Pancreatic cancer is characterized by its lethality and rapid progression, with many patients dying shortly after diagnosis. Mortality counts quantify the number of deaths, but fail to the capture the amount of expected lifespan lost. Years of life lost (YLL) measures premature mortality by estimating the years not lived when death occurs before an expected lifespan. In this study, we estimated national sex-, age-, and race/ethnicity-specific patterns and temporal trends in years of life lost to pancreatic cancer over a 25 year period (1999 to 2023). Pancreatic cancer deaths (ICD-10 C25) were obtained from the National Vital Statistics System underlying cause of death mortality files (1999-2023). Years of life lost (YLL) were calculated by multiplying deaths at each single-year age and sex by remaining life expectancy from year- and sex-specific US life tables, and summing across ages. Temporal trends were summarized using annual percent change (APC) from log-linear regression of yearly totals. Race/ethnicity comparisons pooled 1999-2001 and 2021-2023 and estimated age-standardized YLL per 100,000 using the 2000 US standard population and life table. From 1999 to 2023, 956,308 pancreatic cancer deaths accounted for 14,189,121 YLL. Annual YLL increased 76% from 416,228 to 733,772 (APC: 2.52%; 95% CI: 2.35-2.69; P < 0.0001), outpacing a 70% increase in deaths from 29,082 to 49,451 (APC: 2.26%; 95% CI: 1.38-3.15; P < 0.0001). Each death from pancreatic cancer resulted in a mean loss of 14.8 years of expected life. Adults aged 55-74 years accounted for 74% of the national increase in YLL. Cumulatively, from 1999 to 2023, males contributed 7.1 million YLL and females 6.8 million YLL. In 2021-2023, age-standardized YLL/100,000 was higher among Black individuals than White individuals (198.5 vs. 161.2). The absolute burden was geographically concentrated in California, Florida, Texas, and New York, who together accounted for an estimated 30.4% of the national YLL to pancreatic cancer. Premature mortality from pancreatic cancer has increased substantially in the United States, with much of the increase concentrated among adults aged 55-74 years. Our findings support greater prioritization of pancreatic cancer research to define and mitigate the drivers causing this increase in loss of life.

Drug-coated balloons (DCBs) are increasingly used in femoropopliteal (FP) endovascular therapy (EVT) to limit permanent scaffold implantation. Although this paradigm shift has substantially altered treatment strategies, its effects on real-world clinical outcomes remain unclear. Temporal trends in device selection and clinical outcomes after FP EVT were evaluated in contemporary practice. This multicenter, retrospective study included patients who underwent EVT for de novo FP artery disease at six institutions between July 2017 and December 2023. Patients were stratified into three equal, chronological eras (early, middle, and late). Trends in device use were evaluated, and clinical outcomes, including primary patency and restenosis patterns, were compared. Overall, 2815 patients were included in the analysis. DCB use increased substantially across eras (24.5% vs. 50.6% vs. 70.4%, p < 0.0001). Although the proportion of patients with chronic limb-threatening ischemia increased over time, lesion complexity seemed to decrease, with lower rates of severe calcification and poor distal runoff in the later era. The 1-year primary patency rates were comparable across the three eras (83% vs. 81% vs. 81%, p = 0.2688). Conversely, the incidence of re-occlusion in restenotic lesions declined progressively over time (37% vs. 35% vs. 26%, p = 0.0002). Despite substantial temporal changes in FP EVT strategy, including increased DCB use and more selective scaffold implantation, 1-year outcomes remained stable. Restenosis patterns shifted toward fewer reocclusive failures, indicating qualitative improvement in treatment outcomes. Contemporary FP EVT therefore reflects a more strategy-driven approach that preserves durable outcomes while reducing unfavorable restenosis patterns in real-world practice.

Modified case-crossover estimators were unbiased in the presence of temporal trends in the exposure of interest: a simulation study.

