BACKGROUND The morbidity of papillary thyroid carcinoma (PTC) is primarily related to locoregional recurrences and distant metastases. The definition of minimal extrathyroidal extension (mETE) has been recently revised. The presence of mETE does not impact mortality and is generally not thought to be a predictor for risk of recurrence. This study aimed at comparing risk of recurrence and response to therapy of PTC with mETE and gross ETE into the strap muscles (gETE) to low- and intermediate-risk PTC without ETE (low w/o ETE and intermediate w/o ETE) to further characterize the impact of ETE on outcomes. METHODS 596 PTCs were analyzed according to degree of ETE and other predictors of recurrence. Four groups of patients were compared, low w/o ETE (n=251), intermediate w/o ETE (n=89), mETE (n=191) and gETE (n=65), to determine the risk of recurrence and the response to treatment. Cox proportional hazards models were used to investigate associations between groups and disease-free survival (DFS). RESULTS The rinounced impact on the recurrence risk, and is associated with a worse response to therapy, mETE may not be associated with a low risk of recurrence and should be followed, in part, as an intermediate risk carcinoma.BACKGROUND Decreased lean muscle mass in the lower extremity in diabetic peripheral neuropathy (DPN) is thought to contribute to altered joint loading, immobility, and disability. However, the mechanism behind this loss is unknown and could derive from a reduction in size of myofibers (atrophy), destruction of myofibers (degeneration), or both. Degenerative changes require participation of muscle stem (satellite) cells to regenerate lost myofibers and restore lean mass. Determining the degenerative state and residual regenerative capacity of DPN muscle will inform the utility of regeneration-targeted therapeutic strategies. METHODS Biopsies were acquired from 2 muscles in 12 individuals with and without diabetic neuropathy undergoing below-knee amputation surgery. Biopsies were subdivided for histological analysis, transcriptional profiling, and satellite cell isolation and culture. RESULTS Histological analysis revealed evidence of ongoing degeneration and regeneration in DPN muscles. Transcriptional profiliation clinicians. Identifying myofiber degeneration and compromised regeneration as contributors to dysfunction suggests that adjuvant cell-based therapies may improve clinical outcomes.Os paracuneiforme (OPC) is an extremely rare accessory bone located either medial to the medial cuneiform or to the naviculocuneiform joint. Although OPC often appears on the list of accessory ossicles, there are few reported cases regarding this bone. OPC can cause symptoms that require surgical intervention, but only 2 surgically treated cases have been published in the literature in English. Here, we report the case of a patient with painful OPC who was surgically treated. The patient showed no restriction in his daily living and recreational activities 6 months postoperatively. This is the first report showing not only preoperative and postoperative radiographs, but also preoperative CT images, photographs of intraoperative findings, and the resected ossicle. Level of Evidence Level V.OBJECTIVE To objectively assess the performance of graduating urology residents performing flexible ureterorenoscopy (fURS) using a simulation-based model and to set an entrustibility standard or benchmark for use across the educational spectrum. Dulaglutide Glucagon Receptor peptide METHODS Chief urology residents and attending endourologists performed a standardized fURS task (ureterorenoscopy & repositioning of stones) using a Boston Scientific© Lithovue ureteroscope on a Cook Medical© URS model. All performances were video-recorded and blindly scored by both endourology experts and crowd-workers (C-SATS) using the Ureteroscopic Global Rating Scale, plus an overall entrustability score. Validity evidence supporting the scores was collected and categorized. The Borderline Group method was used to set absolute performance standards for the expert and crowdsourced ratings. RESULTS A total of 44 participants (40 chief residents, 4 faculty) completed testing. Eighty-three percent of participants had performed over 50 fURS cases at the time of the study. Only 47.7% (mean score 12.6/20) and 61.4% (mean score 12.4/20) of participants were deemed ‘entrustable’ by experts and crowd-workers, respectively. The Borderline Group method produced entrustability benchmarks of 11.8/20 for experts and 11.4/20 for crowd-worker ratings, resulting in pass rates of 56.9% and 61.4%. CONCLUSION Using absolute standard setting methods, benchmark scores were set to identify trainees that could safely carry out flexible ureterorenoscopy in the simulated setting. Only 60% of residents in our cohort were rated as entrustable. These findings support the use of benchmarks to earlier identify trainees requiring remediation.BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. METHODS One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. RESULTS Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. CONCLUSION Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.