Time Trends Research Articles

Epidemiology and demographic patterns of cardiovascular diseases and neoplasms deaths in Western Europe: a 1990–2019 analysis

ObjectivesCardiovascular diseases (CVDs) and neoplasms have been considered as public health concerns worldwide. This study aimed to estimate the epidemiological patterns of death burden on CVDs and neoplasms and its attributable risk factors in Western Europe from 1990 to 2019 to discuss the potential causes of the disparities. Study design and methodsWe collected data on CVDs and neoplasm deaths in 24 Western European countries from the Global Burden of Disease Study. We analyzed patterns by age, sex, country, and associated risk factors. The results include percentages of total deaths, age-standardized death rates per 100,000 population, and uncertainty intervals (UIs). Time trends were assessed using annual percent change. ResultsIn 2019, CVDs and neoplasms accounted for 33.54% and 30.15% of Western Europe's total deaths, with age-standardized death rates of 128.05 and 137.51 per 100,000. Over 1990–2019, CVD rates decreased by 54.97%, and neoplasm rates decreased by 19.54%. Top CVD subtypes were ischemic heart disease and stroke; top cancers for neoplasms were lung and colorectal. Highest CVD death burdens were in Finland, Greece, Austria; neoplasm burdens in Monaco, San Marino, Andorra. The major risk factors were metabolic (CVDs) and behavioral (neoplasms). Gender differences revealed higher CVD death burden in males, while neoplasm burden varied by risk factors and age groups. ConclusionIn 2019, CVDs and neoplasms posed significant health risks in Western Europe, with variations in death burdens and risk factors across genders, age groups, and countries. Future interventions should target vulnerable groups to lessen the impact of CVDs and neoplasms in the region.

Global, regional, and national burden of thalassemia, 1990–2021: a systematic analysis for the global burden of disease study 2021

Anemia is a significant contributor to the global disease burden, of which thalassemia is the most common hereditary anaemic disease. Previous estimates were based on data that were geographically limited and lacked comprehensive global analysis. This study provides the prevalence, incidence, mortality and disability-adjusted life years (DALYs) of thalassemia in 204 countries and regions of thalassemia between 1990 and 2021, focusing on the age structure and time trends of the disease burden. To provide effective information for health policy, allocation of medical resources and optimization of patient management programs. Using the standardised Global Burden of Disease (GBD) methodologies, we aimed to derive a more precise representation of the health burden posed by thalassemia by considering four distinct types of epidemiological data, namely the incidence at birth, prevalence, mortality and DALYs. The presented data were meticulously estimated and displayed both as numerical counts and as age-standardised rates per 100,000 persons of the population, accompanied by uncertainty interval (UI) to highlight potential statistical variability. The temporal trends spanning the years 1990-2021 were subjected to a rigorous examination utilizing Joinpoint regression analysis. This methodological approach facilitated the computation of the annual percentage change (APC) and the average annual percentage change (AAPC), along with their corresponding 95% confidence intervals (CIs). Globally, the age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALYs rates for thalassemia in 2021 were 18.28 per 100,000 persons (95% UI 15.29-22.02), 1.93 per 100,000 persons (95% UI 1.51-2.49), 0.15 per 100,000 persons(95% UI 0.11-0.20), and 11.65 per 100,000 persons (95% UI 8.24-14.94), respectively. Compared to 1990, these rates have decreased by 0.18 (95% UI-0.22 to-0.14), 0.25 (95% UI-0.30 to-0.19), 0.48 (95% UI-0.60 to-0.28), and 0.49 (95% UI-0.62 to-0.29) respectively. In 2021, the ASIR of thalassemia was highest in East Asia at 7.35 per 100,000 persons (95% UI 5.37-10.04), and ASMR was highest in Southeast Asia at 0.37 per 100,000 persons (95% UI 0.29-0.45).Gender comparisons showed negligible differences in disease burden, with the highest prevalence noted in children under five, decreasing with age. The global ASPR and ASMR declined from 1990 to 2021 overall, though an increasing trend in prevalence was found among the elderly. Joinpoint analysis revealed that the global ASPR increased between 2018 and 2021 (APC=9.2%, 95% CI: 4.8%-13.8%, P<0.001), ASIR decreased (APC=-7.68%, 95% CI:-10.88% to-4.36%, P<0.001), and there was a significant rise in ASMR from 2019 to 2021 (APC=4.8%, 95% CI: 0.1%-9.6%, P<0.05). Trends in ASPR and ASMR varied across regions, with notable changes in South Asia. The global burden of thalassemia, reflected in its prevalence, incidence, mortality, and DALYs, exhibits significant disparities. Geographic and demographic shifts in disease distribution have been observed from 1990 to 2021, with an overall decrease in burden, yet an increase in cases among the elderly population. Analysis of epidemiological trends over time highlights the influence of health policies and significant public health interventions on thalassemia outcomes. There data are crucial for healthcare professionals, policymakers, and researchers to refine and enhance management strategies, aiming to further mitigate thalassemia's global impact. National Natural Science Foundation of China; Guizhou Province Science and Technology Project; Guizhou Province Science and Technology Foundation of Health Commission.

