Trend Test Research Articles

Serum uric acid/creatinine ratio and 1-year stroke recurrence in patient with acute ischemic stroke and abnormal renal function: results from the Xi'an stroke registry study of China

BackgroundThe relationship between abnormal renal function and serum uric acid levels in patients with acute ischemic stroke (AIS) remains insufficiently explored. Although uric acid is associated with cardiovascular and cerebrovascular risk, the specific link between normalized serum uric acid (SUA/SCr) and stroke recurrence in patients with impaired renal function has not been well studied. This study aims to fill this gap by investigating the association between SUA/SCr and 1-year stroke recurrence in patients with AIS and abnormal renal function.MethodsThis study utilized the ratio of serum uric acid (SUA) to serum creatinine (SCr) to represent SUA levels normalized for renal function. Abnormal Renal function was defined by the estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2. Multivariable Cox regression, curve fitting, and stratified analyses were employed to assess the relationship between SUA/SCr and 1-year stroke recurrence in patients with AIS and abnormal renal function, considering SUA/SCr as both a continuous variable and in quartiles (Q1–Q4).ResultsOf 1,932 enrolled patients (65.3% male; mean age 66.7 ± 11.3 years), each unit of increase in SUA/SCr was associated with a 17% decrease in 1-year stroke recurrence (HR = 0.83, 95% CI 0.73 to 0.96, P = 0.009). Compared to Q1, the Q2 and Q4 groups showed significantly reduced risk in 1-year stroke recurrence (Q2: HR = 0.46, 95% CI 0.27 to 0.79, P = 0.005; Q4: HR = 0.47, 95% CI 0.27 to 0.81, P = 0.007), with a significant trend across all quartiles (P = 0.01 for trend tests). Curve fitting revealed a negative but non-linear correlation. Subgroup analyses showed that in patients with eGFR < 60 ml/min/1.73 m2, Q4 had significantly lower 1-year stroke recurrence risk than Q1 (HR = 0.19, 95% CI 0.04 to 0.86, P = 0.031).ConclusionLow SUA/SCr independently predicts 1-year stroke recurrence in patients with AIS and abnormal renal function, particularly in those with eGFR < 60 mL/min/1.73 m2.

Gender Difference in Cardiology Publications in South Asia

Introduction Women are still underrepresented in prestigious author positions in medical publications. This study was done to evaluate gender differences in the first authorship of cardiology-related publications in South Asia over the past two decades. Methodology This is a cross-sectional study, and we strictly followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. An electronic search was conducted in PubMed on January 15, 2023, using specific MeSH terms and keywords for articles published from 2002 to 2022. The easyPubMed package of R statistical software was used to retrieve articles. The gender of the author was determined by first name. We used the www.genderapi.io and also did a manual search of the public profile of authors to determine the gender. Mann–Kendall’s trend test was used to know the trend for gender disparities. Results A total of 5,105 publications are included in the final analysis. The study found that a total of 1,470 (28.8%) studies have female first authors, and 3,632 (71.1%) have male first authors. According to the countries, 29 (31.5%) in Afghanistan, 104 (24.1%) in Bangladesh, 2 (33.3%) in Bhutan, 879 (27.8%) in India, 1 (25%) in Maldives, 84 (28.9%) in Nepal, 322 (33.4%) in Pakistan, and 49 (33.1%) in Sri Lanka publications have female first authors. It was found that from 2002 to 2022, there has been a significant increase in female first authors. Only 16.3% of publications had a female first author in 2002, which increased to 32.9% in 2022. Conclusion Gender disparities in the authorship of cardiology research publications persist despite the declining trend.

Nonlinear associations of the hs-CRP/HDL-C index with metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in US adults: insights from NHANES 2017–2018

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a globally widespread chronic liver condition that may progress to severe liver diseases, including advanced liver fibrosis. The high-sensitivity C-reactive protein-to-high-density lipoprotein cholesterol (hs-CRP/HDL-C) index may be a potential indicator for MASLD and advanced liver fibrosis, given its relevance to inflammation and plasma lipids. In this study, the hs-CRP/HDL-C index was investigated in relation to prevalent MASLD and advanced liver fibrosis. The study analyzed secondary data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 database. The hs-CRP/HDL-C index was calculated by the quotient of hs-CRP and HDL-C. Multiple logistic regression models, Cochran-Armitage trend tests, smooth curve fitting, threshold effect analyses, and stratified analyses were used to evaluate whether the hs-CRP/HDL-C index associated with MASLD and advanced liver fibrosis. The study cohort comprised 3684 participants, of whom 1268 (34.42%) were diagnosed with MASLD and 156 (12.28%) with advanced liver fibrosis. Logistic analyses adjusted for covariates revealed positive associations of the hs-CRP/HDL-C index with MASLD and advanced liver fibrosis, consistent across all subgroups. Smooth curve fitting and threshold effect analyses revealed nonlinear relationships of hs-CRP/HDL-C index with MASLD and advanced liver fibrosis, with inflection points at 0.8 for MASLD and 1.2 for advanced liver fibrosis. Additionally, significant interactions were observed between MASLD and covariates such as gender, smoking status, chronic kidney disease (CKD), and cancer. Similarly, the hs-CRP/HDL-C index exhibited positive correlations with advanced liver fibrosis across diverse subgroups, with notable interactions related to cancer. MASLD and advanced liver fibrosis were associated with hs-CRP/HDL-C index, indicating its potential utility as a clinical marker for these conditions.

