type A or B classification and surgical versus medical management. Newly diagnosed AD was diagnosed in 1.9% (62/3255) with one false positive, mean age 60 years. Discrepancy rate was 1.6% (1/61). Type A AD/IMH was treated surgically in 85% (23/27), medically in 15% (4/27). Type B AD/IMH was treated surgically in 56% (19/34) (endovascular 95% (18/19)), medically in 44% (15/34). Discrepancy rate between radiologists and surgeons in Stanford classification of aortic dissection was low. Management of type B AD/IMH was predominantly endovascular, reflecting a shift in practice from the historical binary management strategy of type A dissections being treated surgically and type B dissections medically.

Purpose The pandemic related to the novel coronavirus (COVID-19) has led to a decrease in communicable diseases due to social distancing and mask-wearing. How have the prevalence of otitis media (OM) and its associated procedures changed during the pandemic? Study design Retrospective Cohort Study. Methods This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 48 children's hospitals. Regions were defined according to PHIS rules. We compared proportion of OM to total diagnoses codes, and collected mastoiditis, and MT placements from all encounters through January 1, 2019-June 31, 2021. Results In April 2020, there was a decrease in mean proportion of OM cases per 100 hospital visits (7 v. 2, p

Postpartum psychosis (PPP) is a severe mood disorder following childbirth that rarely leads to injurious or suicidal behavior. This report illustrates otolaryngologic intervention for pharyngeal laceration and airway instability following traumatic foreign body ingestion in the setting of PPP. A 25-year-old woman with PPP presented with hemoptysis after attempting suicide by traumatically forcing tree branches into her oropharynx. Imaging revealed pneumomediastinum, and flexible laryngoscopy and esophagoscopy showed a large foreign body (tree branch) extending from the hypopharynx to the gastroesophageal junction. She was taken to the operating room for direct microlaryngoscopy, bronchoscopy and esophagoscopy with removal of the 25-cm tree branch. Panendoscopy revealed a mucosal laceration at the cricopharyngeus with supraglottic and hypopharyngeal edema but no injury to the larynx. Due to airway concerns, a cuffed tracheostomy was placed along with a gastrostomy tube for feeding access. She tolerated her postoperative course with successful decannulation and oral feeding prior to discharge.

Purpose: Conditions and thresholds applied for evidence weighting of within-codon concordance (PM5) for pathogenicity vary widely between laboratories and expert groups. Because of the sparseness of available clinical classifications, there is little evidence for variation in practice. Methods: We used as a truthset 7541 dichotomous functional classifications of BRCA1 and MSH2, spanning 311 codons of BRCA1 and 918 codons of MSH2, generated from large-scale functional assays that have been shown to correlate excellently with clinical classifications. We assessed PM5 at 5 stringencies with incorporation of 8 in silico tools. For each analysis, we quantified a positive likelihood ratio (pLR, true positive rate/false positive rate), the predictive value of PM5-lookup in ClinVar compared with the functional truthset. Results: pLR was 16.3 (10.6-24.9) for variants for which there was exactly 1 additional colocated deleterious variant on ClinVar, and the variant under examination was equally or more damaging when analyzed using BLOSUM62. pLR was 71.5 (37.8-135.3) for variants for which there were 2 or more colocated deleterious ClinVar variants, and the variant under examination was equally or more damaging than at least 1 colocated variant when analyzed using BLOSUM62. Conclusion: These analyses support the graded use of PM5, with potential to use it at higher evidence weighting where more stringent criteria are met.

BACKGROUND: Corrective nasal surgery has historically been avoided in the pediatric population out of concerns surrounding the potential disruption of nasal growth centers. There is a paucity of data on the rate of complications or revision surgery following septoplasty in this population. As such, the purpose of this study is to review the long-term outcomes of a large cohort of children who underwent nasal septoplasty and to compare outcomes of septoplasty patients under the age of 14 to those 14 years and older. METHODS: A retrospective review was performed on all patients who received nasal septoplasty at our tertiary care pediatric referral center between October 2009 and September 2016. All patients who underwent septoplasty for a deviated nasal septum and were 0–18 years of age at the time of surgery were included in this analysis. Outcomes were compared between patients under the age of 14 to those 14 years and older. Demographic, surgical, and follow-up data were collected including complications and the need for revision surgery. RESULTS: A total of 194 pediatric patients were identified as meeting inclusion criteria for the study. Mean age for the total cohort was 14.6 years (0–18 years), with a mean of 15.9 years in the older group and 10.6 years in the younger group. Revision septoplasty was performed more frequently in the younger group. However, no significant difference in the rate of complications was seen between the two groups. CONCLUSIONS: To the best of our knowledge, this is the largest retrospective study examining outcomes following septoplasty in pediatric patients. We also specifically examine outcomes of very young septoplasty patients, a population for which limited evidence exists. Further retrospective studies are needed to validate the use of nasal septoplasty in the pediatric population.

Aim To evaluate patient satisfaction and savings, and compare visit outcomes based on chief complaint (CC) of women presenting for a televisit to a female pelvic medicine and reconstructive surgery (FPMRS) clinic at an urban academic center. Methods A cross-sectional study of women completing a televisit with an FPMRS specialist at our institution from June 19, 2020 to July 17, 2020 was conducted. A telephone questionnaire was administered to patients to assess satisfaction and savings (travel costs/time avoided). Electronic medical records were reviewed to collect patient demographics and comorbidities, CC, and televisit outcomes (e.g., face-to-face (F2F) exam scheduled, orders placed). Logistic regression was used to analyze predictors of satisfaction and need for F2F follow-up. Results One hundred eighty-seven of 290 (64.5%) women called completed the survey, of whom 168 (89.8%) were satisfied with their televisit. Eighty-eight (48.1%) saved at least an hour and 54 (28.9%) saved more than $25 on transportation. There were no significant associations between patient characteristics, CC, or televisit outcomes and satisfaction. Ninety-nine (52.9%) televisits resulted in F2F follow-up, with CC of prolapse (odds ratio [OR] = 4.2 (1.7-10.3); p = 0.002), new patient (OR = 2.2 (1.2-4.2); p = 0.01), and Hispanic ethnicity (OR = 3.9 (1.2-13.6); p=.03) as significant predictors. Conclusion Most patients were satisfied with FPMRS televisits at our urban academic center. Televisits resulted in patient travel time and cost savings. Women presenting with prolapse and for new patient visits would likely benefit from initial F2F visits instead of televisits. Televisits are an important mode of health care and in some cases can replace F2F visits.

