0.001). CONCLUSIONS As dangerous and challenging as it may seem, air medical transport of prisoners by a police crew physician, may be safe and reliable, since no complications or safety events were observed. OBJECTIVE Bladder cancer is characterized by frequent recurrence and progression. CD44+ cancer stem cells (CSCs) might be one of the main reasons for recurrence. Although Bacillus Calmette Guerin (BCG) has become a gold standard immunotherapy, after treatment recurrence frequently occur. Based on this knowledge, the aim of this study was to evaluate the changes in cytokine and chemokine expressions in bladder cancer and CSCs cultures in vitro with BCG only and in combination with IL2 and lymphocyte (MNCs) applications. MATERIAL AND METHODS In this study, 3 cell lines of human bladder cancer cells with different characteristics (T24, 5637, and JMSU-1) and CD44+ bladder CSCs isolated by magnetic bead isolation (Miltenyl Magtech) were used. Bladder cancer cell lines and bladder CSCs in complete medium were cultured under humidified conditions of 37°C temperature in 5% CO2. BCG only and its combination with IL2 and MNCs were applied to bladder cancer cell lines and bladder CSCs for 24, 48, and 72 hours. Annexin Vdecreased CCL20 and IL6. When BCG was combined with IL2 and MNCs, CXCL10, CXCL5, and IFNG were increased and CXCL12, IL6, and TNSF11 were decreased. BCG treatment of CSCs caused increases in ADIPOQ, CXCL10, and XCL1 and a decrease in CCL8. When IL2 and MNCs were combined with BCG, the expression of many cytokines and chemokines decreased. SU6656 CONCLUSION BCG treatment changes the expression of many cytokines and chemokines in bladder cancer. The expression differs in 3 different cell lines and their CSCs. Immune modulation of each case differs from each other. The effectivity of BCG-based immunotherapy in bladder cancer on CSCs might decrease in combination with IL2. Our results indicate that recurrence after BCG treatment for bladder cancer may not occur mainly based on the CSCs hypothesis considering bladder cancer occurs at different loci of surface epithelium. Radical inguinal orchiectomy is the standard of care for men diagnosed with a testicular mass suspicious for germ cell tumor (TGCT). Nontraditional approaches to management, including testis-sparing surgery (TSS) and scrotal orchiectomy, occur in clinical practice. We systematically reviewed studies evaluating outcomes after TSS and scrotal violation for the management of a suspected TGCT. We used PubMed, Embase, and the Cochrane Central Register of Controlled Trials (January 1980-December 2018) to search for studies addressing morbidity and oncologic outcomes after TSS or scrotal violation for testicular masses concerning for TGCT. Paired reviewers independently screened abstracts for inclusion, sequentially extracted data, and assessed study quality. Twenty-one studies were included (10 TSS, 11 scrotal violation). Risk of local recurrence after TSS on meta-analysis was 7.5% after 3 to 5 years (absolute proportion reported in studies 10.9%). Aggregated rates of positive margins (1.4%) and testicular atrophy (2.8%) across studies were low with 7.1% of patients requiring subsequent androgen therapy. Scrotal violation led to a higher aggregate risk of local recurrence compared to no scrotal violation (2.5% vs. 0.0%, P less then 0.001) but did not appear to impact subsequent metastasis and survival in the short term (3-5 years). Most patients received adjuvant therapy after scrotal violation with 9.3% found to harbor residual primary tumor after scrotal scar excision. TSS carries a quantifiable risk of local recurrence after 3 to 5 years despite the majority receiving adjuvant radiation or chemotherapy. Scrotal violation carries a risk of local recurrence but does not appear to impact subsequent metastasis and survival in the short term. Malnutrition and depleted muscle stores adversely affect bladder cancer patients and contribute to poorer outcomes. These nutrition-related problems are often not addressed, in part because they are not being identified with screening and assessment tools. In this essay, we discuss validated nutrition screening and assessment tools such as the Patient-Generated Subjective Global Assessment; however, each healthcare team must decide on the one which will work best for their clinic. Patients with bladder cancer may be at risk for specific nutrient deficiencies which should be monitored and corrected to improve outcomes and overall health. BACKGROUND Speckle-type POZ protein (SPOP) mutation defines one of the dominant prostate cancer genomic subtypes, yet the impact of this mutation on clinical prognosis is unknown. METHODS We defined SPOP mutation status either by DNA sequencing or by transcriptional signature in a pooled retrospective multi-institutional cohort, the Decipher retrospective cohort, the Decipher Genomics Resource Information Database prospective cohort, and The Cancer Genome Atlas. Kaplan-Meier survival analysis and multivariable Cox models were used to assess the independent impact of SPOP mutation on survival, biochemical recurrence and time to metastasis. The Decipher retrospective cohort was also used to assess the impact of the addition of SPOP mutation status to a model predicting adverse pathology at prostatectomy which was then validated in the Decipher prospective cohort. RESULTS A fixed-effect model incorporating results from multivariable Cox regression including 5,811 subjects demonstrated that SPOP mutation was associated with a lower rate of adverse pathology at radical prostatectomy (odds ratios 0.57, 95% confidence interval 0.34-0.93), independent of preoperative prostate-specific antigen, age, and pathologic Gleason score. SPOP was not associated with biochemical recurrence, metastasis-free survival, or cancer-specific survival independent of pathologic information. The addition of SPOP status to prognostic models reclassified a large proportion of patients with the mutation (55%) into a favorable risk group when used to predict adverse pathology. CONCLUSION