Continuous service-based process monitoring using Pareto analysis and start-end case diagram

PurposeThe purpose of this study is to offer a straightforward, cost-effective, and feasible resolution for managers to assess their processes in a live manner using the process mining technique and to identify anomalies in cases that deviate from the standard. Consequently, the findings of this research can be utilized by organizational managers, while process mining vendors can also leverage it as a feature for their solutions.Design/methodology/approachOur two-step method is designed to initially evaluate the level of standardization within the process, followed by identifying its underlying cause. These two steps are aimed at helping managers effectively evaluate their business processes. The steps are: (1). Start-End Case Diagram: This diagram allows for the evaluation of the lead time trend and identification of cases that deviate from the standard trend line in a service-based process. (2). Happy Path Analysis: Pareto law is suggested to identify the most frequent process variants.FindingsThis approach enables organizations to easily identify problematic cases and investigate bottlenecks when deviations from the standards occur.Originality/valueThe novelty of the paper lies in the introduction and utilization of the start-end case diagram, as well as the combination of this diagram with the Pareto law for the identification of happy path and root cause analysis.

The Influence of Fatigue, Recovery, and Environmental Factors on the Body Stability of Construction Workers

In the construction industry, falls, slips, and trips (FST) account for 42.3% of all accidents. The primary cause of FST incidents is directly related to the deterioration of workers’ body stability. To prevent FST-related accidents, it is crucial to understand the interaction between physical fatigue and body stability in construction workers. Therefore, this study investigates the impact of fatigue on body stability in various construction site environments using Dynamic Time Warping (DTW) analysis. We conducted experiments reflecting six different fatigue levels and four environmental conditions. The analysis process involves comparing changes in DTW values derived from acceleration data obtained through wearable sensors across varying fatigue levels and construction environments. The results reveal the following changes in DTW values across different environments and fatigue levels: for non-obstacle, obstacle, water, and oil conditions, DTW values tend to increase as fatigue levels rise. In our experiments, we observed a significant decrease in body stability against external environments starting from fatigue Levels 3 or 4 (30% and 40% of the maximum failure point). In the non-obstacle condition, the DTW values were 9.4 at Level 0, 12.8 at Level 3, and 23.1 at Level 5. In contrast, for the oil condition, which exhibited the highest DTW values, the values were 10.5 at Level 0, 19.1 at Level 3, and 34.5 at Level 5. These experimental results confirm that the body stability of construction workers is influenced by both fatigue levels and external environmental conditions. Further analysis of recovery time, defined as the time it takes for body stability to return to its original level, revealed an increasing trend in recovery time as fatigue levels increased. This study quantitatively demonstrates through wearable sensor data that, as fatigue levels increase, workers experience decreased body stability and longer recovery times. The findings of this study can inform individual worker fatigue management in the future.

Safety and surgical outcomes of robotic adrenalectomy from a 15-year experience at a single institution

Robotic adrenalectomy (RA) has gained significant popularity in the management of adrenal gland diseases. We report our experience at a single tertiary institution and evaluate the safety and surgical outcomes of RA. The data of 122 consecutive patients who underwent RA from October 2009 to December 2022 at Korea University Anam Hospital (Seoul, Korea) were reviewed. There were no perioperative complications. Clinicopathological features and surgical outcomes were retrospectively analyzed through complete chart reviews. Noteworthy findings include the influence of sex, tumor size, and body mass index on operation time, with the female and small tumor groups exhibiting shorter operation times (P = 0.018 and P = 0.009, respectively). Pheochromocytoma was identified as a significant independent risk factor for a longer operation time in the multivariate analysis [odds ratio (OR), 3.709; 95% confidence interval (CI), 1.127–12.205; P = 0.031]. A temporal analysis revealed a decreasing trend in mean operation times across consecutive groups, reflecting a learning curve associated with RA adoption. RA is a safe and effective operative technique alternative to laparoscopic adrenalectomy that has favorable surgical outcomes and enhances the convenience of the operation.

Reasons for alcohol use from 1976 to 2020 in the United States among individuals aged 18 to 30: Historical changes and mediation of cohort effects in binge drinking.