Background Unlike Papanicolaou tests, there are no commercially available computer-assisted automated screening systems for urine specimens. Despite The Paris System for Reporting Urinary Cytology, there still is poor interobserver agreement with urine cytology and many cases in which a definitive diagnosis cannot be made. In the current study, the authors have reported on the development of an image algorithm that applies computational methods to digitized liquid-based urine cytology slides. Methods A total of 2405 archival ThinPrep glass slides, including voided and instrumented urine cytology cases, were digitized. A deep learning computational pipeline with multiple tiers of convolutional neural network models was developed for processing whole slide images (WSIs) and predicting diagnoses. The algorithm was validated using a separate test data set comprised of consecutive cases encountered in routine clinical practice. Results There were 1.9 million urothelial cells analyzed. An average of 5400 urothelial cells were identified in each WSI. The algorithm achieved an area under the curve of 0.88 (95% CI, 0.83-0.93). Using the optimal operating point, the algorithm's sensitivity was 79.5% (95% CI, 64.7%-90.2%) and the specificity was 84.5% (95% CI, 81.6%-87.1%) for high-grade urothelial carcinoma. Conclusions The authors successfully developed a computational algorithm capable of accurately analyzing WSIs of urine cytology cases. Compared with prior studies, this effort used a much larger data set, exploited whole slide-level and not just cell-level features, and used a cell gallery to display the algorithm's output for easy end-user review. This algorithm provides computer-assisted interpretation of urine cytology cases, akin to the machine learning technology currently used for automated Papanicolaou test screening.

Objective To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice. Methods A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders. Results A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P = .03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P = .05], labs ordered [OR:2.74 (1.12-6.70); P = .03] and female patient gender [OR:2.28 (1.03-5.03); P = .04] were significantly associated with satisfaction. Conclusion Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.

The NHS Long Term Plan prioritises NHS action to reduce health inequalities and give children a good start in life. A Sustainability and Transformation Partnership (STP) is a collaborative working arrangement between local authorities and the NHS covering a defined population and geography. Within the STP in Devon, England, all three local authorities had separate supervised toothbrushing programmes; all were precariously funded. Devon has limited access to routine NHS dentistry and children in deprived areas have high rates of general anaesthetics for dental extractions. Consolidating the supervised toothbrushing programmes presented an opportunity to address oral health inequalities across Devon STP.1. Reduce oral health inequalities for children in deprived areas. 2. Reduce treatment need for children who have limited access to routine NHS dentistry. 3. Invest in prevention.A proposal, supported by local authorities in Devon STP, was developed for a targeted supervised toothbrushing programme at early years sites across the most deprived 50% of areas in Devon. Return on investment was estimated using a national resource. Methods are described for identifying eligible sites and defining procurement lots. The NHS dental services commissioner agreed to support this proposal using an innovative approach to commissioning.Three lots, totalling 525 sites, were awarded to two providers. Mobilisation over summer 2019 led to implementation from September 2019.Partnership working and innovative commissioning can enable NHS England to invest in prevention at scale where options to increase dental access are limited. Implementation across a large geographical area creates challenges but facilitates equitable programme delivery.

Oral surgeons remove third molars (wisdom teeth) to prevent impaction. Given the close anatomical relationship to the maxillary sinus, perforation and displacement of third molars into the maxillary sinus is a well-known phenomenon that is typically removed with a buccal mucoperiosteal flap or through a Caldwell–Luc approach. However, a less invasive route of endoscopic removal has been utilized to success in one report. A literature review shows few reports of displaced molars into the maxillary sinus and no reported patient below the age of 18. A 14-year-old patient presented with a displaced third molar into her maxillary sinus following third molar extraction with her oral surgeon. The tooth was removed successfully, utilizing endoscopic sinus surgery (ESS) with a transition to transoral retrieval to prevent nasal trauma. This is the first reported case of displaced third molar into the right maxillary sinus in a pediatric patient that was removed via ESS.

To describe dentists' perceptions of their professional roles, including the reasons why they make, accept or decline patient referrals within primary dental care in England.Qualitative semi-structured interviews, conducted via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis and typologies were developed.Ten general dental practitioners (GDPs) and 12 community dentists working in England.Five main themes were identified: professional independence, the nature of dental care, the business of dentistry, obscure rules and 'no man's land'. This final theme described a notional gap between GDPs' and community dentists' responsibilities towards vulnerable people, who were perceived by participants to include frail older people, anxious and socially marginalised adults and children with high levels of disease. Three typologies of dentists were generated. 'Entrepreneurs' felt no allegiance to the National Health Service and no obligation to treat vulnerable patients. 'Altruistic carers' were committed to caring for exceptionally deserving patients. 'Pragmatic carers' tried to provide relational dental care (time and emotional support) for vulnerable patients but encountered discouraging systemic barriers.Dentists' perceptions of their roles may influence whether and how they provide access to primary dental care for vulnerable people through referral systems. Access issues may exacerbate the oral health inequalities experienced by vulnerable groups. Based upon the findings, approaches are proposed that may encourage and enable the dental workforce to support vulnerable people actively to receive primary dental care.

To investigate the discrepancy rate in classification of newly diagnosed aortic dissection (AD) between radiologists and surgeons and explore patient management.3255 CTs performed for AD from June 2013 to June 2018 at our institution were retrospectively identified. CT reports and charts were reviewed to identify newly diagnosed AD or intramural hematoma (IMH). Radiology reports and electronic health records were reviewed for Stanford type A or B classification and surgical versus medical management.Newly diagnosed AD was diagnosed in 1.9% (62/3255) with one false positive, mean age 60 years. Discrepancy rate was 1.6% (1/61). Type A AD/IMH was treated surgically in 85% (23/27), medically in 15% (4/27). Type B AD/IMH was treated surgically in 56% (19/34) (endovascular 95% (18/19)), medically in 44% (15/34).Discrepancy rate between radiologists and surgeons in Stanford classification of aortic dissection was low. Management of type B AD/IMH was predominantly endovascular, reflecting a shift in practice from the historical binary management strategy of type A dissections being treated surgically and type B dissections medically.

