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The objective of the study was to estimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in the Howard County, Maryland, general population and demographic subpopulations attributable to natural infection or coronavirus disease 2019 (COVID-19) vaccination and to identify self-reported social behaviors that may affect the likelihood of recent or past SARS-CoV-2 infection. A cross-sectional, saliva-based serological study of 2,880 residents of Howard County, Maryland, was carried out from July through September 2021. Natural SARS-CoV-2 infection prevalence was estimated by inferring infections among individuals according to anti-nucleocapsid immunoglobin G levels and calculating averages weighted by sample proportions of various demographics. Antibody levels between BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) recipients were compared. Antibody decay rate was calculated by fitting exponential decay curves to cross-sectional indirect immunoassay data. Regression analysis was carried out to identify demographic factors, social behaviors, and attitudes that may be linked to an increased likelihood of natural infection. The estimated overall prevalence of natural infection in Howard County, Maryland, was 11.9% (95% confidence interval, 9.2% to 15.1%), compared with 7% reported COVID-19 cases. Antibody prevalence indicating natural infection was highest among Hispanic and non-Hispanic Black participants and lowest among non-Hispanic White and non-Hispanic Asian participants. Participants from census tracts with lower average household income also had higher natural infection rates. After accounting for multiple comparisons and correlations between participants, none of the behavior or attitude factors had significant effects on natural infection. At the same time, recipients of the mRNA-1273 vaccine had higher antibody levels than those of BNT162b2 vaccine recipients. Older study participants had overall lower antibody levels compared with younger study participants. The true prevalence of SARS-CoV-2 infection is higher than the number of reported COVID-19 cases in Howard County, Maryland. A disproportionate impact of infection-induced SARS-CoV-2 positivity was observed across different ethnic/racial subpopulations and incomes, and differences in antibody levels across different demographics were identified. Taken together, this information may inform public health policy to protect vulnerable populations. IMPORTANCE We employed a highly innovative noninvasive multiplex oral fluid SARS-CoV-2 IgG assay to ascertain our seroprevalence estimates. This laboratory-developed test has been applied in NCI's SeroNet consortium, possesses high sensitivity and specificity according to FDA Emergency Use Authorization guidelines, correlates strongly with SARS-CoV-2 neutralizing antibody responses, and is Clinical Laboratory Improvement Amendments-approved by the Johns Hopkins Hospital Department of Pathology. It represents a broadly scalable public health tool to improve understanding of recent and past SARS-CoV-2 exposure and infection without drawing any blood. To our knowledge, this is the first application of a high-performance salivary SARS-CoV-2 IgG assay to estimate population-level seroprevalence, including identifying COVID-19 disparities. We also are the first to report differences in SARS-CoV-2 IgG responses by COVID-19 vaccine manufacturers (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]). Our findings demonstrate remarkable consistency with those of blood-based SARS-CoV-2 IgG assays in terms of differences in the magnitude of SARS-CoV-2 IgG responses between COVID-19 vaccines., Competing Interests: The authors declare no conflict of interest.

Introduction: High intensity focused ultrasound (HIFU) is a non-invasive technique that uses focused ultrasound waves to ablate tissue. This retrospective study evaluates the early HIFU experience at a single Canadian center., Materials and Methods: Ninety-five patients were treated between March 2006 and December 2007 using the Sonablate-500 device (Focus Surgery, Indianapolis, IN, USA). Follow up occurred at 3 month intervals and included serial prostate-specific antigen (PSA) measurements, assessments of erectile function and continence rates with the international index of erectile function (IIEF) and expanded prostate cancer index composite (EPIC) questionnaires respectively. Early and late complications were also studied., Results: There were 95 patients treated by five urologists. The mean age of patients was 64 years (range 46-91). The majority of men treated had Gleason 6 (n = 53) or Gleason 7 (n = 35) disease. The remainder had Gleason 8 (n = 5) and Gleason 9 (n = 2) prostate cancer. Prostate volume in the pre-treatment group was 30.5 cc (range 14.4 cc-73 cc). Cytoreductive androgen deprivation therapy prior to treatment was administered to 10 men. Post-HIFU with a minimum 6 months follow up (mean 10.62 months), 2% (1/59) of men had de novo moderate to severe erectile dysfunction (IIEF ≤ 11). With a minimum of 6 months follow up (mean 8.85 months), 17% (7/41) of the men had significant incontinence according to their EPIC scores. Early complications included catheter-related problems (n = 10), retention (n = 16), and urosepsis (n = 1). Late complications included need for cystoscopy (n = 25), TURP (n = 6), VIU/dilatation for stricture or bladder neck contracture (n = 13) and self-catheterization (n = 1). Prostatorectal fistula occurred in one patient who had prior radiotherapy. Salvage HIFU following radiation failure was performed in seven men. Recurrence of cancer following HIFU was diagnosed in seven men. Salvage treatment included radical prostatectomy (n = 3), radiation therapy (n = 2), repeat HIFU (n = 1), hormone therapy (n = 1)., Conclusions: In our early experience HIFU treatment for prostate cancer was associated with a moderate rate of complications and failure. Further studies are required to examine long term outcomes with HIFU.

