Accurate diagnosis of plasmacytoid urothelial carcinoma (PUC) is important given its poor prognosis and frequent presentation at high stage. We aim to assess the clinicopathologic features, molecular aberrations, and follow-up data in a series of PUC cases from a single tertiary cancer center. Seventy-two urinary bladder, ureteral, and renal pelvic specimens with urothelial carcinoma with plasmacytoid differentiation were identified. Immunohistochemical (IHC) stains were performed on 48 cases. Among urinary bladder origin markers, GATA3 was most sensitive (96%). Breast carcinoma markers (ER, mammaglobin) were usually negative, but PR stained 1 case (4%). Neuroendocrine markers CD56 and TTF-1 were each positive in 1 case (4% and 4%, respectively). Gastrointestinal adenocarcinoma marker CDX2 was positive in 4 cases (15%), but nuclear β-catenin was negative in all cases. CD138 was positive in 83% and e-cadherin expression was lost in 57% of cases. Fluorescence in situ hybridization (FISH) using the UroVysion Bladder Cancer Kit and FGFR3 mutational analysis using polymerase chain reaction (PCR) were performed on 15 cases; deletion of chromosome 9p21 was common (60%) and FGFR3 mutations were detected in 60% of cases (5 cases had both deletion 9p21 and FGFR3 mutations). Cases were divided into 3 morphologic groups: classic (29%), desmoplastic (35%), and pleomorphic (36%). The three morphologic subtypes had distinct survival outcomes (p=0.083), with median survival for all patients 18 being months versus 10 months for the desmoplastic group.

Objective: To determine the audiologic improvement after middle cranial fossa (MCF) approach to repair spontaneous cerebrospinal fluid (sCSF) leaks Study Design: Retrospective cohort study Setting: Tertiary referral center Patients: Twenty-four consecutive patients (27 ears) with temporal bone sCSF leak over a 4year period. Patient age, gender, ethnicity, body mass index (BMI), location of CSF leak, recurrence of CSF leak, and presence of encephalocele(s) were recorded. Intervention: Audiometric testing in patients undergoing MCF repair of temporal bone sCSF leak. Main Outcome Measures: Comparison of preoperative and postoperative pure tone average (PTA), air bone gap (ABG), and word recognition score (WRS) in the sCSF leak ear.Results: Out of 27 ears, 55% had multiple tegmen defects and 82% had ≥1 encephaloceles.There were no recurrent CSF leaks at a median follow up of 4 months. The mean (SD) preoperative PTA and ABG were 40.58 [15.67] dB and 16.44 [6.93] dB, respectively. There was significant improvement in mean PTA (10.28 [8.01] dB; p < 0.001; Cohen d=0.95) and ABG (9.31 [7.16] dB; P <0.001; Cohen d=0.88) after sCSF repair. Mean WRS improved (by 3.07 [6.11] %; p=0.024; Cohen d=0.46) from a mean preoperative WRS of 93.16 [9.34] % to a mean postoperative WRS of 96.26 [6.49] %.Conclusions: MCF approach for repair of sCSF leaks yields significant improvement in conductive hearing loss and is highly effective in management of the entire lateral skull base where multiple bony defects are often identified.

Background: Acute and chronic rhinosinusitis are debilitating diseases that affect from 5% to 16% of the population. YouTube is the second most commonly used search engine and is o en utilized by patients to garner health information regarding various disease processes and their respective management options. An evaluation of these information resources for quality and reliability is warranted, especially in an era in which patients are increasingly turning to audiovisual (A/V) media to educate themselves regarding their ailments. Methods:The YouTube video database was searched using the term "sinusitis" from its inception through to November 2018. The first 50 videos populated under the relevancebased ranking option were collected and parsed by time and language. Of the 50 videos, 10 were eliminated either for length (ࣘ1 minute or ࣙ20 minutes), language (any language other than English), and/or for later being removed by YouTube for copyright violations. The videos were then assessed using the Patient Education Materials Assessment Tool-Audio/Visual (PEMAT-A/V) by 2 independent reviewers for understandability and actionability. Results:A total of 40 videos were examined using the PEMAT-A/V tool. The average understandability score was 57.7%, whereas the average actionability score was 46.3%. Eleven videos (28%) had actionability scores of 0%. Videos most commonly addressed disease management options (38%). The second largest category was case presentations regarding surgical techniques (30%). There were only 6 videos focused primarily on education about the definition and common traits of sinusitis (15%). Conclusion:Our results show a paucity of high-quality online A/V educational material pertaining to sinusitis, with a majority of videos being neither understandable nor actionable. As patients increasingly turn to internet video databases like YouTube for medical information, it is critical that physicians and institutions create A/V material that is accurate, understandable, and actionable. C 2020 ARS-AAOA, LLC.

Prospective cohort study. Methods: A total of 12 otolaryngology residents were recruited to perform sinonasal surgery on the simulator followed by cadaveric heads. Resident performances were recorded and de-identified. Face and content validities were evaluated based on 5-point Likert scale questionnaires. The recordings were evaluated by extramural expert rhinologists based on a validated Global Rating Scale (GRS). These results were analyzed and compared to assess construct and concurrent validity. Results: The appearance of anatomic structures was rated as realistic by 75% of all participants, while only 30% and 41.7% rated the mucosal and bony tissues as realistic, respectively. A total of 91.7% of participants found the model useful for teaching anatomy, while 66.7% said it was useful for teaching operative technique. Construct validity was confirmed by showing significant differences in performance between the novice and experienced groups. Concurrent validity was confirmed by showing significant correlation between performance on the model and gold standard (i.e. cadaver head). Conclusions: This study demonstrates the face, content, concurrent, and construct validity of a 3D-printed SNSS. Although this model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents, improvements are required with respect to the quality of simulated mucosal tissue as well as the simulated anatomy of the frontoethmoid compartment

Introduction: Parents who make decisions about hypospadias repair for their child may seek information from online platforms such as YouTube. Objective:The purpose of this study was to evaluate the health literacy demand of hypospadias videos on YouTube using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). Study Design:We performed a YouTube search using the term "hypospadias," limiting results to the first 100 videos. We excluded videos that were < 1 minute or > 20 minutes and videos that were not in English or did not include subtitles. Two evaluators independently examined videos and determined PEMAT-A/V scores for understandability and actionability (i.e. ability to identify actions the viewer can take). Videos with scores >70% are understandable or actionable. The interrater reliability (kappa) and intra-class correlation coefficient (ICC) of PEMAT scores were calculated. Bivariate and multivariable linear regression models assessed the association of video characteristics with respective scores.