Alcohol use is declining among US adolescents/early young adults and increasing among other adults, with increases in adult binge drinking more concentrated in females than males. Reasons for drinking are historically patterned by age and sex, and if historically variant, could suggest that changes over time could in part explain age- and sex-differential cohort effects. We analyzed longitudinal Monitoring the Future data for individuals born from 1958 to 1990. These individuals were aged 29/30 from 1987 to 2020, and first surveyed at age 18 from 1976 to 2008 (N = 14,190). Five reasons for drinking were analyzed (social, enhancement, avoid problems, relax, boredom). Drinking for social reasons and to relax were most prevalent. Total effects of birth cohort predicting past-2-week binge drinking were estimated with polynomial regression models by age;indirect effects through mediators were estimated. Drinking reasons exhibited dynamic time trends across birth cohort and sex. Notable increases were observed in social reasons: among women aged 29/30, social reasons increased from 53% to 87% from 1987 to 2020. Social reasons to drink had prominent positive indirect effects at adult ages (age 23/24 and above among men; age 19 and above among women), indicating that binge drinking would have increased less were it not for the increase in social reasons for drinking. Social reasons also mediated adult male/female differences, indicating that part of the reason sex differences are diminishing is the more rapid increases in social reasons for drinking among women. Indirect effects were also observed for drinking to relax and for boredom, and limited indirect effects were observed for enhancement and to avoid problems. Changing endorsement of drinking reasons, especially social reasons, among US adult drinkers mediate cohort effects in binge drinking in the US adult population and explain in part why binge drinking is converging by sex.

Time-trends of sex differences in stroke risk in atrial fibrillation: Are female patients still at higher risk today? A nationwide cohort study

Abstract Background Female sex is associated with higher risk of stroke in patients with atrial fibrillation (AF), particularly in the presence of other stroke risk factors. This has implications for oral anticoagulant treatment (OAC) decision-making, based on points of the CHA2DS2-VASc score. However, stroke rates have declined over recent years, and management has evolved over time towards a holistic approach that may have diminished the sex differences in AF-related stroke. Purpose To examine the changes in stroke risk over time in relation to risk differences between males and females not treated with oral anticoagulants in a nationwide cohort study. Methods This was an observational cohort study including patients with a hospital diagnosis of AF between 2007 and 2021. Data were obtained from the Danish nationwide registries. We identified a cohort of adult patients who were not receiving OAC treatment for up to 30 days after their AF diagnosis. Patients were followed up for thromboembolic events within one year after the AF diagnosis. Survival analysis was applied to describe the yearly rate of events and to estimate the risk ratio for females vs males of thromboembolism according to baseline risk levels, i.e., the CHA2DS2-VA score level (leaving out the ‘Sc’ sex criterion). Results A total of 188,704 AF patients (median age 75 years (IQR: 64 to 84); 49.7% female) who did not receive OAC treatment were included. The risk of thromboembolism during the entire study period was overall higher in females (3.5% in males vs. 4.7% among females). The overall one-year thromboembolic risk declined over time from 4.9% between 1997-2000 to 3.3% between 2017-2020, with male-female risk differences less evident in recent years (Figure 1a). The relative risk of stroke diminished from 1.22 (95%CI 1.10-1.34) in years 1997-2000 to 1.02 (95%CI 0.85-1.19) in years 2017-2020 for patients with a CHA2DS2-VA score of ≥2 (Figure 1b). For patients with a score of &amp;lt;2, the relative risk was lowest between 2005-2008 (1.02 (95%CI 0.63-1.42)) and was 1.18 (95%CI 0.54-1.83) in the latest time period. Formal statistical test for time trends according to score level revealed non-significant results (p-value=0.10 for score 0-1; p-value=0.17 for score levels of ≥2). Conclusion The risk of stroke among patients with AF has been declining over the last two decades. The excess stroke risk observed among females relative to males has also diminished, most evident among AF patients with ≥2 prevalent stroke risk factors.

Implementation of near zero fluoroscopy in supraventricular tachycardia ablation procedures: a single center experience

