Objectives To assess outcomes following tympanoplasty for blast-induced tympanic membrane perforations in a military population. Study Design Case series with chart review. Setting Tertiary care medical centers. Subjects and Methods Military personnel (N = 254) undergoing tympanoplasty for blast-related tympanic membrane perforations sustained between April 2005 and July 2014 were identified from the Expeditionary Medical Encounter Database. Descriptive statistics were obtained regarding demographics, primary and revision surgery success rates, hearing status pre- and postsurgery, and frequency of ossicular reconstruction. Rates of successful perforation closure were assessed against perforation size and character (central vs marginal) and time to surgery. Rates and types of complications were additionally explored. Results There were a total of 352 operations among 254 subjects, with an 82.1% rate of successful closure following primary surgery. For successful primary tympanoplasty, the mean improvement in pure tone average was 11.7 ± 12.1 dB. Ossiculoplasty was performed in 9.1% (32 of 352) of cases. There was no significant relationship between successful perforation closure and perforation size, perforation character, or time between injury and surgery. Cholesteatoma complicated 4.3% (15 of 352) of cases. A significant relationship was identified between risk of cholesteatoma development and increasing perforation size and marginal perforations. Conclusion Tympanoplasty success rates for blast-induced tympanic membrane perforations are lower than for other common injury mechanisms. Due to appreciable rates of postoperative cholesteatoma development, close clinical surveillance is recommended.

Phosphorus (P) loading of soils from the repeated application of manure and the associated loss of P to water systems is a serious and increasing problem in today's agricultural landscape. The hypothesis of this study was that the application of mineral amendments to manure might reduce P availability in manure and soil without affecting crop productivity. An incubation experiment was conducted to evaluate the ability of aluminum sulfate, ferric chloride or calcium hydroxide at 100 and 200 g kg -1 of manure to reduce phytoavailable (Mehlich-3 extractable) P in liquid dairy, laying hen and broiler chicken manure. Mehlich-3 extractable P was reduced from 59 to 97% in all manure treated with aluminum sulfate and ferric chloride. The calcium hydroxide treatment resulted in a Mehlich-3 extractable P reduction ranging from −17 to 51%. A container experiment was then carried out to examine the effect of soil with pre-treated manure on timothy (Phelum pretense L.) growth and soil P levels. Timothy yields in all dairy manure treatments were 45-57% lower compared to an N-P-K control, but were not lower compared to the untreated manure control. Dairy manure + aluminum sulfate (200 g kg -1) reduced water-extractable P by 82% relative to the N-P-K control. All other manure and amendment treatment combinations were not statistically different from the N-P-K or the untreated soil controls in terms of water-extractable P, Mehlich-3 extractable P or grass yield. Significant reductions in Mehlich-3 extractable P were observed with the aluminum sulfate or ferric chloride amendments, while varied results were observed with the calcium hydroxide amendment. Results suggest that the use of manure amended with aluminum sulfate or ferric chloride has little effect on growth or P accumulation by timothy. Overall, this study demonstrated that mineral pre-treatment of manure can reduce the extractable P content of the manure and soil without negative effects on plant growth.

Despite the advances in early diagnostics and therapeutics, women with metastatic breast cancer have limited treatment options. Women with TNBC, who constitute 15-20% of breast cancer patients, are often diagnosed with aggressive/metastatic disease. Advanced studies implicated immunosuppressive tumor microenvironment (TME) in aggressive/metastatic properties of TNBC subtype. Alternatively activated immature myeloid cells including tumor-associated macrophages (TAM), tumor-associated neutrophils (TAN), tumor-associated dendritic cells (TADC) and myeloid derived suppressor cells (MDSC) constitute a major component of TME. However, anti-tumorigenic microenvironment is also reported and that may have clinical relevance in early TNBC patients. Therefore, our hypothesis is that myeloid cells polarize to become immunosuppressive and infiltrate tumors and pre-metastatic niches in patients with advanced disease, while patients with early TNBCs may elicit anti-tumor immune response eliminating disseminated tumor cells (DTC). The utilization of syngeneic immunocompetent mouse models has contributed to our current understanding of immunosuppressive or immunomodulatory TME. Using these models, we have demonstrated that tumor dissemination and growth at metastatic sites is facilitated by MDSC’s. Emerging technologies; single cell RNA sequencing (scRNA-Seq), mass cytometry (CyTOF) or cellular indexing of transcriptomes and epitopes sequencing (CITE-Seq) has been powerful platforms for detailed characterization of tumors and TME compartments. We performed scRNA-Seq and CyTOF analyses of the myeloid cell populations of tumors and spleens from metastatic 4T1 and non-invasive EMT6 tumor-bearing mice. Tumors and spleens from 4T1 tumor-bearing mice exhibited a marked expansion of myeloid cell subsets that are characterized by the expression of immunosuppressive as well as progenitor markers. On the contrary, indicated tissues from EMT6 mice were enriched in NK cells, T and B lymphocytes and they were lacking immunosuppressive myeloid cell subsets. Furthermore, we identified a distinct differentiation pattern of immature myeloid cell subsets from neutrophil progenitors (NP) in 4T1 tumor-bearing mice. Using the murine TNBC models in syngeneic mice, we provide evidence that early TNBC tumors may elicit anti-tumor immune responses and thus the survival outcome in those patients is substantially increased after complete surgical resection of the primary tumors. Whereas immunosuppressive tumor microenvironment contributes to the poor overall survival in patients with advanced TNBCs. Therefore, identifying an anti-tumor immune signature in early TNBC patients may be utilized as a clinical biomarker before surgical intervention as well as improve the survival outcome. Citation Format: Fulya Alkan, Justin D. Wilson, Nika Shekastehband, Catherine HEDRICK, Alicia Arnold, Roni Bollag, Huidong Shi, Hasan Korkaya. Detailed analyses of pro-metastatic and anti-metastatic microenvironments of murine breast tumors in syngeneic mice [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-21-09.

Presentation schedule is subject to change. For the most up-to-date information, visit www.entannualmeeting.org. through survey, and subsequently used to teach PTA drainage to PGY2 otolaryngology residents.Results: The expert panel unanimously agreed that they would use the device to teach PTA drainage to trainees. The model was then used to instruct a novice group (N = 6). The majority of this novice group reported that the session was a vital part of their training experience, and it was important to practice drainage of a PTA on a mannequin.Conclusions: We validated a mannequin task trainer for drainage of peritonsillar abscesses and successfully implemented it into a teaching session. Given the frequency of presentation of PTA, the need to become competent in the procedure early in residency, and the success demonstrated using our model, we believe the model could be inexpensively replicated at other institutions for more safely and effectively teaching the procedure. national Trends in Pediatric Basilar Skull Fractures

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