Evaluation of claims-based frailty measurements in older patients with cancer: a retrospective cohort study.

Frailty is associated with poor outcomes in older adults with cancer. Several efforts have been made to assess frailty using the administrative claims data based on the number of clinical diagnosis codes, yet the literature reporting on this is scarce. This study aimed to evaluate the impact of frailty measures using administrative databases in Japan. A retrospective cohort study. 5176 patients with cancer aged ≥65years who underwent cancer treatment in hospitals. The Electronic Frailty Index (eFI) and Veterans Affairs Frailty Index (VA-FI), based on diagnostic codes recorded were calculated. We plotted Kaplan-Meier survival curves and calculated hazard ratios (HR) using Cox regression analyses. The primary outcome was mortality, whereas the composite secondary outcome included a decline in care-need level, admission to a long-term care facility (LTCF) or mortality. The Kaplan-Meier survival curve demonstrated a significant association between the eFI and VA-FI and each research outcome. Compared to the lowest frailty group, the highest frailty group exhibited an HR of 2.59 [95% confidence interval (CI), 1.66-4.06] for eFI and 2.45 (95%CI, 1.02-5.91) for VA-FI in relation to a decline in care-need level, an LTCF admission and mortality. The trend test indicated a significant increase in the rate of each outcome with higher frailty levels. Higher frailty levels are associated with an increased risk of composite outcomes in older adults with cancer. This study suggests the potential application of frailty measurements in oncology care settings.

Global Dynamics of Grassland FVC and LST and Spatial Distribution of Their Correlation (2001–2022)

Fractional Vegetation Cover (FVC) and Land Surface Temperature (LST) are critical indicators for assessing grassland ecosystems. Based on global remote sensing data for FVC and LST from 2001 to 2022, this study employs the Mann–Kendall trend test and Spearman correlation analysis to explore the dynamic changes in and spatial distribution patterns of both variables. The results indicate that the FVC is increasing in regions such as Europe, the eastern southern Sahara, western India, eastern South America, western and southern North America, and central China. However, it is decreasing in southern Canada, the central United States, and northern Australia. Significant increases in LST are observed in subarctic regions and the Tibetan Plateau, attributed to polar warming effects associated with global climate change. Conversely, the LST is decreasing in central China, eastern coastal Australia, and southern Africa. The global FVC–LST relationship exhibits the following four distinct spatial distribution patterns: (1) FVC increase and LST increase (Type 1), (2) FVC increase and LST decrease (Type 2), (3) FVC decrease and LST increase (Type 3), and (4) FVC decrease and LST decrease (Type 4). Type 1, covering 33.72%, is primarily found in high-latitude and high-altitude areas, such as subarctic regions and the Tibetan Plateau. Type 2, the largest group (46.98%), is mainly located in eastern North America, eastern South America, and southern Africa. Type 3, which comprises 18.72%, is concentrated in arid and semi-arid regions, while Type 4, representing only 0.59%, lacks clear spatial distribution patterns.

Utilization of Radical Prostatectomy Versus Radiation Therapy for Gleason Grade Group 5 Prostate Cancer Before and After USPSTF Grade D Recommendation Against Prostate‐Specific Antigen Screening in 2012

ABSTRACTObjectivesThe 2012 United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate‐specific antigen (PSA) screening has resulted in a shift to higher‐stage prostate cancer (PC) at diagnosis. We evaluate the utilization of radical prostatectomy (RP) versus radiation therapy (RT) in the US for Gleason grade group 5 (GG5) prostate cancer before and after 2012.MethodsWe identified 34,011 men with localized GG5 PC undergoing primary therapy with (1) RP or (2) RT + androgen deprivation therapy (ADT) between 2004 and 2017 from the National Cancer Database. The chi‐square test was used to compare the relative use of RP and RT before versus after 2012. Annual use of RP versus RT from 2004 to 2017 was compared using Cochran‐Armitage test for trend. We modeled the effect of treatment year on the use of RP using multivariable logistic regression.ResultsAcross all centers, the use of RP increased from 31% to 41% (p for trend < 0.001). 2012 was associated with significant inflection for increase in RP use in all centers. There was an increased odds of receiving RP after 2012 (adjusted OR 1.34, 95% CI 1.28–1.40, p < 0.001).ConclusionsUtilization of RP for GG5 PC has significantly increased in the United States over the past decade. It remains unknown if outcomes may be compromised in this group of high‐risk men, many of whom require post‐prostatectomy RT and/or ADT. Prospective comparison of RP versus RT + ADT for GG5 PC are needed to determine optimal treatment for these patients.