Temporal Trends in Heart-Liver and Heart-Kidney Transplantation Following the 2018 OPTN Policy Change: Regional and Sex-Specific Signals, 2013-2025

Metabolic dysfunction-associated steatohepatitis (MASH) is an increasingly significant contributor to primary liver cancer in the Asia-Pacific region, with substantial regional variation. To quantify the burden and temporal trends of MASH-related liver cancer across countries and subregions from 1990 to 2023. Using the Global Burden of Disease (GBD) 2023 dataset, we analysed age-standardized prevalence, deaths, and disability-adjusted life years (DALYs) for MASH-related liver cancer, assessing temporal trends, regional variation and associations with the Socio-demographic Index (SDI). Decomposition analysis estimated the contributions of ageing, population growth and epidemiological changes. In 2023, the high-income Asia-Pacific region had the highest age-standardized prevalence of MASH-related liver cancer (1.19 per 100 000), followed by Oceania (0.98 per 100 000) and Australasia (0.88 per 100 000), with Central Asia the lowest (0.56 per 100 000). Across the Asia-Pacific region, prevalence, mortality and DALYs generally increased with SDI, though patterns varied by subregion. The high-income Asia-Pacific region showed a distinct 'increase-peak-decline' pattern in both mortality and DALYs, whereas low- and middle-income regions (i.e., South Asia, South-east Asia and Central Asia) showed steady increases in prevalence. Pacific island nations experienced disproportionately higher DALYs despite their smaller populations. Decomposition analyses showed that ageing and population growth accounted for the largest proportions of the observed changes in East Asia (44.8% and 41.4%, respectively) and South Asia (41.1% and 30.1%, respectively), whereas epidemiological change was the largest contributor in Australasia (58.4%). MASH-related liver cancer is rising across the Asia-Pacific region, with substantial regional variation, underscoring the need for region-specific public health strategies.

In-hospital stroke is associated with delayed recognition and worse outcomes compared with community-onset stroke. Contemporary national data in the mechanical thrombectomy (MT) era are limited. We performed a retrospective cohort study of adult ischemic stroke admissions in the Get With The Guidelines-Stroke registry from January 2016 to December 2023 (the MT era). In-hospital stroke was compared with community-onset stroke as the primary analysis. A secondary descriptive analysis comparing in-hospital patients with stroke from January 2006 to April 2012 and January 2016 to December 2023 was also performed. Primary outcomes were in-hospital mortality, discharge home, and independent ambulation at discharge. Multivariable logistic regression with generalized estimating equations accounted for within-hospital clustering and adjusted for demographics, vascular risk factors/comorbidities, and hospital characteristics. Temporal trends in MT use were assessed with the Cochran-Armitage trend test. Among 4 996 392 ischemic stroke admissions from 2016 to 2023, 191 355 (3.8%) were in-hospital, and 4 805 037 (96.2%) were community onset. In-hospital patients presented with greater severity (National Institutes of Health Stroke Scale score >20: 14.5% versus 7.9%; National Institutes of Health Stroke Scale score, 0-4: 43.3% versus 60.4%) had worse outcomes including higher in-hospital mortality (adjusted odds ratio, 2.27 [95% CI, 2.18-2.36]; P<0.001), lower likelihood of discharge home (adjusted odds ratio, 0.46 [95% CI, 0.45-0.48]; P<0.001), and lower independent ambulation at discharge (adjusted odds ratio, 0.52 [95% CI, 0.50-0.53]; P<0.001). Recognition-to-computed tomography time was longer for in-hospital (median 51 [interquartile range, 16-269] versus 18 [10-39] minutes; P<0.001). MT rates increased significantly from 2016 to 2023 in both in-hospital and community-onset patients (4.47%-9.54% and 2.35%-5.55%, respectively; P<0.001). Quality metrics and outcomes significantly improved in the MT era, independent of treatment modality. In patients with in-hospital stroke, MT rates increased over time, and improvements in quality metrics were observed regardless of treatment modality. A higher level of stroke severity and worse outcomes persists.