Background Nasopharyngeal carcinoma (NPC) is a cancer of epithelial origin with a high incidence in certain populations. While NPC has a high remission rate with concomitant chemoradiation, recurrences are frequent, and the downstream morbidity of treatment is significant. Thus, it is imperative to find alternative therapies. Methods We employed a Search Tag Analyze Resource (STARGEO) platform to conduct a meta-analysis using the National Center for Biotechnology’s (NCBI) Gene Expression Omnibus (GEO) to define NPC pathogenesis. We identified 111 tumor samples and 43 healthy nasopharyngeal epithelium samples from NPC public patient data. We analyzed associated signatures in Ingenuity Pathway Analysis (IPA), restricting genes that showed statistical significance (p Results Our meta-analysis identified activation of lipopolysaccharide (LPS)-induced tissue injury in NPC tissue. Additionally, interleukin-1 (IL-1) and SB203580 were the top upstream regulators. Tumorigenesis-related genes such as homeobox A10 (HOXA10) and prostaglandin-endoperoxide synthase 2 (PTGS2 or COX-2) as well as those associated with extracellular matrix degradation, such as matrix metalloproteinases 1 and 3 (MMP-1, MMP-3) were also upregulated. Decreased expression of genes that encode proteins associated with maintaining healthy nasal respiratory epithelium structural integrity, including sentan-cilia apical structure protein (SNTN) and lactotransferrin (LTF) was documented. Importantly, we found that etanercept inhibits targets upregulated in NPC and LPS induction, such as MMP-1, PTGS2, and possibly MMP-3. Conclusions Our analysis illustrates that nasal epithelial barrier dysregulation and maladaptive immune responses are key components of NPC pathogenesis along with LPS-induced tissue damage.

Adenotonsillectomy (AT) is the most common surgical procedure for the treatment of sleep related breathing issues in children. While overnight observation in the hospital setting is utilized frequently in children after a AT, ICU setting is commonly used for patients with sleep apnea. This objective of this study is to examine factors associated with the preoperative decision to admit patients to PICU following AT as well as co-morbidities that may justify necessity for higher level of care.This is a retrospective chart review from the years of 2009-2016. All patients who underwent AT for known sleep-related breathing issues at Nationwide Children's Hospital were eligible for inclusion. A complication was defined as an adverse event such as pulmonary edema, re-intubation, or a bleeding event. Respiratory support was defined as utilizing supplementary oxygen for more than one day, positive pressure ventilation, or intubation. Proportions and medians were used to describe the overall rate of complications/complexities in care, and bivariate statistics were used to evaluate the relationship between patient characteristics and outcomes. Similar methods were used to evaluate factors associated with preoperative referral to the PICU.There were 180 patients admitted to hospital in non-ICU setting and 158 patients with a planned PICU stay. The patients with planned PICU stays had higher rates of technological dependence (13% vs. 3%; p = 0.0006), perioperative sleep studies (80% vs. 29%; p 0.0001), and more severe classifications of OSA (p 0.0001). Patients with planned ICU placement also had higher rates of apneas, hypopneas, respiratory disturbance indexes, apnea hypopnea indexes, lower oxygen saturation nadirs, and a longer time spent below 90% oxygenation in sleep studies (p 0.0001). Nearly 45% of the patients with planned ICU stays required respiratory support compared to just 8% of non-PICU patients. Additionally, 32% of the patients with planned ICU stays experienced complications compared to just 8% of the floor population. Complications were associated with younger ages, gastrointestinal comorbidities, technological dependence, viral infections, and a history of reflux. Interestingly, there were no differences in the complication rate by sleep studies findings. Similarly, there were no population level differences between patients who required respiratory support in the ICU and those that did not. Unplanned PICU placement was a rare but significant adverse event (n = 24). None of the hypothesized risk factors were associated with unplanned PICU placement.This study suggest that while our pre-operative referral program for PICU placement is effective in identifying patients needing higher levels of care, the program places many patients in the PICU who did not utilize respiratory support or suffer from complications. We observed some misalignment between characteristics associated with planned ICU stays and actual complications. This suggests that patients with specific clinical histories, not findings on their sleep studies, should be prepared to receive higher levels of care.

Peritonsillar abscess (PTA) in pediatric patients is a challenging condition to diagnose and treat, and recurrence can occur in up to 15% of patients. This condition can be managed in various settings and there may be outcome differences depending on the choice of inpatient/outpatient management. The objective of this study was to evaluate immediate and long-term outcomes, specifically recurrence, after PTA management in the inpatient versus outpatient setting as well as specific patient characteristics leading to hospital management decisions.We conducted a retrospective cohort study of all suspected cases of PTA seen at a tertiary pediatric hospital from 2008 to 2017, and 566 confirmed cases of PTA were included in this study. Demographics, PTA management, recurrence, and subsequent tonsillectomy (immediate or within 1 year of diagnosis) were ascertained from patient medical records. We compared characteristics of patients seen in the inpatient and outpatient setting using Chi-squared and Wilcoxon-Mann-Whitney tests.Patients treated in the outpatient setting were more likely to be older and have a lower rate of recurrent ear infections (p 0.0001 and p = 0.01 respectively). Additionally, no differences in gender, Down Syndrome, or autism were found. Patients who were admitted were more likely to undergo immediate tonsillectomy within a month or tonsillectomy within one year (p 0.0001 and p = 0.02 respectively), whereas patients in the outpatient setting were more likely to receive antibiotics alone (p 0.0001). Outpatient management was associated with no differences in recurrence rate within 30 days (p = 0.56). However, recurrence was associated with older age, a history of recurrent tonsillitis, but not a history of ear infections (p = 0.005, p 0.0001, and p = 0.49 respectively). A history of recurrent ear infections, recurrent tonsillitis and recurrent PTAs were associated with the decision to pursue a tonsillectomy (p = 0.003, p = 0.03, and p 0.0001 respectively).Patients seen in the outpatient setting are more likely to receive antibiotics alone as their initial treatment, likely a result of certain clinical characteristics and presenting features as well as uncertain diagnosis. Inpatient status was associated with a younger age and a history of ear infections while recurrence was associated with a history of recurrent tonsillitis and older age. The recurrence rates for outpatient management were not statistically different than inpatient, suggesting that triaging and treatment of patients was occurring appropriately. The association of tonsillectomies in the inpatient group within 12 months is likely due to the higher rate of preexisting tonsil issues considering that recurrent tonsillitis, ear infections and a higher rate of PTA recurrence were all statistically correlated.