Abstract TMP63: Genetic investigation for cerebral small vessel disease genes in patients with spontaneous intracerebral hemorrhage

Objectives: Spontaneous intracerebral hemorrhage (ICH) is caused by the rupture of small arterioles due to cerebral small vessel disease (SVD), commonly with hypertensive arteriolosclerosis (HTA) or cerebral amyloid angiopathy (CAA). Several genes associated with SVD or ICH have been reported in studies of European populations, but it is unclear whether these genes are associated with ICH in the Japanese cohort. The aim of this study was to assess genetic variants associated with SVD in patients with ICH. Methods: We analyzed 920 patients with primary ICH and genetic data available from an ongoing, prospective, cohort study. ICH was diagnosed according to CLASsification system for ICH (CLAS-ICH) by stroke neurologists, and mixed-SVD was classified as HTA. We focused on the 27 genes previously identified in SVD ( APOE, CETP, PMF1, SLC25A44, TRHDE, APP, NOTCH3, COL4A1, COL4A2, PARVB, FOXC1, FOXF2, TREX1, ZCCHC14, WDR12, ICA1L, GCH1, SH2B3, ACOX1, UNC13D, TRIM65, TRIM47, WBP2, PLEKHG1, EFEMP1, VCAN, HTRA1 ) to investigate their association with the ICH phenotypes (ICH subtypes [HTA-ICH vs. CAA-ICH], hematoma location [non-lobar vs. lobar], modified Rankin Scale (mRS) at 90d [0-4 vs. 5-6]). Variants with minor allele frequency ≥0.05 were analyzed. Trend test was used to assess the association, and the significance level was defined as false discovery rate (FDR) <0.1. The reference allele was defined as a base allele of odds ratio (OR). Results: Characteristics of 920 patients with ICH are mean age 71 ± 13 years, 59% men, HTA-ICH vs. CAA-ICH:88% vs. 10%, non-lobar vs. lobar: 74% vs. 26%, and mRS 0-4 vs. 5-6: 78% vs. 22%. We assessed the 667 variants in 27 genes. In CAA-ICH vs HTA-ICH, two variants on APP (amyloid-β protein precursor) gene showed significance. One was rs2830008 (NM_000484:c.865+2696A>G, OR=2.67, p=5.9×10 -6 , FDR=0.039) and the other was rs73163761 (NM_000484:c.866-7085C>T, OR=2.59, p=1.9×10 -4 , FDR=0.064). These 2 variants were in linkage equilibrium (r 2 =0.93). The alternative allele frequencies of rs2830008: T>C and rs73163761: G>A were 0.182 vs. 0.077 and 0.166 vs. 0.071 in CAA-ICH vs. HTA-ICH, respectively, with the HTA-ICH frequencies aligning with those of the general population (0.081, 0.072, respectively). No significant association was observed for other phenotypes. Conclusion: We found that 2 variants on APP genes were associated with CAA-ICH in the Japanese ICH cohort, confirming the link to amyloid β pathology.

Adverse events (AEs) –derived biomarker in predicting clinical outcomes in patients with colorectal cancer (CRC) treated with immunotherapy (IC).

132 Background: There are insufficient studies evaluating the role of AEs in CRC patients treated with IC. This study aims to transform AEs from traditional toxicity evaluation tools to informative biomarkers for assessing treatment efficacy by utilizing modern analytical strategies. Methods: We analyzed a single arm study of 51 mismatch repair proficient, refractory CRC patients (NCT03712943) treated with regorafenib and nivolumab. Data for analysis included CTCAE version 5 AE data, RECIST treatment response, progression-free survival (PFS), and overall survival (OS). Analytic approach leveraged multiple AE parameters to develop a set of innovative AE biomarkers. One AE biomarker of interest was treatment related low-grade early AEs (TR-LG-AE) which was defined as frequency of all TR-LG-AEs occurring between the 1st day and day 30 after the 1st treatment. Results: TR-LG-AE was associated with treatment response (p<0.001 by ANOVA trend test). Patients with higher AE events tended to be a responder, compared to PD patients with a lower frequency of AE events. The TR-LG-AE also correlated with improved PFS and OS with hazard ratio of 0.83 (p=0.01) and 0.89 (p=0.03), respectively. Accordingly, patients were grouped into high versus low TR-LG-AE based on optimal cutoff of 6 events for further analysis. The dichotomized TR-LG-AE (high vs low) showed significant association with survival outcomes (median PFS: 15.3 vs 3.7 months; p<0.001; median OS: 21.9 vs 9 months; p=0.02). Further interaction analysis showed patients with high TR-LG-AE had improved PFS regardless of occurrence of high-grade AE (HG-AE) (p=0.01), suggesting its independence of HG-AE. Individual AE analysis identified patients experienced with early low-grade rash maculo-papular, lipase increased, or hypertension had improved PFS (p<0.001). In biomarker analysis, one key mutation biomarker, RAS, did not show significant association with survival outcomes (PFS: p=0.66; OS: p=0.81). In contrast, integration with TR-LG-AE led to remarkable improvement. Specifically, the TR-LG-AE was able to help improve RAS classification by identifying patients with better treatment benefit. Specifically, patients with RAS mutation and high TR-LG-AE experiences had a median PFS of 15.3 months compared to others (median PFS of 3.7 months; p=0.007), and a median OS of 21.9 months compared to others (median OS of 9.4 months; p=0.04). Conclusions: The study demonstrated utility of AE in predicting clinical outcomes in CRC, similar to our previous findings in lung cancer. Moreover, it discovered that integration of AE-derived biomarkers with molecular biomarkers could produce a more robust classifier than when considered individually. This analysis is the first of its kind to identify subgroups of CRC patients that benefit from IC treatment.

