Background The Afirma gene expression classifier (GEC) is used to assess malignancy risk in indeterminate thyroid nodules (ITNs) classified as Bethesda category III/IV. Our objective was to analyze GEC performance at two institutions with high thyroid cytopathology volumes but differing prevalence of malignancy. Methods Retrospective analysis of all ITNs evaluated with the GEC at Memorial Sloan Kettering Cancer Center (MSK; n = 94) and Mount Sinai Beth Israel (MSBI; n = 71). These institutions have differing prevalences of malignancy in ITNs: 30–38 % (MSK) and 10–19 % (MSBI). Surgical pathology was correlated with GEC findings for each matched nodule. Performance characteristics were estimated using Bayes Theorem. Results Patient and nodule characteristics were similar at MSK and MSBI. The GEC-benign call rates were 38.3 % (MSK) and 52.1 % (MSBI). Of the GEC-benign nodules, 8.3 % (MSK) and 13.5 % (MSBI) were treated surgically. Surgical pathology indicated that all of GEC-benign nodules were benign. Of the GEC-suspicious nodules, 60.0 % (MSK) and 61.7 % (MSBI) underwent surgery. Positive predictive values (PPVs) for GEC-suspicious results were 57.1 % (95 % CI 41.0–72.3) at MSK and 14.3 % (95 % CI 0.2–30.2) at MSBI. The estimated negative predictive values (NPVs) were 86–92 % at MSK and 95–98 % at MSBI. Conclusions There were wide variations in the Afirma GEC-benign call rate, PPV, and NPV between MSBI (a comprehensive health system) and MSK (a tertiary referral cancer center), which had differing rates of malignancy in ITNs. The GEC could not routinely alter management in either institution. We believe that this assay would be expected to be most informative in practice settings where the prevalence of malignancy is 15–21 %, such that NPV >95 % and PPV >25 % would be anticipated. Knowing the prevalence of malignancy in ITNs at a particular institution is critical for reliable interpretation of GEC results.

Background Respiratory epithelial adenomatoid hamartomas (REAH) are benign nose neoplasms found in the nasal cavity and sinuses. Symptoms include anosmia, nasal obstruction, facial pressure, and rhinorrhea. Although previously thought to be rare, these tumors are being increasingly recognized on pathology in patients undergoing endoscopic sinus surgery. However, REAH is difficult to diagnose before surgery because it may mimic other entities, such as nasal polyps or inverted papilloma, and is often found incidentally only after surgery. Objective The aims of this study were to (1) add an additional case series of REAH to the literature, (2) report unique imaging findings on computed tomography and magnetic resonance imaging, and (3) pool and summarize all available data from existing publications. Methods Retrospective chart review from years 2004 to 2015 and a literature review Results Twenty-three cases were found in our case series, which included 12 men (52%) and 11 women (48%), with a mean age of 59 years. No cases were found before 2007. Lund-Mackay scores were comparable with those found in chronic rhinosinusitis without nasal polyposis. Imaging consistently demonstrated a discoid-shaped mass at the olfactory cleft. Fifty previous publications were found (4 prospective, 11 retrospective studies, 9 case series, 26 cases reports), which included 660 patients diagnosed with REAH. Pooled data revealed a mean age of 54 years (range, 9–86 years) and a male to female ratio of 3:2. Conclusion The results of our study further refined the average age at which REAH diagnosis occurs as 54 years old, although it may occur at any age. There is a clear male-to-female predominance (3:2). In addition, olfactory cleft widening and discoid soft tissue at the olfactory cleft are hallmark radiographic findings. The vast majority of published cases occurred during the past 4 years, which indicated increased recognition of REAH.

Objective: This study was conducted to determine whether the incidence of idiopathic sudden sensorineural hearing loss (ISSHL) varies throughout the year. Study Design: This study is a retrospective case review. Setting: This study was conducted at a tertiary referral center within a teaching hospital. Patients: Inclusion criteria were a diagnosis of ISSHL confirmed by audiometric data. Exclusion criteria were intracranial neoplasms, a history of Ménière's disease, previous ear procedures, chemotherapy, or radiation therapy to the head or neck. There was no exclusion criterion based on age. Ninetyseven patients met these criteria. The median age was 52 years (range, 26Y85 yr), and there were 53 (54.6%) women and 44 (45.4%) men. Main Outcome Measures: Monthly incidence counts were compiled across a 3-year period. Counts were analyzed for uneven incidence distributions and seasonal variation via standard statistical tests. Results: Overall, no evidence was found for an uneven distribution or for a peak either by W 2 ( p 9 0.1), which assesses for any uneven distribution, or by the circular mean ( p 9 0.1), which assesses for a pattern of seasonal variation. In the subset of patients (24 of 97; 24.7%) who reported experiencing an upper respiratory infection before or concurrent with the onset of ISSHL, no evidence was found for an uneven distribution of hearing loss onset throughout the year either by W 2 ( p 9 0.1) or by the circular mean ( p 9 0.1). Conclusion:The results of this study suggest that ISSHL incidence does not display uneven distribution throughout the year.

Cardiac arrest results in global hypoxic-ischemic brain injury from which there is a range of possible neurological outcomes. In most cases, patients may require a surrogate to make decisions regarding end-of-life care, including the withdrawal of life-sustaining therapies. This article reviews ethical considerations that arise in the clinical care of patients following cardiac arrest, including decisions to continue or withdraw life-sustaining therapies; brain death determination; and organ donation in the context of brain death and cardiac death (so-called non-heart-beating donation). This article also discusses ethical concerns pertaining to the design and conduct of resuscitation research that is necessary for the development of effective therapies to prevent anoxic brain injury or promote neurological recovery.