While the clinical utility of delineating any single molecular alteration in prostate cancer remains unclear, these results illustrates the importance of genomic subtypes in prostate cancer behavior and potential role in prognostic tools. BACKGROUND This study aims to determine the effect of formal, preclinical curricular interventions on medical students‘ perceptions of surgeons, surgical learning objectives, and concerns regarding the surgical clerkship. METHODS Thirty-eight medical students underwent a newly required, formal introduction to surgery during the preclinical curriculum. Two months later, these students were given surveys regarding their perception of surgery before and after a bootcamp-style transitions to the wards workshop that immediately preceded their core clinical rotations. Student responses were compared to historical peers. RESULTS Thirty-seven students participated in the study (97.4%). Relative to historical peers, students demonstrated improved overall perception of surgery (71.2 vs 66.6, p = 0.046). A smaller proportion of students indicated that they were worried about evaluation (18.9% in 2018 vs 55.3% in 2017, p = 0.001) and interactions with surgical educators (18.9% vs 50%, p = 0.005). Students‘ overall perception of surgery significantly improved after participation in the transition to the wards workshop (71.2 to 77.8, p ≤ 0.0001), as did student agreement with 9 of 21 specific items. Improvement in surgical perception across the bootcamp-style workshop was similar to that of a prior workshop (8.6 in 2018 vs 6.4 in 2017, p = 0.21). CONCLUSIONS A preclinical introduction to surgery can have a positive impact on medical student perception of surgery prior to entry to the wards and may mitigate student fears regarding their surgical rotation. OBJECTIVE Resilience is a vital quality for the successful completion of any residency training program. Resilience is a commonly used but poorly understood term and is defined in multiple ways by people during different times of their lives. The transition from medical student to general surgical resident (GSR) is one of the most formative times in a young surgeon’s professional career. The purpose of this study is to determine how a cohort of aspiring surgical residents define resilience. DESIGN This is a qualitative study where interviews were conducted prospective GSRs over 2 application seasons. During the institution’s standard interview process, applicants were asked to provide a definition of resilience. Responses were documented. Qualitative content analysis was conducted by the research team. Initial codes were developed and defined. Research team members independently coded the responses, and then an iterative group consensus process was used to develop the final themes. SETTING This study was conducted at Geisinger Medical Center, an academic tertiary care hospital in Danville, PA with 5 categorical GSR positions per year. PARTICIPANTS All applicants who underwent an in-person interview were included in this study. RESULTS A total of 261 comments about resilience were available from 117 interviews. These responses were categorized into 5 themes support, learning from failure, adaptability, self-reflection, and perseverance. CONCLUSION Resilience as defined by applicants to a general surgery residency program is a multifaceted term. The thematic categories suggest that resilience can be viewed through the framework of the 5 components of emotional intelligence self-aware, self-regulation, motivation, empathy, and social skills. OBJECTIVE The aim of this study is to evaluate a longitudinal medical student surgical curriculum. DESIGN This is a case-controlled study of students who participated in a longitudinal surgical curriculum compared to students who participated in a standard 12-week surgical clerkship. This study evaluates qualitative data including exam scores as well as qualitative data regarding student experience. SETTING All students were from Columbia College of Physicians and Surgeons in New York City. A portion of the students completed their clerkship at the main university campus and others performed their clerkship at an affiliate site including Bassett Health Network. The longitudinal curriculum was only at the Bassett Health Network. PARTICIPANTS All medical students who completed their surgical curriculum from 2012 to 2015 were eligible. The survey response rate was 45% for a total of 128 students. RESULTS The students receiving the longitudinal curriculum outperformed the block students on the national shelf exam (77 vs 71, p = 0.001). The longitudinal students were also more likely to learn directly from attending surgeons and were more likely to have a greater interest in a surgical career after their surgery experience. CONCLUSIONS The longitudinal approach to teaching surgery to medical students achieves non-inferior or superior testing outcomes when compared to the block model, and superior outcomes in terms of students‘ own attitudes and perceptions. OBJECTIVE To assess the utility of simulated ward rounds to train healthcare professionals in nontechnical skills using a qualitative analysis of participant feedback. DESIGN We developed simulated scenarios to train members of the surgical healthcare team in nontechnical skills, derived from observations of real ward rounds. Participants performed the simulated ward rounds as a team, led by a Urology trainee. Scenarios were carried out using actors as patients, and a simulated „switchboard“ for phone conversations. Throughout the scenarios, distractions were introduced and directed at different members of the participating team. Following each scenario, a whole group debrief took place to discuss and provide feedback on performances. All participants completed a 2-part feedback form comprising of questions answered on a Likert scale, as well as free-text responses. SETTING All simulations took place in a high-fidelity simulated ward bay. Observers were in a separate room, where the scenarios were projected on a screen in real-time.