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In this report, we summarized the clinicopathologic features of 9 cases of plasmacytoid transitional cell carcinoma (TCC) of the urinary bladder, a rare variant of TCC. All 9 patients were men with a mean of age 64.3 years (range, 46 to 81 y). All but 1 patient presented with gross hematuria; the remaining patient had urgency and microscopic hematuria. Cystoscopic findings revealed a dominant solid mass with surrounding multiple papillary lesions in 6 cases and multiple masslike lesions in 3 other cases. The initial diagnosis of plasmacytoid TCC was made on transurethral resection in 8 cases and cystoscopic biopsy in 1. One patient had TNM stage I disease, 2 had stage II disease, 3 had stage III disease, and 3 had stage IV disease. Four patients were treated by radical cystectomy with chemotherapy, 2 by radical cystectomy alone, 1 each by chemotherapy or intravesical bacillus Calmette-Guerin infusion alone, and 1 did not receive any further therapy. Microscopically, all tumors contained plasmacytoid cells, which composed 30% to 100% of the entire tumor. Eight of 9 cases were associated with high-grade TCC, and transitional cell carcinoma in situ was present in 4 cases. The plasmacytoid tumor cells were characterized by eccentrically located nuclei and abundant eosinophilic cytoplasm. Interestingly, plasmacytoid transitional cell carcinoma in situ was noted in 1 case. Immunohistochemical staining demonstrated that both plasmacytoid and conventional TCC components were positive for cytokeratins 7 and 20. The mean Ki-67 labeling index was 30% (range, 10% to 50%), and p53 expression in the majority of cases was low (5% to 10%), except for in 2 cases (70% and 80%). The mean follow-up in 8 patients was 24.5 months (range, 5 to 47 mo); the other patient was lost to follow-up. Five patients died of disease from 5 to 36 months, 2 patients were alive with disease at 30 and 47 months, and 1 patient was alive and well at 36 months with no evidence of disease. In summary, plasmacytoid TCC tends to present at an advanced stage and to have a poor prognosis. Morphologic recognition and distinction from other plasmacytoid malignant neoplasms is critical for its clinical management and immunohistochemical studies may be required for differential diagnosis.

Importance While poorer populations have more eye problems, it is not known if they face greater difficulty obtaining eye care appointments. Objective To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid and private insurance. Design In this prospective observational study, researchers telephoned a randomly selected sample of vision care providers in Michigan and Maryland stratified by neighborhood (urban vs. rural) and provider type (ophthalmologist vs. optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye exam and a child requesting a routine eye exam for a failed vision screening. Researchers called each practice twice, approximately 2–7 days apart, once requesting an appointment for a patient with Medicaid, and the other for a patient with BlueCross BlueShield (BCBS), and asked if 1) the insurance was accepted, and if so, 2) when the earliest available appointment was. Setting Eye clinics throughout Maryland and Michigan. Participants Random sample of 330 ophthalmology and optometry practices. Main Outcomes and Measures Rate of successfully made appointments and mean wait time for the first available appointment. Results A total of 330 eye care providers were contacted. The sample consisted of ophthalmologists (50%) and optometrists (50%) located in Maryland (53%) and Michigan (47%). The rates of successfully obtaining appointments among callers said to have Medicaid and BCBS were 62% [56%,67%] and 79% [75%,84%] (p<0.001), respectively, for adults, and 45% [40%,51%] and 63% [57%,68%] (p<0.001), respectively, for children. Mean wait time did not vary significantly between BCBS and Medicaid for both adult and child. Factors associated with decreased odds of obtaining an appointment for adults and children included Medicaid insurance, appointment with an ophthalmologist and practice location in Maryland. Conclusions and Relevance Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, though confounding factors may have also contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease healthcare spending in the long term.

IMPORTANCEChildren with strabismus have poorer functional vision and decreased quality of life than those without strabismus.OBJECTIVE To evaluate the association between strabismus and mental illness among children. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study analyzed claims data from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, from 12 005 189 patients enrolled in the health plan between January 1, 2007, and December 31, 2017. Eligibility criteria included age younger than 19 years at the time of strabismus diagnosis, enrollment in the health plan between 2007 and 2018, and having at least 1 strabismus claim based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes. Controls were children in the same database with no eye disease codes other than refractive error reported. Demographic characteristics and mental illness claims were compared. Statistical analysis was conducted from December 1, 2018, to July 31, 2021. MAIN OUTCOMES AND MEASURES Presence of mental illness claims.RESULTS Among the 12 005 189 patients (6 095 523 boys [50.8%]; mean [SD] age, 8.0 [5.9] years) in the study, adjusted odds ratios for the association of mental illnesses with strabismus were 2.01 (95% CI, 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59-1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and 0.99 (95% CI, 0.97-1.02) for substance use disorder. There was a moderate association between each strabismus type (esotropia, exotropia, and hypertropia) and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder; odds ratios ranged from 1.23 (95% CI, 1.17-1.29) for the association between esotropia and bipolar disorder to 2.70 (95% CI, 2.66-2.74) for the association between exotropia and anxiety disorder.CONCLUSIONS AND RELEVANCE This cross-sectional study suggests that there was a moderate association between strabismus and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder but not substance use disorder. Recognizing that these associations exist should encourage mental illness screening and treatment for patients with strabismus.

Hypothesis: Magnetic vestibular stimulation (MVS) elicits nystagmus in C57BL/6J mice but not head tilt mice lacking Nox3, which is required for normal otoconial development. Background: Humans have vertigo and nystagmus in strong magnetic fields within MRI machines. The hypothesized mechanism is a Lorentz force driven by electrical current entering the utricular neuroepithelium, acting indirectly on crista hair cells via endolymph movement deflecting cupulae. We tested an alternate hypothesized mechanism: Lorentz action directly on crista hair cell stereocilia, driven by their currents independent of the utricle. Methods: Before MVS, vestibulo-ocular reflex (VOR) responses of 8 C57BL/6J mice and 6 head tilt mice were measured during whole-body sinusoidal rotations and tilts using video-oculography. Mice were then placed within a 4.7 Tesla magnetic field with the horizontal semicircular canals approximately Earth-horizontal for ≥1 minute in several head orientations, while eye movements were recorded via infrared video in darkness. Results: Outside the magnet, both C57BL/6J and head tilt mice had intact horizontal VOR, but only C57BL/6J mice exhibited static counter-roll responses to tilt (normal utiruclo-ocular reflex). When placed in the magnet nose-first, C57BL/6J mice had left-beating nystagmus, lasting a median of 32.8s. When tail-first, nystagmus was right-beating and similar duration (median 28.0s, p>0.05). In contrast, head tilt mice lacked magnetic field-induced nystagmus (p<0.001). Conclusions: C57BL/6J mice generate nystagmus in response to MVS, while mice deficient in Nox3 do not. This suggests (1) a normal utricle is necessary, and (2) functioning semicircular canals are insufficient, to generate MVS-induced nystagmus in mice.