Abstract Background Supraventricular tachycardia (SVT) are common cardiac arrhythmias, and catheter ablation has proven to be a very effective treatment, but exposes patients and healthcare providers to radiation. "Near Zero Fluoroscopy" (NZF) techniques, utilizing advanced imaging, aim to reduce radiation exposure while maintaining efficacy. Purpose To present an analysis of near-zero fluoroscopy in SVT ablation procedures, in a tertiary center, since its implementation. Methods We prospectively enrolled 446 SVT-diagnosed patients for this study. All of them underwent NZF procedures using the same specific 3D mapping system, between January/19 and December/22. Patients with atrial fibrillation or macroreentrant atrial tachycardias or when a different mapping system was used, were excluded. All patients provided informed consent. Results Our population had 266 (60%) females and a median age of 39 (IQR 24-51) years. AVNRT was the most frequent arrhythmia documented (229 cases, 51%), followed by Accessory Pathways (AP) (201 cases, 45%) and focal atrial tachycardia (AT) (16 cases, 4%). The ablation success rate was high (405/418, 97%). There was no ablation attempt in 12 patients (9 APs and 3 ATs) and the unsuccessful ablations (7/418 cases, 1,67%) were APs. Overall, fluoroscopy time was 1.1 minutes (IQR 0-2.6). There was no statistically significant difference in the distribution of fluoroscopy time among the types of SVT based on the Kruskal-Wallis test (p 0.14). Observing trends of fluoroscopy use through time, we acknowledge the presence of a learning curve, leading towards shorter times of X-ray during procedures along the first 3 years of implementation of a near-zero strategy. Median times (IQR) of fluoroscopy were as follows: 2019 – 2.25 (0.45-3.4) min; 2020 – 1 (0-2.5) min; 2021 – 0 (0-1.9) min; 2022 – 0.55 (03.05) min. (see BoxPlot) Pairwise comparisons using the Wilcoxon rank-sum test with continuity correction revealed statistically significant differences in medians between all pairs of years, with p-values adjusted for multiple comparisons using the Bonferroni method (p&amp;lt;0.01). In 2022, fluoroscopy time increased, when compared to 2021. We believe this finding can be explained by the fact that in 2022, our department received a new fellow and a young EP consultant (coming from a center where NZF was not the standard for SVT ablation), both being in the lab on a daily basis, explaining this upward trend in fluoroscopy time. There were no acute complications requiring hospital admission or active treatment. Conclusion Our results emphasize the potential of near-zero fluoroscopy techniques to enhance safety and reduce radiation exposure while maintaining a high level of procedural efficacy in the treatment of SVT cases. Absence of acute complications highlighted the safety of these approaches.

Unveiling hotspots and trends in hip arthroscopy research: A bibliometric and visualized analysis (1900-2022).

Over the past 10 years, hip arthroscopy has been increasingly employed to effectively diagnose and safely treat a range of hip pathologies. With research related to hip arthroscopy continually expanding, the number of articles connected with hip arthroscopy has also consistently grown. We aimed to investigate trends and hotspots in hip arthroscopy-related research, and analyze the top 100 most-cited articles on hip arthroscopy. We searched for ("hip arthroscopy") AND ("article" OR "review") AND "English" in the Web of Science database from 1900 to 2022, which was used to obtain all publications relating to hip arthroscopy. Distribution of country, affiliated institution, journal, authors, citation frequency and keywords were analyzed using VOSviewer. A total of 1094 articles were selected from the Web of Science Core Collection (WoSCC) from 1900 to 2022. The number of publications concerning hip arthroscopy displayed an ascending trend over time. Among the countries, the United States emerged as the largest contributor to the number of articles. The highest prolific institution was American Hip Institute. Among the journals, the highest-ranking journal was "Arthroscopy-the Journal of Arthroscopic and Related Surgery," with 8316 citation counts and 262 articles. The area of greatest research interest was diagnosis and therapy in the field. The scientific articles on the subject of hip arthroscopy have risen continuously in recent years. The United States was the most influential country and made the most significant contributions to this field globally. We identified the research direction and trend for the first time and provided the most recent bibliometric analysis on hip arthroscopy, which may assist researchers in conducting studies on hip arthroscopy.

Swiss national cardiac device registry: changing trends in pacemaker and ICD procedures over the last two decades

Abstract Background The Swiss National Device and Ablation Registry (SwissEPnet) provides a comprehensive database for cardiac pacemaker and ICD procedures. All Swiss centers performing device implantations are obliged to provide their data in this web-based platform. The purpose of this study was to provide an in-depth look at pacemaker and Implantable -defibrillator (ICD) statistics and changing trends over the course of the last 20 years. Methods and Results We analyzed the database of pacemaker and ICD procedures between January 1, 2003, and December 31, 2022. During the study period, a total of 124 458 pacemaker and cardiac resynchronization (CRT) procedures (mean age 77.7 years; 59.7% male) were performed in 73 centers while 29 133 ICDs and CRT-D procedures (mean age 63.63 years; 80.2 % male) were performed in 56 centers in Switzerland. While the number of pacemaker procedures doubled in 20 years and there has been a constant increase in the mean age of patients receiving a pacemaker, the number of ICD procedures has more than tripled and now plateaued with a mean age which remained stable over time. Throughout the study period, the main indications for de novo pacemaker implantations were AV block in 41.7% of patients, followed by sick sinus syndrome combined with tachy-bradycardia syndrome (29.6%) and atrial fibrillation (AF) with slow ventricular conduction (13.7%). The main indication for ICD implantation was primary preventive (66.7%). Since 2016 there has been a decline in primary preventive interventions. Fluoroscopy and procedure durations remained stable over time in pacemaker and ICD procedures. Newer technologies, such as leadless pacemakers and CRT procedures required more fluoroscopy time, but this has also decreased over time. While regular battery changes remained stable (80% in pacemakers, 68% in ICDs), the proportion of DDD and CRT upgrades has increased. The overall reintervention rate due to device-associated infections was 2.4% in pacemaker- and 2.8% in ICD procedures. Since 2013, there has been a steady increase in lead removals/extractions, which were performed mainly due to device-related infections, but also because of lead dysfunctions and worsening electrical parameters. Conclusions In the last 20 years, there was a pronounced increase in the number of pacemaker procedures and a marked increase in the number of ICD procedures which has plateaued now. In younger technologies there is decreasing trend in fluoroscopy time by stable procedure times. Overall, there is a constant increase in mean age of patients receiving a pacemaker, while the mean age of patients receiving an ICD did not change during follow up. Female patients are constantly younger and undergo ICD implantation significantly less often than men. Despite of a stable infection rate, there has been a significant increase in lead removal and extractions in Switzerland.

