Citations

Chimeric antigen receptor T-cell (CAR-T) and CD20xCD3 bispecific antibody (BsAb) therapies are both effective for relapsed/refractory (R/R) follicular lymphoma (FL), but comparative real-world survival outcomes and time toxicity have not been characterized. We performed a multicenter retrospective study of 228 patients with R/R FL treated with standard-of-care CAR-T (n = 141) or BsAb (n = 87) across 17 U.S. academic centers in the third-line or later setting. Progression-free survival (PFS) and overall survival (OS) were stratified by 2 or ≥3 prior lines of therapy (LOT2 or LOT3+), including propensity matching. Time toxicity was measured by physical health care contact days. Median PFS was not reached (NR) with CAR-T and 581 days with BsAb in the LOT2 cohort (p < .0001), and was NR with CAR-T and 584 days with BsAb in the LOT3+ cohort (p = .0064). CAR-T recipients were younger (p < .0001) and had better performance status (p = .007) but were more refractory to prior LOT (p = .017). PFS advantages of CAR-T were independent of these differences. OS did not differ between treatment groups. CAR-T had significantly greater time toxicity over the first year, with higher mean contact days than BsAb in both the LOT2 (58 vs 44) and LOT3+ (69 vs 49) cohorts. In this large multicenter cohort of patients with R/R FL, CAR-T was associated with superior PFS but greater time toxicity compared with BsAb therapy. These findings provide real-world outcomes data and time toxicity benchmarks to support treatment sequencing decision-making in R/R FL.

Background: Computer-assisted navigation (CAN) offers dynamic intraoperative guidance in total ankle arthroplasty (TAA). Although laboratory data suggest superior precision, in vivo evidence is lacking. This study used weightbearing computed tomography (WBCT) to evaluate CAN accuracy of postoperative TAA implant position relative to the plan. We hypothesized that absolute discrepancies would be <3 mm or <3°. Methods: Thirteen consecutive patients (November 2024–November 2025) underwent TAA using CAN. Preoperative computed tomography–based 3D models were used for templating. Postoperative WBCT scans were used to measure final implant seating, and computerized measurements were used to identify implant placement discrepancy. We analyzed absolute discrepancies between planned vs final postoperative positions. Results: Tibial absolute discrepancies were within desired limits for varus/valgus (1.65° ± 1.43°), slope (1.87° ± 1.34°), and cut height (0.68 ± 0.62 mm) but not for axial rotation (3.97 ± 2.64). For the talus, varus/valgus (2.93° ± 1.86°) and cut height (0.66 ± 0.71 mm) absolute discrepancies were within desired limits. The increased talar slope deviation (3.90 ± 2.89) in the final position may be due to non-navigated implant impaction. Conclusion: Although discrepancies persisted in tibial rotational alignment and talar positioning, the low variability across measurements suggests that CAN may support accurate implant positioning. These short-term positioning accuracy findings support the utility of CAN as a potential tool for enhancing implant positioning reproducibility in TAA. Level of Evidence: Level IV, case series.

Objective Assess if velopharyngeal gap size during speech is associated with consonant accuracy and whether hypernasality severity and compensatory misarticulation errors (CMAs) mediate this relationship. Design Cross-sectional. Setting Metropolitan hospital. Participants Eighty-one patients undergoing assessment for velopharyngeal insufficiency (VPI). Assessment(s) Each patient completed a preoperative magnetic resonance imaging protocol during sustained /i/ production and a perceptual speech evaluation. Velopharyngeal gap size was measured in millimeters. Hypernasality was rated using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification. Percent consonants correct (PCC) and percent of CMAs used were derived from transcriptions of the American English sentence or phrase sample. Main Outcome Measure(s) A generalized structural equation model was used to examine whether velopharyngeal gap size is associated with PCC indirectly through hypernasality severity and CMA use. Results Larger velopharyngeal gap sizes were associated with more severe hypernasality ( P < .001), greater hypernasality severity was associated with increased CMA use ( P < .001), and greater CMA use was associated with lower PCC ( P < .001). Velopharyngeal gap size was not directly associated with PCC ( P = .400). However, the full indirect pathway from gap size to PCC through hypernasality severity and CMA use was significant ( P = .001); gap size was significantly associated with PCC when accounting for both direct and indirect pathways combined ( P = .005). Conclusions These findings suggest hypernasality severity is the key mediator between gap size and speech accuracy. Patients with more severe hypernasality may benefit from timely surgical remediation of VPI to increase overall consonant accuracy.