The temporal dynamics of shot quality in elite football remain poorly understood, despite well-documented declines in physical and technical performance during matches. This study aimed to analyze the evolution of advanced shot metrics across match halves and 15 min intervals in elite men’s and women’s international competitions. A total of 4074 shots from the UEFA European Championships were examined. To ensure methodological consistency among the three advanced shooting metrics (expected goals, xG; expected shot impact timing, xSIT; and expected goals on target, xGOT), analyses were restricted to shots on target (men: 775; women: 554), as xGOT can only be calculated for on-target attempts. Shot quality was assessed using xG, xSIT and xGOT. Differences between halves were evaluated using the Mann–Whitney U test, while temporal trends were analyzed through linear mixed-effects models. Results showed no significant differences between halves in shot distribution or quality metrics in either competition (all p &gt; 0.05). Likewise, no significant temporal variations were found across the six match intervals for any metric. Women’s football exhibited a largely stable quality of shots on target throughout the match. In men’s competitions, although a significant difference in xG was observed (p = 0.04, effect sizes were trivial (d = −0.17), and no consistent patterns emerged in xSIT or xGOT. No sex-related differences were observed. Overall, shot quality remained stable despite match progression, suggesting that changes in goal frequency are not driven by variations in the intrinsic quality of shooting opportunities. Therefore, these findings suggest that optimizing the contextual conditions that facilitate the creation of shooting opportunities may be as important as, or more important than, focusing solely on shooting execution.

Fracture hematoma (FH) initiates fracture healing and is key in the inflammatory phase. Neutrophils, the first infiltrating cells, play a dual role in this process. The discovery of pro-inflammatory N1 and regenerative N2 neutrophil phenotypes provides new insights into their functions. This study aims to investigate the presence, dynamics, and osteogenic effects of N1 and N2 neutrophils in human FH. Human neutrophils were polarized into N1 and N2 phenotypes in vitro. CD15 and CD16 served as general markers, while CD54, CD95, and CD182 expression and TNF-α, IL-8, MCP-1, and SDF-1α secretion characterized N1/N2 polarization. After validation, 15 FH samples (4-14 days post-trauma) were analyzed by flow cytometry and immunofluorescence to determine the N2/N1 ratio and its temporal trend. Functional assays assessed their influence on human BMSC osteogenesis in co-culture. In vitro, N1 neutrophils expressed high CD54 and CD95 and secreted elevated TNF-α, IL-8, MCP-1, and SDF-1α, whereas N2 cells showed increased CD182 and SDF-1α. Both phenotypes were detected in human FH, with a rising N2/N1 ratio over time, indicating a shift from inflammation to regeneration. Functionally, N1 neutrophils counteracted N0-induced inhibition of early osteogenesis but reduced cell metabolism, while N2 neutrophils alleviated N0-mediated suppression of late mineralization. Our findings provide the first evidence of the coexistence and temporal evolution of N1 and N2 neutrophils within human fracture hematoma, consistent with their polarization characteristics observed in vitro. Moreover, these phenotypes exert distinct effects on osteogenesis, in alignment with the progressive increase of the N2/N1 ratio in vivo, supporting the gradual transition from inflammation to regeneration during the human fracture-healing cascade. Collectively, this study advances the understanding of neutrophil heterogeneity in bone regeneration and bridges fundamental immunobiological mechanisms with potential clinical translation.

Cardiovascular disease-associated admissions in patients with Cystic Fibrosis: A 7-Year U.S. National Inpatient Sample Analysis.

Recombinant human growth hormone (rhGH) treatment for idiopathic short stature (ISS) in China faces challenges including delayed initiation, poor persistence, limited adoption of advanced therapies, and conservative dosing. This study characterized real-world temporal and geographical patterns of rhGH therapy and identified associated socioeconomic factors. Data from two nationwide registries comprising 24,384 children with ISS initiating rhGH were analyzed. Predictors of treatment effectiveness were identified via linear regression. Provincial variations and temporal trends were assessed via descriptive analysis and seasonal-trend decomposition. Spearman correlation was used to examine associations between treatment patterns and socioeconomic indicators. The median rhGH initiation age was 8.45years. Most patients (81.3%) initiated short-acting GH (SAGH; median dose 0.15IU/kg/day), while 18.7% initiated long-acting GH (LAGH; median dose 0.20mg/kg/week). Younger age and treatment duration ≥ 9months predicted superior 1-year height standard deviation score gain (P < 0.001). Temporally, LAGH adoption and standard-dose regimens showed significant longitudinal increases (P < 0.05). Geographically, substantial variation existed in median initiation age (7.11-9.70years), LAGH adoption rates (11.8-31.1%), and duration of therapy (DOT; 10.3-28.1months). Higher per capita gross regional product correlated with younger initiation (ρ = - 0.530), higher LAGH adoption (ρ = 0.371), and longer DOT (ρ = 0.552). Conversely, higher rural population ratios correlated with delayed initiation, lower LAGH adoption, and shorter DOT (all P < 0.05). Geographic heterogeneity in rhGH therapy is observed and correlates with regional socioeconomic profiles. To enhance therapeutic outcomes and support the balanced development of pediatric endocrine care, adaptive clinical management considering regional socioeconomic contexts is recommended.