Development of an Italian National Epidemiological Register on Endometriosis Based on Administrative Data

Background/Objectives: Endometriosis is a female chronic inflammatory disease in which endometrial tissue develops outside the uterine cavity. It is a complex pathology, which significantly contributes to morbidity in premenopausal women, leading to chronic pain, infertility, and subfertility negatively impacting physical and emotional well-being and the overall quality of life. The public health burden of endometriosis remains elusive and challenging to determine, and this uncertainty can lead to inadequate healthcare services and treatments. The objective was to estimate the incidence and prevalence of endometriosis in Italy using the hospital discharge records database via a population-based retrospective study, nationwide between 2011 and 2020. Methods: From the National Hospital Discharge Database, we selected all admissions with a diagnosis of endometriosis (ICD-9-CM, codes 617.x), supported by the presence of a procedure code of laparoscopy or any other surgical procedure allowing for direct visualisation of the lesions. The main outcomes measured: incidence and prevalence of endometriosis were estimated for the entire 2011–2020 period and by individual year, analysing the time trend and variability in different geographical areas of Italy. Results: There were a total of 134,667,646 women aged 15–50 years with one or more hospitalisations for endometriosis in all Italian hospitals. The incidence of endometriosis in Italy during this period was 0.839 per 1000 women (CI95% 0.834–0.844), exhibiting a statistically significant decreasing trend over the years. A discernible north–south gradient was observed, with higher rates documented in the northern regions. The prevalence rate stood at 14.0 per 1000 during the same period, and a similar north–south geographical gradient was identifiable in the prevalence rates as well. Conclusions: The utilization of national-level hospital data enables the generation of incidence and prevalence data for endometriosis without variations in methods and definitions, facilitating the evaluation of temporal trends and regional comparisons. Understanding and quantifying this phenomenon is essential for appropriate healthcare planning in various Italian regions.

#541 Secular trends in CKD and ESKD mortality rates in the United States, 2011–2021

Abstract Background and Aims Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) have a considerably higher mortality than the general population. Nevertheless, in the United States, mortality rates in the CKD and ESKD populations have declined steadily over the last decade until the onset of the COVID-19 pandemic [1]. Through a quantitative analysis of the age- and time-dependence of mortality rates in renal patient populations in the US, we aimed at quantifying trends in life expectancy between 2011 and 2021. Method We analysed CKD and ESKD mortality rates as reported in the US Renal Data System's (USRDS) Annual Data Report 2023 for the years 2011–2021 [1]. There, CKD mortality rates were determined from a Medicare 5% random sample (CKD stages 4 and 5) for patients aged 65 and above (“CKD 65+”). ESKD mortality rates were obtained from the USRDS database; we analysed data for patients aged 45 and above (“ESKD 45+”). We used fits of analytical functions to the data to hosphorzed their dependence on age and time. This technique enables us to extract quantitative trends in time by tracking fit parameters. Results We found that for each year between 2011 and 2021, mortality rates in the adult CKD and ESKD populations in the US largely conformed to an exponential dependence on patient age, $m = {{m}_0}( t ){{2}^{a/{{\Delta }}a}}$, that is, mortality rates doubled over constant age increments ${{\Delta }}a$. While overall, mortality rates were declining between 2011 and 2019, the age increments over which mortality rates doubled were nearly identical for each year (CKD 65+: ${{\Delta }}a$ = 10.5 ± 0.4 y, ESKD 45+: ${{\Delta }}a$ = 15.1 ± 0.9 y; mean ± SD). Exploiting this simple relationship, we found that the changes in mortality rates over time could largely be reduced to a steady right-shift of an otherwise unchanged mortality curve over time (shown for the ESKD 45+ group in Fig. 1a). By quantifying this right-shift over time, we estimated the gain in 1-year survival probability for different ages (Fig. 1b,c). This gain in survival does not necessarily imply a prolonged time on renal replacement therapy (RRT), e.g., when patients concomitantly start RRT at a later age. The onset of the COVID-19 pandemic in 2020 coincides with an abrupt cessation of these positive trends, reflected by a setback of mortality curves close to those in the year 2016 for the CKD population and to before 2011 for the ESKD population. Conclusion Public health data on CKD and ESKD show systematic dependencies of mortality rates on age and time, which can be revealed using analytical parameterisations of the data. Using this technique, we can capture trends in mortality rates and 1-year survival probability in adult kidney patient populations in the US during the years 2011–2019 and can quantify the abrupt cessation of these trends during the onset of the COVID-19 pandemic. In the CKD population we observed a setback of mortality rates close to those in the year 2016 with the onset of the pandemic. Changes in mortality rates in the ESKD population were more distinct. Specifically in elderly patients (aged 65 and above) 1-year survival dropped abruptly to levels lower than those observed in the previous decade.