Antimicrobial Drug Use and Changing Trends From 2021 to 2023-A Case Study of a General Hospital in Sichuan Province.

Antibiotic resistance (AR) is a growing concern as a result of the widespread and excessive use of antibiotics. Because of this, China's health authorities have implemented a number of antibiotic control measures, including a requirement that the intensity of antibiotic usage stay within 40.00 DDDs. This study, which used a tertiary general hospital in Sichuan Province as an example, examined the hospital's trend in antibiotic use from 2021 to 2023, the relationship between antibiotic use and hospitalization days and CMI, and the viability of 40.000 DDDs in light of the evolving medical landscape. Data were obtained through the hospital information system (HIS) and the hospital DRG system. Boston matrix diagrams were used to find the departments that needed to be focused on control, Cochran-Armitage trend test, and ANOVA to analyze the trends of AUR and antimicrobial use density (AUD) in the hospital over time in the last 3 years and to analyze the factors affecting the changes in antibiotic consumption. Over the previous 3 years, the hospital's antibiotic use rate varied between 40% and 50%, and its intensity of use varied between 40.000 and 50.000 DDDs, both of which were rather steady. January 2023 had a significant rise, with an AUD of 59.38 DDDs and an AUR of 61.80%. The second quadrant has eight departments. Each department's AUD varied dramatically; neurosurgery saw an increase annually (p < 0.05), abdominal wall surgery and gastrointestinal hernia procedures, obstetrics and gynaecologist, and ophthalmology saw a drop annually (p < 0.05). The average number of preoperative hospitalization days (r = 0.1402, p < 0.01) and the CMI (r = 0.4864, p < 0.001) were strongly connected with the AUD of surgical and nonsurgical departments, respectively. Hospitals should concentrate on the issue of surgical departments' lengthy preoperative prophylactic medication times. AUD management should also be dynamically modified based on CMI, particularly in departments in the second quadrant (low CMI and high AUD). Furthermore, it is challenging to maintain the hospital AUD target value of 40.00 DDDs under the new medical model, given the decline in hospitalization days of discharged patients and the high prevalence of infectious diseases. It is also unclear whether this target value is still appropriate given the current state of medicine.

Trends in surgery and overall survival in non-metastatic anal cancer: A population-based analysis.

3 Background: The incidence of anal cancer has recently exceeded &gt; 10,000 patients/year in the United States. For non-metastatic squamous cell carcinoma of the anal canal (SCCA), concurrent chemoradiotherapy (CRT) followed by abdominoperineal resection (APR) as salvage surgery for non-responders is a key treatment approach. Over the past two decades, findings from phase III trials (RTOG 98-11 and ACT II) have increased our knowledge about appropriate treatment approaches. ACT II indicated that delayed assessment of tumor response and consideration of APR up until 26 weeks is appropriate, as many patients demonstrate delayed response to treatment. Our analysis examines whether current evidence has influenced real-world clinical practice by analyzing trends in rates of primary APR and overall survival (OS) outcomes. Methods: We conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) registry, including patients diagnosed with non-metastatic SCCA between 2004 and 2020. Patients with T0 or T1N0 stage disease were excluded. Descriptive statistics were generated, and chi-square tests were used to compare characteristics between patients who underwent surgery and those who did not. Temporal trends in surgery and radiation therapy were analyzed using the Cochrane-Armitage trend test. Multivariable logistic regression was employed to identify factors associated with surgery uptake, while OS trends were analyzed using Kaplan-Meier and Cox proportional hazard models. Results: A total of 16,718 patients were included, with 33.1% requiring salvage APR following CRT. The proportion of patients requiring surgery significantly declined from 46.6% in 2004 to 31.1% in 2020 (p &lt; 0.001). Factors associated with surgery included younger age, male gender, and non-Hispanic Black race (p &lt; 0.001). Kaplan-Meier analysis revealed significant improvements in OS over the study period (log-rank p = 0.0002), with more recent years (2016-2020) associated with significantly better OS compared to earlier periods (2004-2007, HR = 0.77, p &lt; 0.001). Conclusions: The significant decrease in rates of salvage APR for non-metastatic SCCA likely reflects the global impact of recent phase III trials. Meanwhile, OS rates have been steadily improving. These findings suggest improved overall knowledge regarding treatment strategies and highlight the real-world impact of clinical investigation in non-metastatic squamous cell carcinoma of the anal canal.

