Citations

Summary Asthma genetic architecture varies according to age at onset and biological sex. Medication‐defined severity showed limited common variant genetic heterogeneity compared with age at onset and sex.

Abstract Objective Otolaryngology–Head and Neck Surgery (OHNS) residency remains highly competitive, with persistent disparities in applicant representation. This study presents a cross‐sectional analysis of OHNS residency and faculty demographics using 2025 program rosters, evaluating degree type (MD vs DO), geographic distribution, and leadership influence. Study Design A cross‐sectional review. Setting All US ACGME‐accredited OHNS residency programs, with data collected in 2024 to 2025. Methods Demographic data were collected on OHNS faculty and residents, including post‐graduate year (PGY) 1 through PGY5 trainees at the time of data collection, corresponding to entry years from 2020 to 2024 across all US ACGME‐accredited residency programs. Data was extracted from official program websites, FREIDA, ACGME, NRMP, and social media. Programs with incomplete data, those using the military match, and non‐accredited sites were excluded. Descriptive statistics, χ 2 tests, and correlation analyses were performed ( p < .05). Results Of 131 programs, 125 were analyzed at the program level and 121 at the faculty level. DO residents were concentrated in Michigan (59%), Ohio (50%), and Oklahoma (50%). DO representation correlated with DO faculty ( r = .82, p < .0001), DO program director ( r = .95, p < .0001), and former AOA program designation ( r = .92, p < .0001). A negative correlation existed between program size and DO resident ( r = –.4, p < .0001). Conclusion Despite growing diversity following the single accreditation system, disparities persist in OHNS. DO residents remain underrepresented and geographically concentrated, with representation strongly associated with osteopathic faculty presence, program leadership, and prior AOA affiliation.

Background: Incidental thyroid nodules (ITNs) detected on nonthyroid imaging contribute to thyroid cancer overdiagnosis, largely through downstream evaluation initiated by thyroid ultrasound (TUS). However, TUS follow-up rates for ITNs and their drivers in routine practice remain unclear. We quantified TUS utilization after ITN detection and identified patient, imaging, nodule, and reporting factors associated with this first step in the diagnostic cascade. Methods: We conducted a retrospective cohort study of adults without prior thyroid disease who underwent imaging that incidentally captured the thyroid at Mayo Clinic sites (2017–2023). A validated natural language processing pipeline identified ITNs and extracted nodule characteristics from radiology reports across multiple imaging modalities. The main outcome was the rate of TUS within 180 days after ITN detection. Clinical outcomes, including thyroid biopsy, thyroidectomy, and thyroid cancer diagnosis, were compared between patients who underwent TUS and those who did not. Factors associated with TUS utilization were assessed using multivariable logistic regression with penalized variable selection. Results: Among 115,683 patients who underwent thyroid-capturing imaging, 8426 (7.3%) had an ITN. These patients were predominantly female (64.6%) and White (89.7%), with a mean age of 61.7 years (standard deviation 15.2). Most nodules were detected on computed tomography (80.8%), most commonly from chest imaging (52.3%). Overall, 1677 patients with ITNs (19.9%) underwent TUS. In multivariable analysis, TUS use was independently associated with higher body mass index (odds ratio [OR], 1.20 per 10-unit increase; confidence interval [CI] [1.08–1.33]), nodule size ≥1.5 cm (OR, 1.79; CI [1.52–2.10]), and a radiologist recommendation (OR, 2.51; CI [2.12–2.98]), whereas older age was associated with lower odds of TUS (OR, 0.89 per 10-year increase; CI [0.84–0.93]). Patients undergoing TUS had higher rates of thyroid biopsy, partial thyroidectomy, and total thyroidectomy compared with those without it. All detected thyroid cancers (103 cases) occurred in the TUS group, representing 6.1% of that cohort. Conclusions: One in five patients with ITNs underwent TUS, representing a critical gateway to downstream diagnostic procedures and thyroid cancer detection. Factors associated with TUS utilization highlight opportunities to better define appropriateness of ultrasound after incidental nodule detection and to reduce unnecessary testing and treatment.

Abstract Neuroanatomy remains a core competency in neurosurgical training, particularly in skull base education, where learners must integrate three‐dimensional spatial understanding, radiologic correlation, and stepwise procedural knowledge. Cadaveric dissection remains foundational, but adjunctive digital tools may strengthen repeated visualization and anatomical review. We describe the educational rationale and implementation of integrating stereoscopic teaching, a stepwise digital application, photogrammetry, and virtual reality within an established neurosurgical skull base curriculum. Within the Mayo Clinic cranial base course embedded in a broader longitudinal curriculum, four postgraduate year 4 neurosurgery residents participated in transcranial and endoscopic cadaveric dissections supported by stereoscopic lectures, workstation‐based tablet guidance, and immersive review using photogrammetry, virtual reality, and computed tomography/magnetic resonance imaging correlation. The integrated design aligned these modalities with course objectives in anatomical landmark recognition, operative corridor planning, radiologic‐anatomic translation, and stepwise procedural rehearsal. The educational contribution of this model lies in the intentional integration of digital adjuncts around cadaveric dissection rather than in a single technology alone. This multimodal sequence may support spatial understanding, procedural preparation, and competency‐oriented skull base training while extending review beyond the laboratory. Current evaluation is best interpreted as preliminary program evaluation rather than definitive learner‐outcome evidence. This model may offer a transferable approach for programs seeking to complement cadaveric education with emerging digital tools and provides a basis for future prospective evaluations using multiple low‐stakes assessment data points across the broader curriculum.