Objectives The objective of this study is to examine the impact that an institution-wide policy to reduce radiation exposure in pediatric patients had on the use of computed tomography (CT) imaging in children presenting with suspected peritonsillar abscess (PTA)1. Methods A single institution retrospective review was conducted for all pediatric patients under the age of 18 who presented to the emergency department with suspected PTA over a ten-year period. Patients were divided into two groups; those that presented during the years prior to policy implementation and those that presented during the years following. Main outcome measures were the frequency of patients who underwent CT scanning as a part of their workup, the specialty of the ordering physician, and the treatment for suspected PTA. Results A total of 317 patients with suspected PTA were seen prior to policy implementation, with an additional 275 patients seen in the years after. The frequency of CT use was 41% (131/317) in pre-policy patients, and 28% (77/275) in post-policy patients (p = 0.004). The most common specialty of ordering physician was Pediatrics in the pre-policy patients (45%), and Otolaryngology in the post-policy patients (41%) (p = 0.0003). Of the 131 patient who underwent CT scanning before policy implementation, 36 patients (27%) required incision and drainage (I&D) of their PTA in the OR. This is in comparison to 42/77 patients (55%) in the post-policy group who underwent I&D in the OR (p Conclusion An institution-wide policy to decrease unnecessary imaging studies in pediatric patients resulted in a significant reduction in the use of CT imaging in the work-up for suspected PTA. Additionally, there was increase in the frequency of patients who underwent surgical intervention for their PTA after CT imaging, suggesting a more scrutinized approach to CT usage since policy implementation.

Orbital abscess and subperiosteal abscess are pathologies which may require surgical treatment in the pediatric patient. Though rare, orbital cerebrospinal fluid (CSF) leak is a serious complication of abscess drainage. This paper presents a unique 5-month-old male with transorbital abscess drainage complicated by CSF leak. An endoscope was used to repair the defect through the orbitotomy incision. There was no evidence of persistent leak at follow-up. The surgical approach likely contributed to the complication, and the otolaryngologist played a key role in the leak repair. This case should serve to raise the awareness regarding considerations to avoid orbital CSF leak.

Introduction The clinical implications of single-sided deafness (SSD) in children has historically been underappreciated by patients and providers alike, despite a large body of literature on the wide-ranging neurocognitive, language, scholastic, and functional impairments that occur. Conventional amplification options are marked by variable results and frequent loss of follow-up. Methods Retrospective case series for pediatric SSD from 2008 to 2018. Results 88 children with congenital SSD were identified. Seventeen (N = 17/88, 23.9%) passed their newborn hearing screen. Median age at first otolaryngology evaluation was 0.65 years (range 0.1–16.9 years). Most common etiologies included cochlear nerve deficiency (N = 39, CND, 44.3%), unknown (N = 30, 35.2%), inner ear malformation (N = 7, 8.0%), and congenital cytomegalovirus (N = 6, 6.8%). 32.5% of patients elected for continued observation only, followed by bone conduction hearing aid (27.7%), contralateral routing of sound aid (20.5%), conventional hearing aid (13.3%), or cochlear implant (6%). Lack of follow-up at ≥1 year was common (39.8%). Of those with device use data (N = 39), 84.7% reported either discontinued or Conclusions Despite early diagnosis and evaluation, the pediatric SSD cohort is characterized by high rates of loss of follow-up and amplification discontinuation. Cochlear nerve deficiency is commonly seen in congenital SSD. Early specialist referral is critical for habilitation evaluation. Patients and caregivers should be educated on the significant implications of unilateral hearing loss.

7531 Background: Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and has a heterogenous presentation. CLL is known to shape the immune response to survive. Studying these processes will help gauge the potential success of immunotherapy and point to therapeutic targets. Methods: We used our Search, Tag, Analyze, Resource platform to meta-analyze patient samples from Gene Expression Omnibus. We tagged peripheral B cells from 741 CLL patients and peripheral B cell samples from 150 healthy donors as a control. We also tagged and compared B cell samples from 84 CLL progressors to 91 patients with stable CLL. Lastly, we tagged peripheral T cells from 70 CLL patients and T cells from 35 healthy donors as a control. We then analyzed the signature in Ingenuity Pathway Analysis. Results: Analysis of CLL cell samples identified T cell exhaustion signaling as our top canonical pathway. IL2, IL5, and TGFB1 were top upstream regulators. We found upregulation of PDL1, CTLA4, and Lag3, known markers for immunosuppressive B cells. FMOD, which sequesters TGFB, was also upregulated along with molecules that modulate BCR signaling such as MIR155HG. EBF1, required for B cell differentiation, and the co-stimulatory molecule CD80 were downregulated. Analysis of progressing CLL versus stable CLL highlighted metabolic changes. S-adenosyl-L-methionine biosynthesis, methionine degradation to homocysteine, cysteine biosynthesis, and acetate conversion to acetyl-CoA were top canonical pathways. No difference was seen in PDL1, CTLA4, and Lag3 expression but EBF1 was upregulated. Lastly, our T cell analysis demonstrated NFAT in regulation of the immune response as the top canonical pathway. Conclusions: Our results reinforce the promise immunotherapy can have in treatment of CLL and suggests more aggressive cases of CLL are a function of metabolic changes as opposed to differences in immune escape. We also suggest a role of NFAT in T cell exhaustion in the context of CLL.