The Changing Landscape of Peritoneal Dialysis in America: A Facility-Level Analysis of Growth.

Seasonal variation, temporal trends, and factors associated with PCR-confirmed cholera in Goma city and surrounding health zones in Eastern Democratic Republic of the Congo, 2020–2024: a multilevel analysis

Evolving Comorbidity Burden and Clinical Characteristics in Peritoneal Dialysis: A 17-Year Nationwide Study.

Territorial inequalities in cancer mortality in Chile, 2002-2022: a rurality-continuum analysis using spatiotemporal Bayesian models.

Global burden, temporal trends and cross-national inequalities of the comorbidity between depressive disorder and hormone-dependent tumors in women of reproductive ages from 1990 to 2021: A population-based analysis with projections to 2036.

The practice of living donor kidney transplantation has evolved through innovations in logistics, technology, and clinical practice. In the United States, Good Samaritan donation, a historical label exclusive to nondirected donors, now incorporates voucher-based models. To determine how voucher-based nondirected living kidney donation has influenced the volume and practice of Good Samaritan living kidney donation in the United States, we analyzed living donor kidney transplants from 2000 to 2024 using data from the National Kidney Registry (103 transplant centers) and the Scientific Registry of Transplant Recipients. Temporal trends were derived by linear regression. We identified 4662 Good Samaritan living donor kidney transplants, defined as historical nondirected and novel voucher-based nondirected donations. Of 2131 Good Samaritan living donor kidney transplants facilitated by the National Kidney Registry, donors had a median age of 43 y, were predominantly of White race (93%), and were women (60%). Recipients had a median age of 52 y and were racially and ethnically diverse (63% White, 14% Black, and 10% Hispanic). Annual Good Samaritan donation counts in the United States increased from 17 in 2000 to 439 in 2024, corresponding to a growth rate of 14.5%. Voucher-based nondirected donations increased from 2 in 2015 to 314 in 2024, comprising 72% of all Good Samaritan donations in that year. The advent of voucher-based nondirected donation correlated with growth in Good Samaritan donation volume. Given the prevalence of voucher-based donations, connecting local kidney paired donation practices to voucher-based nondirected donation may improve access to and participation in living kidney donation.

Proton Beam Therapy for Cancer in Children and Adolescents: A Retrospective Canadian Paediatric Tumour Consortium Study.

Temporal trends of selected diabetic foot deformities and risk factors: an exploratory analysis from a tertiary diabetes clinic.

Oral and maxillofacial space infections (OMSIs) are potentially life-threatening polymicrobial conditions requiring timely and appropriate antimicrobial therapy. We conducted a systematic review and meta-analysis of 53 studies (12,408 cases) to evaluate microbial epidemiology and resistance patterns. Streptococcus was the predominant pathogen (45.51%), followed by Prevotella (15.89%) and Porphyromonas (15.61%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 19.18% of S. aureus isolates. Diabetic patients exhibited a higher prevalence of Klebsiella (27.09% vs. 8.13% in nondiabetics). Antimicrobial resistance was lowest for levofloxacin (11.03%) and cephalosporins (16.83%), and highest for gentamicin (39.66%) and erythromycin (39.35%). The microbiological landscape and antimicrobial resistance patterns were influenced by multiple factors, including infection source, diabetic status, diagnostic methods, national income level, and temporal trends. Incorporating these variables with local antimicrobial surveillance data can support more targeted and effective empirical therapy. Well-designed, representative studies across diverse settings are urgently needed to optimize antimicrobial use amid rising resistance.

A decade of change in delirium management: Temporal trends in psychotropic recommendations in a tertiary care hospital.