Background: In Canada, waiting times for cancer care have been increasing, particularly for patients with genitourinary malignancies. We examined whether delay from diagnosis for patients undergoing surgery for clinically localized prostate cancer affects cancer cure rates., Methods: We conducted a historical cohort study among 645 patients who underwent radical prostatectomy between 1987 and 1997, using biochemical recurrence (PSA elevation) and metastasis as endpoints. We examined whether patients who underwent surgery >/= months (delayed surgery group) from the date of diagnosis had reduced recurrence-free survival, compared to patients who had surgery <3 months (early surgery group) from the date of diagnosis, adjusting for grade, stage and PSA level at diagnosis., Results: The crude 10-year recurrence-free and metastasis-free survival rates for all patients were 71.1% (95% C.I.: 64.9% - 77.3%) and 95.3% (95% C.I.: 91.3% - 99.3%), respectively. Of the 645 patients, 189 (29.3%) had surgery >/= months after diagnosis. The median time from the date of diagnosis to surgery was 68 days (range 15 to 951 days). The 10-year recurrence-free survival was higher for patients who underwent early surgery (74.6%, 95% C.I.: 67.9% - 81.4%) compared to patients in the delayed surgery group (61.3%, 95% C.I.: 46.7% - 76.0%, p=0.05). The crude and adjusted hazard ratios for developing biochemical recurrence for patients in the delayed surgery group were 1.58 (95% C.I.: 1.0 - 2.4, p=0.04) and 1.46 (95% C.I.: 0.9 - 2.3, p=0.09), respectively, compared to patients who underwent early surgery., Conclusions: There may exist a possible relationship between delays from diagnosis for radical prostatectomy and prostate cancer cure rates. These findings may have many biases that could not be properly accounted in this retrospective analysis and larger cohort analyses will be required to confirm these findings.

PURPOSE: To assess the effect of donor nephrectomy on blood pressure, 24-hour urine protein excretion, and renal function. MATERIALS AND METHODS: Of the 198 individuals who donated a kidney between 1991-1996, 101 had their blood pressure, 24-hour urine protein excretion, and serum creatinine concentration levels measured. The mean duration of follow-up was 3.2 +/- 1.6 years (range: 8.5 months to 6.5 years). RESULTS: Serum creatinine concentration was significantly higher (p<.001) at follow-up (107 +/- 20 umol/L) compared to before donation (86 +/- 18 umol/L). When follow-up serum creatinine concentrations were expressed as percentages of their pre-operative values, a gradual decline was observed with time (R= -.380). Diastolic blood pressures (p<.05) and 24-hour urine protein levels (p<.001) were significantly higher at follow-up, however, neither increased with time. The prevalence of hypertension and proteinuria in our donors was no different from that of the general population. CONCLUSIONS: Donor nephrectomy does not impair renal function or result in a progressive rise in blood pressure or urine protein excretion up to 6.5 years after nephrectomy.

PURPOSE: To determine the psychosocial effects of donor nephrectomy on a sample of Canadian donors. MATERIALS AND METHODS: Patients donating one of their kidneys for transplantation at the Toronto Hospital between 1991-1996 were asked to complete a 170-item questionnaire designed to assess their psychosocial well-being and the impact of renal donation on various aspects of their lives. Of the 153 donors contacted, 104 (68.0%) have responded to date. RESULTS: Less than 5% of donors complained of renal donation severely affecting any aspect of their life. Most donors (84%) were able to perform their normal daily activities within 12 weeks of nephrectomy, and 75% had recovered their pre-donation level of work function by this time. Almost one third of donors lost wages because of their donation, and half incurred significant transportation costs. Very few donors (< 10%) complained of other costs. Almost 90% of donors felt that donating a kidney had positively impacted their relationship with the recipient, and donors felt that their relationships with the recipient were significantly more positive at follow-up (p<.003). CONCLUSIONS: Donating a kidney results in a moderate psychosocial impact on the donor and appears to strengthen the bond between donor and recipient. Recovery times to daily activities and work may be longer than anticipated in a large proportion of donors.