Abstract TP169: Presence of a Mismatch Perfusion Profile in Large Core Ischemic Stroke Over Time Significantly Varies by Mismatch Definition

Introduction: The prevalence of Mismatch (MM) profiles on admission perfusion imaging in large core ischemic strokes, stratified by time since last known normal (LKN) and MM profile definition, is not well described. Methods: We used a retrospective multicenter study of patients with anterior circulation large vessel occlusion, baseline MR or CT perfusion (MRP, CTP), and definitive LKN within 24 hours. We studied four MM profile definitions: 1) Mismatch ratio (MR)≥1.2, penumbral volume (Pen)≥10ml, and (if CTP) core volume defined by CBF&lt;30%; 2) MR≥1.8, Pen≥15ml, CBF&lt;30%; 3) MR≥1.2, Pen≥10ml, CBF&lt;38%; 4) MR≥1.8, Pen≥15ml, CBF&lt;38%. Two definitions of large core were evaluated (≥50ml or ≥70ml; defined as CBF&lt;30% or CBF&lt;38% on CTP and as ADC ≤620x10 -6 mm 2 /s on MRP). We used the Cochran-Armitage Trend Test to evaluate for trends in MM presence over time and McNemar Test to compare MM profiles for differences in prevalence. Results: Of 2012 patients included, 49% were male, median age was 75 (IQR 64-84), median baseline NIHSS was 15 (8-20), median time from LKN to imaging was 5.7 hours (1.8-8), 44% had CTP. In patients with cores ≥50ml and ≥70ml (Figures 1&amp;2), MM profile defined by MR≥1.2 and Pen≥10ml was more prevalent than MM defined by MR≥1.8 and Pen≥15ml (P&lt;0.001). MM prevalence decreased over time in three of four MM profiles in the ≥50ml core group but only one MM profile in the ≥70ml group (P&lt;0.001 in all comparisons). In all core sizes (Figure 3), there was a significant trend toward decreased MM prevalence over time in all four profiles (P&lt;0.0001) and between the MR≥1.2 and Pen≥10 vs MR≥1.8 and Pen≥15 profiles (P&lt;0.001 in all comparisons). Similar significant differences between the MR≥1.2 and Pen≥10 vs MR≥18 and Pen≥15 existed in CTP only, MRP only, and witnessed onset only subgroup analyses (P&lt;0.001 for all). Conclusions: MM is more prevalent when defined as MR≥1.2 and Pen≥10ml than when defined as MR≥1.8 and Pen≥15ml, especially in large cores. MM prevalence decreases over time in all core sizes, though trends are less clear with increasing infarct size. Understanding real-world prevalence of MM in large core strokes may help contextualize results of recent trials, while clarifying the optimal definition and prevalence of MM in the large core population is of import to future prospective study design. This study is limited by potential bias in favor of higher MM presence due to one site’s patient transfer acceptances contingent on favorable CTP profiles.

Impact of time to surgery on outcomes in patients with advanced esophageal squamous cell carcinoma following neoadjuvant therapy: An exploratory analysis of phase III trial JCOG1109.

458 Background: JCOG1109, a multicenter three-arm phase III trial, evaluated three neoadjuvant treatment regimens for advanced esophageal squamous cell carcinoma (ESCC), cisplatin and 5-fluorouracil (CF), docetaxel, cisplatin, and 5-fluorouracil (DCF), and cisplatin, 5-fluorouracil, and radiation therapy (CF-RT). The trial demonstrated the superiority of neoadjuvant DCF therapy in improving overall survival (OS). This exploratory analysis investigates the impact of the interval time from completion of neoadjuvant therapy to surgery (time to surgery, TTS) on both short- and long-term outcomes across different neoadjuvant therapy regimens. Methods: This analysis included patients from JCOG1109 who underwent surgery after neoadjuvant therapy. Patients were categorized into four TTS subgroups within each arm, based on quartiles of the overall cohort. Short-term outcomes such as perioperative complications, as well as long-term outcomes including OS and progression-free survival (PFS) were evaluated across these TTS subgroups. Results: Of the 601 patients enrolled in JCOG1109, 546 patients proceeded to surgery following neoadjuvant therapy. The median TTS was 35 days (range: 16-81) for the CF arm, 38 days (range: 17-109) for the DCF arm, and 41 days (range: 14-98) for the CF-RT arm. Baseline characteristics were well-balanced across all TTS subgroups in each treatment arm. Short-term outcomes revealed that operative time and overall proportions of postoperative complications were comparable. However, in the CF-RT arm, a longer TTS was associated with increased blood loss (200 ml, 210 ml, 300 ml, 370 ml; p-value for trend test = 0.010) and tended to increase the risk of anastomotic leakage (6%, 7%, 14%, 18%; p-value for trend test = 0.073). No significant differences in OS or PFS were observed across TTS subgroups in any treatment arm, with hazard ratios indicating no clear trend toward improved or worsened long-term outcomes. Conclusions: The timing of surgery following neoadjuvant therapy does not appear to affect long-term prognosis in patients with advanced ESCC, irrespective of the neoadjuvant therapy regimen. However, for patients undergoing neoadjuvant CF-RT, earlier surgery may be advantageous in reducing the risk of increased surgical complexity and anastomotic leakage.