Background/Objectives: A 12-week trial demonstrated that phenotype-tailored lifestyle intervention (PLI) was associated with greater weight loss than standard lifestyle intervention (SLI); however, differences in dietary patterns between groups were not examined. Methods: This secondary analysis evaluated caloric and macronutrient intake at 12 weeks in adults with obesity (BMI ≥ 30 kg/m2), classified into four energy-balance phenotypes (abnormal satiation, reduced postprandial satiety, low energy expenditure, emotional eating) (n = 77) who underwent PLI or SLI. Dietary intake was assessed by 24-h recalls and verified by a blinded registered dietitian. Results: Groups were compared at 12 weeks adjusting for baseline values. PLI was associated with lower total energy intake than SLI (1273 ± 182 vs. 1894 ± 176 kcal/day; p = 0.018), due to lower carbohydrate (464 ± 76 vs. 818 ± 73 kcal/day; p = 0.002) and fat intake (479 ± 76 vs. 697 ± 73 kcal/day; p = 0.036); absolute protein intake did not differ. However, protein comprised a greater proportion of energy intake in PLI (26.8 ± 1.6%) than SLI (19.8 ± 1.5%; p = 0.003), and dairy protein contributed more to total energy in PLI (6.8 ± 0.8% vs. 3.7 ± 0.7%; p = 0.004). Conclusions: PLI was associated with lower energy intake, mainly due to reduced carbohydrate and fat intake, and a higher relative contribution of protein, consistent with phenotype-based recommendations rather than macronutrient prescriptions. These findings suggest a potential role for personalized dietary approaches in obesity management. However, the non-randomized design does not allow causal inferences.

Introduction: Frontotemporal lobar degeneration (FTLD) is a devastating disease that commonly results in early onset dementia, yet its rarity and heterogeneity limit large-scale research and clinical trials. Remote monitoring via low-burden digital health tools may overcome these barriers. We evaluated clinical utility of passive smartphone monitoring in FTLD using a multi-domain mobile assessment platform. Methods: Participants were 567 adults (53% clinically normal, 21% prodromal FTLD, 26% symptomatic FTLD) who completed an in-person study visit and downloaded the ALLFTD Mobile App on their personal smartphones. The app delivered unsupervised cognitive tests and passively collected continuous data on battery percentage (proxy for smartphone use) and step count. Longitudinal follow-up included smartphone monitoring and annual in-person study visits. Primary analyses examined associations between passive smartphone features and markers of disease severity at baseline and longitudinally, and tested whether passive features added incremental value beyond app-based cognitive testing. Results: Passive smartphone features were feasible to collect and showed excellent reliability with <2 weeks of monitoring (ICCs>0.9). Features capturing smartphone use and movement demonstrated sensitivity to gold-standard clinical measures of disease severity both at baseline and longitudinally. A classification model combining passive features, the app-based cognitive composite score, and demographics detected longitudinal functional decline (AUC=0.89); passive features alone (AUC=0.84) performed comparably to a cognitive screener (AUC=0.85). Discussion: Passive smartphone monitoring is a valid, zero-burden measure of disease severity and progression in FTLD that adds modest incremental value beyond app-based cognitive testing. Findings support its use as a scalable digital endpoint in longitudinal FTLD research.

Abstract The paradigm in the field of oncolytic virotherapy proposes that tumor cell killing by an oncolytic virus (OV) culminates in the priming of antitumor CD8+ T cells. However, this ignores the impact a highly immunodominant antiviral response against the OV has on the subdominant antitumor response, particularly with regard to the naturally low affinity of tumor antigens to their cognate T-cell receptors. To investigate this experimentally, we first studied the interaction between the two responses in B16 and MC38 tumor models, both expressing ovalbumin (OVA). Contrary to the accepted paradigm, the inflammatory vesicular stomatitis virus (VSV) failed to expand OVA-specific T cells in vivo unless armed with tumor-associated antigen (TAA). In fact, treatment with the control VSV led to the ablation of antitumor T cells and a shift toward dysfunction as determined by the upregulation of markers, including LAG3 and CD39, correlating with lower rates of survival. Combination with anti–PD-1 immune checkpoint blockade therapy significantly improved survival only when VSV expressed TAA. VSV-expressing altered peptide ligand variants of tumor antigens, which evade mechanisms of central tolerance, expanded near self-antigen–specific T cells with the ability to cross-react with tolerized tumor antigens, thus providing an antitumor effector population capable of proliferating in the presence of a potent antiviral response. Taken together, these findings offer a rational approach to OV design which preserves acute antitumor therapy provided by antiviral innate and T-cell responses while promoting the induction of tumor-specific T cells. Significance: Oncolytic viruses can induce an antiviral T-cell response that occludes an antitumor response, challenging the paradigm in the field and elucidating strategies to optimize the efficacy of oncolytic viroimmunotherapy.