e13048 Background: Hurthle Cell Carcinoma (HCC), a variant of follicular thyroid carcinoma, is a rare form of thyroid cancer. Though it accounts for 3-10% of thyroid cancer cases, very little is known about its pathogenesis. While HCC holds good survival rates, it is still vital to understand the pathogenesis of HCC in order to further optimize treatment protocols. Methods: We tagged 46 HCC samples and 90 healthy thyroid samples as a control. Gene signatures were analyzed in Ingenuity Pathway Analysis, using statistical significance p < 0.05 and absolute log ratio > 0.5 between disease and controls. Methods: Search Tag Analyze Resource was employed to conduct meta-analysis using the National Center for Biotechnologys Gene Expression Omnibus to define HCC pathogenesis. Results: Hepatic fibrosis, hepatic stellate cell activation and retinoic acid receptor (RAR) activation were the top canonical activators associated with HCC. Of the molecules involved, Defensin Beta 1 (DEFB1), Lipocalin-2 (LCN2), Aldehyde Dehydrogenase 1 Family Member A3 (ALDH1A3), and CDC28 Protein Kinase Regulatory Subunit 2 (CKS2) had the highest associations with HCC. The most down-regulated molecules were Hemoglobin Subunit Beta (HBB), Hemoglobin Subunit Alpha 1 and 2 (HBA1/HBA2), Cellular Retinoic Acid Binding Protein 1 (CRABP1), and BH3-Interacting Domain-Containing Protein 3 (HRK). Conclusions: These results suggest that there are a variety of factors at play regarding the development of HCC. Defensins are peptides made by neutrophils, however DEFB1 is specifically known for its ability to resist bacterial growth on epithelial surfaces, playing a major role in innate immunity. LCN2 is also known for resisting growth on surfaces and does so by sequestering iron-containing siderophores, thus effectively stopping growth of microorganisms. Additionally, ALDH1A3 and CRABP1 are associated with RAR activation. While the exact pathogenesis of HCC is not well known yet, we demonstrate that the two most up-regulated factors in HCC are strongly involved in innate immunity. This suggests that the dysfunction of innate immunity may play a vital role in the neoplastic pathogenesis of HCC.

Based mainly on the newspaper articles and published speeches of Canadian politicians, this article deals with the anticommunist measures undertaken in Quebec during the time of Maurice Duplessis‟ second mandate as Prime Minis-ter, after the Second World War. Located far from the real communist threat, Quebec theoretically had no need to organ-ize the anti-comminist hunt. However, it was launched and lasted until Duplessis‟ death in 1959. It should be noted that prosecutions of communists, socialists and other potentially “dangerous” groups started in 1930s with police raids and persecution of radical or ethnic groups potentially threatening national security of Canada. In 1940s the relationship of Ca-nadian government with the socialist republic remained tense, even though the Soviet Union joined the Allied powers. Ra-pidly growing gap between the East and the West after the end of the Second World War demanded stern policy aimed at neutralization of the “Red Scare”. The article analyses the causes and political strategies at the root of such measures as well as the nature of the Quebec‟s society throughout this pe-riod. Quebec authorities, especially Maurice Duplessis, had a strong fear of communism even after Khrushchev had voiced his doctrine of peaceful co-existence. Never ending struggle with communists was held in order to preserve national iden-tity and traditional institutions. Anticommunism turned into a policy was also used as a process of social regulation and a means of bringing under control any political challenges po-tentially compromising for the established order.

It is unequivocal that a wide variety of incentives can motivate behavior. However, few studies have explicitly examined whether and how different incentives are integrated in terms of their motivational influence. The current study examines the combined effects of monetary and liquid incentives on cognitive processing, and whether appetitive and aversive incentives have distinct influences. We introduce a novel task paradigm, in which participants perform cued task-switching for monetary rewards that vary parametrically across trials, with liquid incentives serving as post-trial performance feedback. Critically, the symbolic meaning of the liquid was held constant (indicating successful reward attainment), while liquid valence was blocked. In the first experiment, monetary rewards combined additively with appetitive liquid feedback to improve subject task performance. Aversive liquid feedback counteracted monetary reward effects in low monetary reward trials, particularly in a subset of participants who tended to avoid responding under these conditions. Self-report motivation ratings predicted behavioral performance above and beyond experimental effects. A follow-up experiment replicated the predictive power of motivation ratings even when only appetitive liquids were used, suggesting that ratings reflect idiosyncratic subjective values of, rather than categorical differences between, the liquid incentives. Together, the findings indicate an integrative relationship between primary and secondary incentives and potentially dissociable influences in modulating motivational value, while informing hypotheses regarding candidate neural mechanisms.

Membrane proteins mediate processes that are fundamental for the flourishing of biological cells. Membrane-embedded transporters move ions and larger solutes across membranes; receptors mediate communication between the cell and its environment and membrane-embedded enzymes catalyze chemical reactions. Understanding these mechanisms of action requires knowledge of how the proteins couple to their fluid, hydrated lipid membrane environment. We present here current studies in computational and experimental membrane protein biophysics, and show how they address outstanding challenges in understanding the complex environmental effects on the structure, function, and dynamics of membrane proteins. © 2015, Springer Science+Business Media New York.