Abstract WP98: Temporal Trends and Predictors of Door-in-Door-out Times for Interhospital Stroke Transfers in the Greater Cincinnati Northern Kentucky Stroke Study

Introduction: Acute treatment for stroke often requires emergent interhospital transfer for access to advanced therapies not available at the initial hospital. Prolonged transfer times have been associated with worse outcomes. Door-in-door-out time (DIDO: the amount of time a patient spends in the transferring emergency department [ED]) is an important quality metric in acute stroke care, with current recommendations for DIDO times ≤ 120 minutes. We sought to characterize trends and predictors of DIDO times for interhospital stroke transfers using the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS). Methods: We utilized data from the GCNKSS, a population-based epidemiologic stroke study, from the following time points: 1999, 2005, 2010, 2015, and 2020. Patients ≥18 years with acute ischemic stroke (AIS) or hemorrhagic stroke (HS) who presented to an initial ED and were not admitted but were transferred to another hospital were included. The primary outcome was DIDO time. Temporal trends in DIDO time were tested using the Mann-Kendall trend test. Generalized linear mixed effects models with hospital-specific random intercepts were constructed to evaluate the associations between patient- and hospital-level covariates and DIDO time. Results: Of 13,678 stroke cases over the time periods studied, 1574 patients met inclusion criteria for the overall stroke group (mean age 64.7 [SD: 15.6], 51.6% female), with 851 (54.1%) having AIS and 723 (45.9%) HS. Over the time periods examined, the median DIDO time for the overall stroke group was 213 minutes (IQR 142-305), and DIDO times significantly increased over time (Figure 1; P&lt;.0001). In the overall stroke group, hospital-level factors explained 4.0% of the variation in DIDO time. In the multiple regression model, factors associated with increased DIDO time included: history of prior stroke (+33.6 minutes; P&lt;.0001) and receipt of MRI prior to transfer (+165.7 minutes; P&lt;.0001); whereas EMS transport (-30.0 minutes; P&lt;.001) and increasing NIHSS score (P&lt;.0001) were associated with decreased DIDO time. Results were similar for AIS and HS subgroups (Table 2). Conclusions: In this population-based epidemiologic study, DIDO times exceeded recommended time targets and increased over time. Hospital-level factors accounted for only a minor proportion of the overall variation in DIDO times, suggesting that future quality improvement efforts should target modifiable clinical and systems factors to improve DIDO times.

Artificial Intelligence‐Supported Student Engagement Research: Text Mining and Systematic Analysis

ABSTRACTArtificial intelligence (AI) is increasingly exploited to promote student engagement. This study combined topic modelling, keyword analysis, trend test and systematic analysis methodologies to analyse AI‐supported student engagement (AIsE) studies regarding research keywords and topics, AI roles, AI systems and algorithms, methods and domains, samples and outcomes. Findings included the following: (1) frequent‐used and emerging keywords comprised ‘machine learning’, ‘artificial intelligence chatbot’ and ‘collaborative knowledge building’. (2) Frequently studied topics included ‘AI for MOOCs and self‐regulated learning’ and ‘affective computing and emotional engagement’. (3) Most studies adopted intelligent tutoring systems, traditional machine learning methods and natural language processing. (4) Emotional engagement regarding affective or psychological states among college students received the most attention. (5) Most studies adopted quantitative approaches and concerned computer science and language education. Accordingly, we highlighted AI's roles as tutors, advisors, partners, tutees and regulators for behavioural, cognitive and emotional engagement to inspire AI's effective integration into education.

The Association of moisture intake and constipation among us adults: evidence from NHANES 2005–2010

BackgroundConstipation is a common gastrointestinal disorder that affects the quality of life of millions of adults worldwide. Dietary moisture intake is considered to have a significant impact on intestinal health, yet its specific role in constipation has not been thoroughly investigated in large-scale population studies. This study aims to explore the correlation between adult dietary moisture intake and constipation by analyzing the NHANES database, filling a knowledge gap in the literature.MethodsData from NHANES participants aged 20 years and older from 2005 to 2010 were analyzed. Moisture intake was assessed using dietary recall data, which included moisture from all food and beverages consumed. A weighted logistic regression model was used to assess the relationship between moisture intake and the risk of constipation, calculating the odds ratios (ORs) and their 95% confidence intervals (CIs), while controlling for potential confounders. Additionally, restricted cubic splines (RCS) were applied to further explore potential non-linear patterns in the relationship between moisture intake and constipation, along with subgroup analysis.ResultsThe study included 14,492 participants, of whom 1,514 reported constipation issues. After adequately adjusting for confounders, a significant negative correlation was observed between moisture intake and constipation risk (OR 0.81; 95% CI: 0.74–0.89). Quartile analysis of moisture intake demonstrated that, compared to the first quartile Q1 (0.06 to 1.90 kg), the constipation risk for the second quartile Q2 (1.91 to 2.53 kg), third quartile Q3 (2.54 to 3.36 kg), and fourth quartile Q4 (3.37 to 16.97 kg) were OR 0.80 (95% CI: 0.64–0.72), OR 0.57 (95% CI: 0.45–0.72), and OR 0.54 (95% CI: 0.44–0.67) respectively, with a trend test P-value ofless than 0.001. RCS regression revealed a significant non-linear negative relationship between moisture intake and constipation prevalence (P < 0.001). Depression may modulate the relationship between moisture and constipation (interaction effect P = 0.014).ConclusionThe findings of this study indicate that appropriate dietary moisture intake is significantly associated with a lower risk of constipation, demonstrating a dose-response relationship. This emphasizes the importance of considering adequate moisture intake in the prevention and management of constipation. Future studies should adopt a prospective design to further verify the causal relationship between dietary moisture intake and constipation progression.