Door to needle time trends after transition to tenecteplase: A Multicenter Texas stroke registry

BackgroundTenecteplase (TNK) is considered a promising option for the treatment of acute ischemic stroke (AIS) with the potential to decrease door-to-needle times (DTN). This study investigates DTN metrics and trends after transition to tenecteplase. MethodsThe Lone Star Stroke (LSS) Research Consortium TNK registry incorporated data from three Texas hospitals that transitioned to TNK. Subject data mapped to Get-With-the-Guidelines stroke variables from October 1, 2019 to March 31, 2023 were limited to patients who received either alteplase (ALT) or TNK within the 90 min DTN times. The dataset was stratified into ALT and TNK cohorts with univariate tables for each measured variable and further analyzed using descriptive statistics. Logistic regression models were constructed for both ALT and TNK to investigate trends in DTN times. ResultsIn the overall cohort, the TNK cohort (n = 151) and ALT cohort (n = 161) exhibited comparable population demographics, differing only in a higher prevalence of White individuals in the TNK cohort. Both cohorts demonstrated similar clinical parameters, including mean NIHSS, blood glucose levels, and systolic blood pressure at admission. In the univariate analysis, no difference was observed in median DTN time within the 90 min time window compared to the ALT cohort [40 min (30–53) vs 45 min (35-55); P = .057]. In multivariable models, DTN times by thrombolytic did not significantly differ when adjusting for NIHSS, age (P = .133), or race and ethnicity (P = .092). Regression models for the overall cohort indicate no significant DTN temporal trends for TNK (P = .84) after transition; nonetheless, when stratified by hospital, a single subgroup demonstrated a significant DTN upward trend (P = 0.002). ConclusionIn the overall cohort, TNK and ALT exhibited comparable temporal trends and at least stable DTN times. This indicates that the shift to TNK did not have an adverse impact on the DTN stroke metrics. This seamless transition is likely attributed to the similarity of inclusion and exclusion criteria, as well as the administration processes for both medications. When stratified by hospital, the three subgroups demonstrated variable DTN time trends which highlight the potential for either fatigue or unpreparedness when switching to TNK. Because our study included a multi-ethnic cohort from multiple large Texas cities, the stable DTN times after transition to TNK is likely applicable to other healthcare systems.

#520 Trends in kidney replacement therapy in Central and Eastern Europe—data from the ERA Registry

Abstract Background and Aims Despite huge efforts to accomplish equitable access to high-quality healthcare, large disparities in kidney care delivery remain across Europe. Economic factors are considered to be the driving force behind differences in access to kidney replacement therapy (KRT), with lower access in lower-income countries. There is a sparsity of epidemiological data on KRT in Central and Eastern Europe. Therefore, we aimed to examine time trends in incidence and prevalence of KRT in Central and Eastern Europe from 2010 to 2021. Method We included incidence and prevalence data on patients starting or receiving KRT between the years 2010 and 2021 from 18 Central and Eastern European countries participating in the ERA Registry. Albania, Belarus, Bulgaria, Cyprus, Czech Republic, Latvia, Lithuania, Northern Macedonia, Poland, Russia, Slovakia, Turkey, and Ukraine provided data on aggregated level, whereas Bosnia and Herzegovina, Estonia, Greece, Romania and Serbia provided individual patient data. General population data were reported by the collaborating registries or extracted from Eurostat. Most registries had full coverage of the general population. We expressed incidence and prevalence per million population (pmp) and time trends were studied with Joinpoint regression and expressed as Annual Percentage Changes (APCs). Results Incidence of KRT varied largely across Central and Eastern European countries (Fig. 1). In 2010, it ranged from 23.0 pmp in Ukraine to 190.5 pmp in Greece, and in 2021 from 53.0 pmp in Ukraine to 283.0 pmp in Cyprus. In 7 countries the KRT incidence increased significantly between 2010 and 2021 (APC; 95% CI): Albania (+8%; 5-10%), Cyprus (+6%; 4-9%), Greece (+3%; 3-4%), North Macedonia (+4%; 3-5%), Romania (+3%; 1-5%), Russia (+9%; 7-10%), and Ukraine (+7%; 4-9%). Serbia was the only country in which KRT incidence decreased: from 188.6 pmp in 2010 to 65.9 pmp in 2021 (APC: −8%; −10 to −6%), whereas for other countries KRT incidence remained stable over the study period. Except for the Baltic States, the age of incident KRT patients increased in all countries during the study period, also reflected by a temporal increase in the proportion of patients initiating KRT at ages of 65 years and older. The KRT prevalence also showed large variation across countries, ranging from 123.6 pmp to 1080.0 pmp in 2010 in Ukraine and Greece (Fig. 1). In 2021 it ranged from 303.6 pmp (Ukraine) to 1445.4 pmp (Greece). In all, but five countries (Belarus, Bosnia and Herzegovina, Czech Republic, North Macedonia, and Serbia) the prevalence of KRT increased annually with 2-9% between 2010 and 2021. This increase was mainly driven by an increase in prevalent patients with a functioning kidney transplant. If, however, the period prior to the COVID-19 pandemic was considered (2010 to 2019) there was also an increasing trend in the KRT prevalence for Bosnia and Herzegovina, Czech Republic, and North Macedonia. In all countries, prevalent KRT patients became older during recent years. Conclusion Large variation exists in the number of incident and prevalent patients treated with KRT across Central and Eastern Europe. In the majority of countries the incidence of KRT remained stable between 2010 and 2021, whereas in about one third of countries the incidence of KRT significantly increased. On the other hand, in most countries the number of prevalent KRT patients significantly increased over the study period, especially prior to the COVID-19 pandemic. This increase was mainly driven by an increase in prevalent kidney transplant recipients. Patients on KRT tended to become older in the entire region, reflecting both the aging population, as well as the increasing willingness and capacity to treat elderly patients. Nevertheless, large country variations in the epidemiology of KRT remain and this study is a first important step to define country-specific priorities for the optimization of kidney care and to create further public awareness for kidney diseases in the Central and Eastern European region.