Purpose: To determine brachytherapy implant dosimetry differences between biochemical failures and matched non‐failures based on prostate, annular margins, and various sectors. Materials and Methods: Nineteen hormone‐naive men with a planning target volume (PTV) day 0 D90 > 100% of Rx and V100 > 90% were biochemical failures after brachytherapy. They were matched to dosimetrically equivalent non‐failures on a 1:4 basis. Patients were also matched in terms of type of therapy, Gleason score, PSA, clinical stage, % positive biopsy, and year of implant. Implants were between 1995 and 2006 and had at least 3 years of follow‐up. The prostate and PTV were drawn prior to initial post‐implant dosimetry. For this study, the PTV was divided into sectors, and the prostate and annulus between the prostate and PTV were analyzed separately. Results: Using conditional logistic regression, there was no significant difference in D90 or V100 between failures and controls in terms of either 12 prostate or annular sectors. The lowest dose was in the anterior superior annulus, with mean D90 = 90.7% ± 15.6% and mean V100 = 75.6% ± 19.2%. All other annular sectors had D90 >108% and V100 > 90%. Four‐fold radial combinations of sectors into superior, medial and inferior regions showed no dosimetric difference between failures and controls. Three‐fold longitudinal combinations of sectors into anterior, posterior, and left and right lateral regions also found no dosimetric differences. The anterior region was the coolest and the lateral regions the hottest. Overall annular dosimetry had mean D90 = 116.8% ± 14.8% and mean V100 = 95.1% ± 3.9% Conclusion: There were no significant dosimetric differences between biochemical failures and controls in terms of prostate, annular margins or any of 12 sectors and various sector combinations analyzed. In a population with good dosimetry,dosimetry was inadequate to explain biochemical failure.

Purpose: To analyze the ProQura database in terms of patient implant sequence number for each institution to determine evidence for a dosimetric learning curve. Materials and Methods: In the ProQura database there are 4,614 patients with postimplant dosimetry implanted at 56 institutions between June 1999 and September 2005. The the mean preimplant prostate volume was 34.5 ± 10.7 cm3, and the mean and median days between implant and postimplant CT scan was 30.4 ± 14.0 and 30 days, respectively. I‐125 seeds were used in 3,071 patients, and Pd‐103 seeds were used in 1,543 patients. Results: The mean V100 was 88.9% ± 8.6% volume and the mean D90 was 101.9% ± 15.1% of the prescribed dose. When analyzed in terms of patient sequence number within each institution, the mean V100 for the first 10 patients was 87.3% ± 9.6% volume, while for the second 10‐patient cohort for each institution, the mean V100 was 88.6% ± 10.1% volume (p = 0.036). Similarly, the mean D90 for the first 10 patients was 98.9% ± 16.8% prescribed dose, while for the second cohort of ten patients the mean D90 was 102.2% ± 16.1% of prescribed dose (p = 0.001). There was little further change in V100 or D90 for subsequent 10 patient institutional groupings of patient sequence numbers. Therefore, the first cohort had a significantly lower V100 and D90 than all subsequent cohorts. The mean monotherapy seed activity per prostate volume was 0.94 ± 0.19 mCi/cm3 for I‐125 and was 4.51 ± 0.94 mCi/cm3 for Pd‐103. The specific monotherapy seed activity fluctuated between cohorts but reached a nadir in the seventh cohort at 0.92 ± 0.18 mCi/cm3 for I‐125 and 4.33 ± 0.87 mCi/cm3 for Pd‐103. Conclusion:Dosimetric quality parameters V100 and D90 improve with experience and approach a plateau after 20 – 30 patients.

Purpose: Recent studies have suggested that extracapsular permanent prostate brachytherapytreatment margins correlate with biochemical control. It is likely that volumetric dosimetric parameters will be more robust than selected radial measurements. We evaluated the impact of extracapsular volumetric dosimetric parameters on biochemical control in low‐risk patients. Materials and Methods: 263 consecutive low‐risk prostate cancer patients randomized to Pd‐103 versus I‐125 were implanted with a brachytherapy target volume consisting of the prostate with a 5 mm periprostatic margin. The median follow‐up was 4.2 years. All patients were implanted at least 3 years prior to analysis. Within 2 hours of implantation, an axial CT was obtained for post‐implant dosimetry. A 5 mm 3‐dimensional periprostatic annulus was constructed around the prostate gland and evaluated in its entirety and in 90° segments. Dosimetric parameters for the prostate gland and the annulus consisted of V100/150/200 and D90. Biochemical progression‐free survival was defined by a PSA ⩽ 0.5 ng/mL. Results: Mean postoperative dosimetry was significantly different (p < 0.001) between I‐125 versus Pd‐103, respectively, for V100 of 97% versus 93% and D90 of 122% versus 112%. Annulus dosimetry was significant (p < 0.001) for a V100 of 80% versus 70% and a D90 of 91% versus 85% for I‐125 versus Pd‐103, respectively. Six‐year biochemical progression‐free survival was 99.6% versus 99.2% for I‐125 versus Pd‐103 (p = 0.125). The most recent median post‐treatment PSA was 0.1 ng/mL and < 0.04 ng/mL for I‐125 and Pd‐103. Biochemically disease‐free patients had statistically higher prostate and annular dosimetric values. In Cox regression analysis, variants of annulus dosimetry were the best predictors for biochemical control in the I‐125, Pd‐103, and overall cohorts. Conclusions: A postimplant 5 mm 3‐dimensional periprostatic annulus provides substantial information regarding dosimetric coverage and appears to be an important predictor for biochemical outcome in low‐risk patients.

Purpose: To evaluate the relationship between post-prostate brachytherapy urinary morbidity and urethral doses calculated at the base, mid-prostate, apex and urogenital diaphragm. Method and Materials: 186 consecutive patients with no history of transurethral resection underwent monotherapeutic prostate brachytherapy (no external beam radiation or androgen deprivation) with urethral sparing techniques (average urethral dose 100–140% of prescribed dose). The median follow-up was 45.5 months. Urinary morbidity was defined by time to International Prostate Symptom Score (IPSS) resolution, maximum increase in IPSS, catheter dependency, and the need for postimplant surgical intervention. An α-blocker was initiated approximately 2 weeks prior to implantation and continued until the IPSS returned to baseline. Evaluated parameters included overall urethral dose, doses to the base, mid-prostate, apex and urogenital diaphragm, patient age, clinical T-stage, preimplant IPSS, ultrasound volume, isotope, D90 and V100/150/200. Results: Of the 186 patients, 176 had the urinary catheter permanently removed on the day zero and only 1 patient required a urinary catheter > 5 days. No patient developed a urethral stricture, and only two patients required a postbrachytherapy TURP. For the entire cohort, mean IPSS peaked 2 weeks following implantation, and the median time to IPSS resolution of 3 weeks. For the entire cohort, only isotope predicted for IPSS resolution, while neither overall average prostatic urethra nor segmental urethral dose predicted for IPSS resolution. The maximum postimplant IPSS increase was best predicted by preimplant IPSS and the maximum apical urethral dose. Conclusion: With the use of prophylactic α-blockers and adherence to urethral sparing techniques, urethral dosimetry did not improve the ability to predict urinary morbidity. Neither the average dose to the prostatic urethra nor urethral doses stratified into base, mid-prostate, apex, and urogenital diaphragm segments predicted for IPSS normalization. Radiation doses of 100–140% mPD are well tolerated by all segments of the prostatic urethra.