Systematic reviews of randomized controlled trials (RCTs) support evidence-based clinical advancement. Clinical trial reporting guidelines, including CONSORT, establish common data elements that support systematic synthesis of published trial outcomes. However, the rapid rise of digital health technologies presents new challenges for reporting guidelines, and substantial real-world reporting heterogeneity has been observed. Therefore, machine-assisted evaluation of reporting adherence offers a pathway for more agile information management to accommodate the diverse and disruptive nature of digital health technology-enabled RCTs. Here, we propose an accelerated retrieval-to-abstraction literature synthesis framework to conduct article screening, text and table data preprocessing, and full-text review using an unmodified pretrained large language model. We apply this methodology in two digital health technology-enabled RCT case studies evaluating adherence to technology and digital health equity guideline reporting items. Large language model performance was on par with inter-annotator agreement F1 scores (≥0.9) in both screening and information-extraction tasks. These findings support the scalability and rigor of accelerated evidence synthesis and demonstrate the importance of common reporting elements across digital health technology-enabled RCTs.

Abstract Background Prostate artery embolization (PAE) requires precise visualization of complex pelvic arterial anatomy and can be aided by advanced vessel navigation tools. Photon counting detector (PCD) CT provides simultaneous ultra‐high resolution and material‐specific imaging, potentially improving automatic vessel tracing workflow for procedural planning and guidance. Purpose To identify, within a PCD‐CT workflow, the reconstruction that provides the most robust and consistent automatic vessel tracing for pre‐procedural PAE planning. Methods Ten patients underwent PCD‐CT angiography of the prostate arteries in ultra‐high‐resolution mode. Four reconstruction approaches were evaluated: conventional reconstructions with (1) standard of care kernel and (2) sharper kernel (Bv64), along with (3) monoenergetic 50 keV, and (4) iodine map spectral results. Using commercial embolization guidance software, three vessels were manually traced for each patient to establish ground truth segmentation. Subsequently, automatic vessel traces were generated using identical start/end points as the ground truth. Root mean squared error (RMSE) between automatic traces and ground truth was used to quantify tracing accuracy. Results Comparing individual traces, iodine maps demonstrated consistency with median RMSE of 0.7 mm (0.4 mm interquartile range (IQR)) versus 0.7 mm (12.5 mm IQR), 1.5 mm (14.7 mm IQR), and 0.8 mm (6.7 mm IQR) for Bv56, Bv64, and 50 keV reconstructions, respectively. Iodine maps produced fewer outliers, with 13.3% of traces and 40.0% of patients having one or more traces exceeding 5 mm RMSE, compared with 26.7%–36.7% of traces and 60.0%–80.0% of patients for the other reconstructions. Conclusions Material‐specific iodine reconstructions from PCD‐CT yield more robust automatic vessel tracing for PAE planning, offering a workflow‐compatible solution requiring minimal protocol modifications.

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.

Background Cardiac rehabilitation (CR) improves peak oxygen uptake (VO 2 peak) and body composition in patients with cardiovascular disease. However, improvement in VO 2 peak is not observed in all patients following a CR program, and whether VO 2 peak non-responders also demonstrate limited changes in body composition remains unclear. This study aimed to examine the association between changes in VO 2 peak and body composition in patients undergoing a CR program. Methods Retrospective analysis of patients who completed CR between 2015 and 2022 at Mayo Clinic. The study included 143 patients who completed cardiopulmonary exercise testing and dual-energy X-ray absorptiometry pre- and post-CR. Patients were grouped by the change in relative VO 2 peak response to CR (responders= Δ&gt;0 vs non-responders=Δ ≤0 mL/kg/min). Two-way repeated ANOVA was used to compare groups, and regression models were used to examine the associations between baseline body composition and changes in body composition with VO 2 peak change. Results Among the cohort, 26% were classified as non-responders based on relative VO 2 peak measurements. Both groups exhibited a significant improvement in most body composition variables including body fat mass, body fat percentage, body lean percentage, and fat mass index (all p&lt;0.001), with no differences in the percentage of change in body composition variables between groups (p&gt;0.05). Regression models demonstrated that neither baseline body composition nor changes in body composition were significantly associated with changes in VO 2 peak. Conclusion Our data suggest that baseline and change in body composition were not significantly associated with changes in VO 2 peak in patients undergoing the CR program.