Influence on the temporomandibular joint induced by mandibular malpositioning caused by vertical dimension elevation and occlusal loss in adult rats: An imaging, histological and immunohistochemical study.

Mandibular malpositioning may result in an abnormal concentration of stresses within the temporomandibular joint (TMJ) in adult rats, which may further lead to a series of pathological changes, such as articular cartilage wear, subchondral bone sclerosis and osteophyte formation. However, the pathological and adaptive changes in condylar cartilage caused by different stress distributions are still controversial. The aim of this study was to observe the effect of sagittal changes in mandibular position on condylar cartilage by changing the occlusal vertical dimension (OVD) in adult rats. Fifteen-week-old female rats were divided into three groups: control (CON), increased OVD (iOVD) and loss of occlusion (LO) groups. An occlusal plate and tooth extraction were used to establish the animal model. TMJ samples of the experimental and CON groups were observed and investigated by bone morphological, histomorphological and immunohistochemical staining analyses at 3 days, 1 week, 2 weeks, 4 weeks and 8 weeks. Weight curves were plotted. Micro-computed tomography showed that, compared with the CON group, cartilage destruction followed by repair occurred in both experimental groups, which was similar to the trend observed in haematoxylin-eosin staining. All experimental results for the iOVD group showed an approximately similar time trend. Compared with the iOVD group, the toluidine blue and immunohistochemical staining results in the LO group showed no obvious change trend over time. Compared with occlusal loss, an increase in OVD caused faster and more severe damage to condylar cartilage, and subchondral bone repair occurred later.

#570 A study of QTc time trends and factors affecting QTc changes during dialysis

Abstract Background and Aims Several studies have revealed the relationship between an abnormal QTc interval and mortality with sudden death in patients undergoing haemodialysis (HD). The QTc interval in HD is regulated by several factors, such as electrolytes, pH, and drugs. However, few studies have investigated the changes in the QTc interval during HD sessions and the determining factors. Therefore, we investigated the relationship between changes in electrolytes and QTc interval during HD. Method In this cross-sectional study, 53 patients undergoing maintenance HD were enrolled. Electrocardiogram and blood samples were obtained two days after dialysis. QTc was measured every hour from the start of the HD session, and blood samples were collected at the start, 2 h after, and at the end of the HD session. At the start of the HD session, we measured the blood levels of urea nitrogen, creatinine, β2-microglobulin (β2MG), HCO3-, albumin, intact-parathyroid hormone, phosphorus, Ca, Mg, and K. Blood Ca, Mg, K, and HCO3- levels were evaluated at the start, 2 h after, and at the end of the HD session. The relationship between changes in the QTc interval and various parameters was analysed by Spearman correlation analysis and multiple regression analysis. Results The patients were aged 37–91 (median; 71.5) years, and the duration of dialysis was 1–402 months (median; 2 months). Of the patients, 40.4% were diagnosed as the prolonged QTc interval (≥460 ms) at the start of HD (median; 455 ms). Conversely, 15.9% of patients at 2 h after the start of HD (median; 444 ms) and 8.4% of patients at end of HD (447 ms) were normalized in QTc interval. The peak change in the QTc interval occurred 2 h after start of HD. Thus, we estimated the factors that affected the change in QTc 2 h after the start of dialysis (ΔQTc2h). The duration of HD treatment (r = 0.312, P = 0.025) and serum levels of β2MG (r = 0.324, P = 0.019) were positively correlated with ΔQTc2h. The 2-h change in corrected Ca (ΔcCa2h) (r = −0. 31, P = 0.03) and intact-PTH (r = −0.30, P = 0.035) were negatively correlated with ΔQTc2h. We found no significant correlation between ΔQTc2h and changes in K and Mg. According to the multiple regression analysis, ΔcCa2h (β = −0.293, P = 0.033) and β2MG (β = 0.271, P = 0.042) were significant predictors of ΔQTc2h. Conclusion We anticipated that QTc interval might be prolonged due to the decreased serum K and Mg levels via HD treatments. However, QTc levels during HD were shortened according to increased serum Ca levels. Among the electrolyte levels, the change in blood Ca was significantly correlated with the change in the QTc interval but not with the change in Mg and K. The study results suggest the importance of optimal dialysate electrolytes composition to prevent adverse events and premature death caused by abnormalities in the QTc interval.