Purpose: To evaluate the relationship between pretreatment post-void residual urine (PVR) 3 days. In multivariate analysis, pretreatment PVR predicted for clinically irrelevant differences in IPSS resolution and did not influence catheter dependency. To date, no patient has required postimplant surgical intervention. Conclusion: The selection of patients with a pretreatment PVR urine 3 day) catheter dependency, and the elimination of post-brachytherapy surgical intervention for bladder outlet obstruction.

Purpose: To determine the incidence and to identify clinical, treatment and dosimetric parameters associated with the development of urethral strictures following permanent prostate brachytherapy.Method and Materials: From April 1995 through May 2003, 1186 consecutive patients underwent permanent prostate brachytherapy for clinical stage T1b‐T3a NxM0 (2002 AJCC) prostate cancer. Nine hundred and twelve patients (76.9%) were implanted with Pd‐103 and 204 (23.1%) with I‐125. The median follow‐up was 4.3 years. Follow‐up was calculated from the date of implantation. Clinical, treatment and dosimetric parameters evaluated for bulbomembranous urethral strictures included patient age, prostate volume, the use of supplemental XRT, isotope, androgen deprivation therapy (ADT), duration of ADT, prostate V100/150/200, D90, prostatic urethral dose (mean, median and maximum), bulbomembranous urethral dose (mean, median and maximum), tobacco use, hypertension, diabetes and BMI. Results: Twenty‐nine patients developed brachytherapy‐induced strictures and all occurred within the first 5 years following brachytherapy. All strictures involved the bulbomembranous urethra. The 9‐year actuarial risk of bulbomembranous urethral strictures was 3.6% with a median time to development of 34 months. The radiationdose to the bulbomembranous urethra was significantly greater in patients with strictures than those without (p 6 months) predicted for the development of a urethral stricture. All patients were successfully managed by either a urethral dilatation or internal optical urethrotomy. Conclusion: Brachytherapy‐related urethral strictures are related to overaggressive implantation of the periapical region and prolonged (> 6 months) treatment with ADT. Careful attention to preplanning and intraoperative execution, along with the judicious use of ADT, is essential to minimize the incidence of brachytherapy‐related strictures.

Purpose: To evaluate the influence of perineural invasion (PNI) in the biopsy specimen on biochemical progression‐free survival in hormone naive prostate brachytherapy patients. Method and Materials: From 1995 through 2001, 512 consecutive hormone naive patients (173 low‐risk, 212 intermediate risk, and 127 high‐risk) underwent permanent brachytherapy for clinical stage T1b‐T2c NxM0 prostate cancer. All patients underwent brachytherapy at least 3 years prior to analysis. The median follow‐up was 5.3 years. Biochemical progression‐free survival was defined by a PSA cutpoint ⩽ 0.4 ng/mL after nadir and by the ASTRO consensus definition. PNI was defined as carcinoma tracking along or around a nerve within the perineural space. Clinical, treatment and dosimetric parameters evaluated for biochemical progression‐free survival included PNI, age, PSA, Gleason score, percent positive biopsies, prostate volume, brachytherapy planning volume, V100/150/200, D90, supplemental external beam radiation therapy, tobacco consumption, BMI, hypertension and diabetes. Results: PNI was documented in 133 patients (26.0%). Regardless of which biochemical progression‐free definition was used, 94.0% and 94.9% of patients with and without PNI remained free of biochemical progression. The median time to failure in patients with and without PNI was 17.2 months and 17.9 months respectively. For the entire biochemically disease‐free cohort, the median post‐treatment PSA was < 0.1 ng/mL. In univariate Cox regression analysis, pretreatment PSA, percent positive biopsies, prostate volume and Gleason score predicted for biochemical outcome. PNI did not approach statistical significance (p = 0.671). In multivariate analysis, only pretreatment PSA (p < 0.001) and percent positive biopsies (p < 0.001) maintained statistical significance. Conclusion: In hormone naive brachytherapy patients implanted with generous periprostatic treatment margins, the presence of PNI in the biopsy specimen did not adversely impact 8‐year biochemical progression‐free survival. PNI is not an independent indicator for ADT in prostate brachytherapy patients.

Purpose: To evaluate the influence of isotope and prostate size on International Prostate Symptom Score (IPSS) normalization, catheter dependency and the need for surgical intervention following permanent prostate brachytherapy.Method and Materials: 976 consecutive patients underwent permanent brachytherapy for clinical stage T1b‐T3a prostate cancer. Of these, 789 were implanted with Pd‐103 and 187 with I‐125. Patients were stratified into size cohorts ⩽ 25.0 cm3, 25–35 cm3, 35–45 cm3, and > 45.0 cm3. 418 received androgen deprivation therapy (ADT). 486 received supplemental external beam radiation therapy (XRT). In all patients, an α‐blocker was initiated prior to implantation and continued until the IPSS returned to baseline. The median number of IPSS determinations per patient was 21. Clinical, treatment and dosimetric parameters evaluated included patient age, pretreatment PSA, Gleason score, clinical T‐stage, percent positive biopsies, preimplant IPSS, ultrasound volume, planning volume, isotope, V100/150/200, D90, urethral dose, supplemental XRT, ADT, and the duration of ADT (⩽ 6 months versus > 6 months). Results: For both isotopes and all size cohorts, IPSS peaked 1 month following implantation and returned to baseline at a mean of 1.9 months. Stratification of prostate size cohorts by isotope resulted in no significant differences in prolonged catheter dependency, IPSS resolution or postimplant surgical intervention. In Cox regression analysis, IPSS normalization was best predicted by preimplant IPSS, XRT and any need for a catheter following brachytherapy. Catheter dependency correlated with prostate volume, while the need for surgical intervention was related to catheter dependency, maximum urethral dose, ADT and maximum IPSS increase. Conclusion: When stratified by prostate size, the choice of isotope did not impact IPSS resolution, catheter dependency or the need for postbrachytherapy surgical intervention. While prostate size did predict for short‐term (< 5 day) catheter dependency, it did not influence IPSS resolution or the need for surgical intervention.