Twenty year trends in prevalence and incidence of diabetic retinal disease.

To determine how the rates of diabetic retinal disease (DRD) and its vision-threatening components (VTDR), diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) among patients with diabetes mellitus (DM) have changed over the past 20 years. Retrospective cohort study. All individuals in a US administrative medical claims database comprised of patients insured by commercial and Medicare Advantage insurance plans from 2000-2022 with DM and at least one full calendar year of data. Cohorts of patients with DM were created using ICD codes to determine the yearly prevalence and incidence of DRD, VTDR DME, and PDR. Logistic and Poisson regression models were used to create prevalence and incidence estimates, respectively. The main outcomes were the unadjusted prevalence and incidence of DRD, DME, and PDR. Among patients with DM, the prevalence of DRD initially decreased from 2001 (13.6%) to 2007 (10.9%) but then increased every year through 2021 (20.8%)(adjusted test for trend[aTT] p<0.001). DRD incidence varied considerably, ranging from 17.7 cases/1000 patient-years in 2013 to its highest of 32.2 in 2022 (aTT p<0.001). The prevalence of VTDR and DME trended similarly, with increases from 2007 (VTDR:5.2%; DME:3.2%) through 2016 (VTDR:7.5%; DME:5.4%) followed by decreases each year through 2021 (VTDR:6.9%; DME:4.9%)(aTT p<0.001). The VTDR and DME incidence rates also tracked similarly, with multi-year peaks in 2009 (VTDR:12.4; DME:8.6) and general decreases through 2022 (VTDR:6.1; DME:5.0)(aTT p<0.001 for both VTDR and DME). PDR prevalence varied between 3.2% and 4.0% throughout the 20-year observation, measuring 3.5% in 2021(aTT p<0.001). PDR incidence varied from 8.3 in 2002 to 7.0 in 2008, then decreased every year to 2.6 in 2022 (aTT p<0.001). DRD Prevalence (through 2007) and incidence (through 2014) initially decreased, but the rate of each has since doubled. Despite increases in DRD, incidence rates of VTDR, DME, and PDR have dramatically improved over the past 20 years.

Psychopathy as a bipolar construct: Testing the risk-promotive status of the four psychopathy checklist-revised/screening version facet scores in six clinical samples.

This study tested the possibility that the four facets of the Psychopathy Checklist-Revised/Screening Version (PCL-R/SV) serve as bipolar constructs in predicting future criminal justice outcomes. Organizing scores on the four facets (Interpersonal, Affective, Lifestyle, and Antisocial) into three categories-that is, lowest 25% of cases (best category), highest 25% of cases (worst category), and middle 50% of cases (intermediate category)-we tested bipolarity by crossing the three categories with a dichotomized crime/violence outcome and calculating both promotive (best category vs. worst + intermediate categories) and risk (worst category vs. best + intermediate categories) effects in six samples. Bipolarity was defined as the simultaneous presence of promotive (low scores predicting a good outcome) and risk (high scores predicting a poor outcome) effects for each PCL-R/SV facet in each sample. Odds ratios and the Cochrane-Armitage linear trend test revealed evidence of bipolarity in one of six samples for the Interpersonal facet, three of six samples for the Affective facet, five of six samples for the Lifestyle facet, and all six samples for the Antisocial facet. An item response theory analysis was then conducted, the results of which supported the facet-level findings from the odds ratio and Cochrane-Armitage analyses at the individual item level. These results provide modest (Affective facet) to moderately strong (Lifestyle and Antisocial facets) evidence of bipolarity in three of the four facets of the PCL-R/SV by showing that low scores are just as effective in predicting good criminal justice outcomes as high scores are in predicting poor criminal justice outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

P-1666. Hematology-Oncology Unit-Specific Antibiogram: A Decade of Experience at a Large Academic Medical Center