An Emerging Trend in the Synthesis of Iron Titanate Photocatalyst Toward Water Splitting.

Hydrogen gas is a prominent focus in pursuing renewable and clean alternative energy sources. The quest for maximizing hydrogen production yield involves the exploration of an ideal photocatalyst and the development of a simple, cost-effective technique for its generation. Iron titanate has garnered attention in this context due to its photocatalytic properties, affordability, and non-toxic nature. Over the years, different synthesis routes, different morphologies, and some modifications of iron titanate have been carried out to improve its photocatalytic performance by enhancing light absorption in the visible region, boosting charge carrier transfer, and decreasing recombination of electrons and holes. The use of iron titanate photocatalyst for hydrogen evolution reaction has seen an upward trend in recent times, and based on available findings, more can be done to improve the performance. This review paper provides a comprehensive overview of the fundamental principles of photocatalysis for hydrogen generation, encompassing the synthesis, morphology, and application of iron titanate-based photocatalysts. The discussion delves into the limitations of current methodologies and present and future perspectives for advancing iron titanate photocatalysts. By addressing these limitations and contemplating future directions, the aim is to enhance the properties of materials fabricated for photocatalytic water splitting.

Localizing Stellar Activity on Low-mass Stars with the Transiting Exoplanet Survey Satellite

Magnetic reconnection is the underlying cause of stellar flares which are linked to regions of high magnetic activity, like star spots. To understand trends in stellar activity, we need to study how it is heightened by rapid rotation and deep convection in young low-mass stars. We analyze light curves of such stars observed by the Transiting Exoplanet Survey Satellite to investigate trends in flare timing with starspot modulation signals. Trends in flare properties and spot modulation can provide a means to “localize” which face of a star flares more frequently and better understand their association with active regions. We present an analysis of light curves from M and K dwarfs with no companions from five nearby and young moving groups spanning ages ∼20–150 Myr. We discuss a technique to analyze the distribution of flares and star spots and describe our results, which reveal a tentative correlation.

Distinct time trends in colorectal cancer incidence in countries with SDI levels from 1990 to 2019: an age–period–cohort analysis for the Global Burden of Disease 2019 study

Distinct time trends in colorectal cancer incidence in countries with SDI levels from 1990 to 2019: an age–period–cohort analysis for the Global Burden of Disease 2019 study

Concurrent decline in teenage fertility rate and binge drinking? An observational study across 45 nations.

Alcohol consumption is associated with unintended pregnancies among teenagers. Its role as a broader determinant of teenage fertility rates remains unclear. We investigate whether adolescent binge drinking affects the number of teenage births. Binge drinking data from 137,898 females aged 15-16 were collected in the HBSC study (2002-2018, 43 countries/regions) and 267,359 in the ESPAD study (1995-2019, 41 countries/regions). Age-specific fertility rates were from the Human Fertility Database and the World Health Organization. We examined changes over time in countries' average levels of binge drinking among female pupils aged 15-16 and population-level fertility rates for the same cohorts when aged 16-19 years. Controlling for differences between countries and survey waves, we found an association between binge drinking and fertility rate, B = 0.019, 95% confidence interval [0.004, 0.034]. When accounting for the countries' time trends, the association was substantially reduced, B = 0.006, 95% confidence interval [-0.0062, 0.0174]. The relationship was not moderated by abortion rates and controlling for contraceptive use had no impact on the findings. The association between adolescent binge drinking and fertility rates diminishes when accounting for country-specific time trends. Given the lack of clear mechanisms linking binge drinking to trends in fertility rates rather than shorter-term changes, the association likely reflects broader secular trends. Binge drinking may be involved in teen pregnancy and childbirth in individual cases but it does not explain recent developments in teenage fertility rates.