Purpose: Biochemical outcome in Gleason score 7 patients with dominant pattern 4 histology is thought to be inferior to those Gleason score 7 patients with primary Gleason grade 3, based on conclusions from radical prostatectomy studies. In this study, we evaluate the effect of the dominant histologic pattern in Gleason score 7 prostate cancer on biochemical progression-free survival following prostate brachytherapy. Method and Materials: 273 consecutive Gleason score patients underwent permanent interstitial brachytherapy for prostate cancer without androgen deprivation therapy. All patients underwent brachytherapy more than 3 years prior to analysis. Biochemical progression-free survival was defined by a PSA cutpoint ⩽ 0.4 ng/mL after nadir or by the ASTRO consensus definition. The median follow-up was 4.7 years. Clinical, treatment and dosimetric parameters evaluated for biochemical progression-free survival included primary Gleason grade, clinical T-stage, pretreatment PSA, risk group, percent positive biopsies, perineural invasion, patient age, isotope, supplemental XRT, prostate volume, brachytherapy planning volume, the percent of the target volume receiving 100%, 150%, and 200% of the prescribed dose (V100/150/200), the minimum percent of the prescribed dose covering 90% of the target volume (D90), tobacco consumption, hypertension and diabetes. Results: The actuarial 8-year biochemical progression-free survival rate was 94.5% and 94.8% using either a PSA cutpoint ⩽ 0.4 ng/mL after nadir or the ASTRO consensus definition, respectively. For biochemically disease-free patients, the median posttreatment PSA was < 0.1 ng/mL. When stratified by the dominant histologic pattern, no statistical difference in outcome was noted for any of the evaluated parameters. In forward conditional Cox regression analysis, pretreatment PSA and percent positive biopsies were statistically significant predictors of biochemical outcome. Conclusion: In hormone naive Gleason score 7 patients, prostate brachytherapy results in a high probability of 8-year biochemical progression-free survival and is independent of Gleason 3+4 versus 4+3 histology.

Panose (O-α-D-glucosyl-(16)-O-α-D-glucosyl-(14)-α-D-glucose) and maltose (O-α-D-glucosyl-(14)-α-D-glucose) coupled to bovine serum albumin (BSA) by means of an azophenyl linkage provided the synthetic antigens panosyl-BSA and maltosyl-BSA, used to examine the anti-hapten specificity of rabbit sera prepared against panosyl-BSA. The combining site specificity of cross-reactive antibodies in carrier-absorbed anti-panoside sera was investigated by quantitative hapten inhibition of maltosyl BSA-anti-panoside cross-precipitation and compared with data obtained by inhibition of homologous precipitation. Immunochemical data obtained demonstrate a heterogeneity in the combining site specificity of anti-hapten produced in response to panosyl-BSA and establish the occurrence of at least two distinct kinds of antibody directed against the α-(16)-α-(14) sequence of glucose units. One type of anti-panoside, inhibited more effectively by isomaltose than by maltose, shows isomaltose end group immunodominance. A second type of anti-panoside, cross-precipitated by maltosyl-BSA and more effectively inhibited by maltose than by isomaltose, shows maltose immunodominance.

Panosyl-BSA, a synthetic sugar-azoprotein conjugate consisting of the trisaccharide panose (glucosyl α-(1,6)-glucosyl-α(1,4) glucose) coupled to bovine serum albumin by an azphenyl linkage, cross precipitates antibody from types II and XX antipneumococcal horse sera. Hapten inhibition indicates that these cross reactions of synthetic antigen are mediated by the α-isomaltosyl moiety of the introduced panosyl haptenic grouping. While interaction of conjugate with horse anti-XX involves a fraction of antibody directed against an α-isomaltosyl end group, interaction with horse anti-II involves a fraction of antibody directed against the α-isomaltosyl end group. Purified fractions of antibody, cross reactive with panosly-BSA were specifically from antipneumococcal horse sera and their behavior with homologous antigen examined and compared with unfractionated serum.

Plasma glutathione peroxidase (GSHPx) (glutathione: H2O2 oxidoreductase) is a unique selenoglycoprotein. Treatment of this enzyme with glycopeptidase F partially deglycosylates it and establishes the presence of N-linked sugar moieties. Antibodies raised in a rabbit against the purified enzyme from plasma were found to be specific, noninhibitory, and capable of precipitating the enzymatic activity. The antibodies precipitated greater than 90% of the GSHPx activity of normal plasma, thus indicating that the selenoenzyme is the main if not the sole GSHPx activity of plasma. The antibodies did not precipitate RBC GSHPx. A slight cross-reactivity of the antibodies was found with rat plasma GSHPx. A GSHPx activity precipitation assay of normal plasma in the presence of selenium (Se)-deficient plasma indicates that no cross-reactive protein in the Se-deficient plasma interferes with the precipitation of the GSHPx activity from normal plasma. Thus, GSHPx protein as well as activity is deficient in plasma in the absence of Se. Antibodies against GSHPx either from RBCs or from plasma were used to specifically immunoprecipitate most of the GSHPx activity from RBCs or plasma, respectively, in healthy individuals to determine the amount of Se associated with the protein. GSHPx accounts for approximately 15% of the Se in RBCs and 12% of the Se in plasma. Thus, in normal individuals, these proteins account for only a fraction of plasma and RBC Se.