Abstract Background Antibiograms are an important stewardship tool that can inform optimal empiric therapy; most antibiograms are hospital-wide. Unit-specific antibiogram data for unique patient populations including intensive care unit and pediatrics is robust; however, published experience with unit-specific antibiograms in the hematology-oncology (heme-onc) population is limited. These patients are unique because of the common use of antimicrobial prophylaxis, prolonged broad-spectrum antibiotics, and an immunocompromised state. We sought to examine the trends in antibiogram antimicrobial susceptibility over time. Methods This retrospective quality initiative included microbiology results (first isolates per patient per timeframe) from Mayo Clinic Rochester from 2012 to 2022. Eligible cultures were those identified as being obtained from one of 8 hematology, oncology, or bone marrow transplant inpatient units. Agar dilution susceptibility testing and Clinical and Laboratory Standards Institute (CLSI) breakpoints were used. Screening PCRs (eg, VRE PCR) were excluded. Culture and susceptibilities were identified by an EMR based report, compiled annually, and reported for two-year periods. Susceptibility rates were compared using the Chi-square test and Chi-square analysis for trends. Results There were 4 gram-negative and 5 gram-positive organism groups that met CLSI antibiogram criteria of ≥ 30 isolates and were included (tables 1-4). There were several significant differences in comparison to the hospital-wide antibiogram, with lower antibiotic susceptibility rates in the heme-onc units for multiple organisms, notably fluoroquinolones to E.coli and P. aeruginosa and several cephalosporins to Enterobacterales as well as penicillin and levofloxacin to Viridans group Streptococcus and vancomycin to E. faecium (tables 1&amp;2). Over the period of 2012-2013 to 2021-2022, susceptibility rates remained stable among the heme-onc antibiogram, with few significant changes (tables 3&amp;4). Conclusion Heme-onc antibiograms illustrated susceptibility rate differences compared to our hospital-wide antibiograms, particularly for antimicrobials used as prophylaxis. Through population-specific antibiograms, providers may be able to improve empiric antibiotic selection. Disclosures Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Board Member

The temporal change of heat exposure and adaptation capacity in Chinese adults from 1994 to 2023

BackgroundStudies have found decreased heat effect and increased minimum mortality temperature (MMT) during the past decades. However, it is unclear whether heat exposure or temperature adaptation play an important role in this change.MethodsThis is a cross-sectional study. Data were collected from 3,094 respondents aged 31–64 years old based on online questionnaire. The Cochran-Armitage test for trend and Cochran–Mantel–Haenszel (CMH) test were used for the difference between three decades. The Chi square test was employed to compare the difference between different demographic subgroups during 2014–2023. Multivariate logistic regression model was used to analyze the risk factors of air conditioner ownership.ResultsMost respondents (94.6%) thought ambient temperature had been increasing, and 57.0% people thought climate change impacted their health. Long duration outdoors work (≥4 h) decreased from 36.01, 30.93 to 24.53% (Z = −9.80, p &amp;lt; 0.01) and bicycling/walking decreased from 62.3, 27.9, to 9.7% (CMH value = 156.40, p &amp;lt; 0.01) significantly during the last three decades. Temperature adaptation capacity increased with air conditioner ownership rates increasing from 25.40, 57.63 to 81.51% at home (Z = −44.35, p &amp;lt; 0.01) and from 22.24, 57.47 to 80.51% in the office/school (Z = −45.95, p &amp;lt; 0.01), and the older adult, women, people with low income, outdoor work, low education, and people from northern China had lower air conditioner ownership rates. The frequency of air conditioner usage when felt hot also escalated significantly both at home (from 42.6%, 54.9, to 63.4%, CMH value = 156.40, p &amp;lt; 0.0001) and in the office/school (from 61.8, 63.1 to 72.7%, CMH value = 65.29, p &amp;lt; 0.0001) during the same periods.ConclusionOur study found that most people perceived climate change and changed behaviors to adapt to heat. Heat exposure significantly decreased and temperature adaptation capacity significantly increased during the last decades. The findings implied that heat-related health risk and burden driven by global warming may not increase in the future.

A Decade of Oocyte Cryopreservation: New Horizons in Patients Accessing Care.

Objective: Utilization of fertility preservation treatments has increased since the American Society for Reproductive Medicine lifted the "experimental" label for oocyte cryopreservation in 2012. This study characterizes changes in insurance coverage, clinical outcomes, and live birth probabilities over a span of a decade (2012-2022) in patients who underwent planned oocyte cryopreservation. Methods: Retrospective analysis of planned oocyte cryopreservation cycles using vitrification from 2012 to 2022. Medically indicated cycles were excluded. Age, anti-mullerian hormone (AMH), number of mature oocytes vitrified, and insurance coverage were evaluated by year of procedure. Comparative statistics were performed using Kruskal-Wallis and chi-square analysis. Linear regression models and Cochran-Armitage trend test were performed to determine the relationships between each variable and time. Result(s): A total of 4,544 planned oocyte cryopreservation cycles were included. Mean age at egg retrieval decreased significantly over time (37.9 ± 2.9 years versus 34.9 ± 3.3, p < 0.0001). Mature oocytes frozen per cycle rose significantly over time (10.7 ± 7.4 in 2012 versus 13.3 ± 8.6 in 2022, p ≤ 0.0001). Cycles with insurance coverage significantly increased, 0% covered in 2012 versus 46.9% covered in 2022 (p ≤ 0.0001). Conclusions: Since 2012, patient age at time of egg freezing has decreased, coinciding with a mean increase in AMH and number of mature oocytes frozen per cycle. Younger participation in extending fertility is likely driven by a boost in social awareness regarding reproductive aging, cryopreservation technologies, and improved access to treatment. Modern oocyte cryopreservation includes more access to insurance coverage, shown by nearly half of current cycles benefiting from plan support. Shifts in patient demographics and insurance coverage, paired with updates to stimulation protocols that optimize oocyte yield, are expected to improve the overall prognosis and future fertility of patients who utilize thawed oocytes.