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ObjectiveThis study aimed to explore the factors affecting the outcomes of spontaneous supratentorial cerebral hemorrhage 90 days after surgery.MethodsA total of 256 patients with spontaneous supratentorial intracerebral hemorrhage underwent craniotomy evacuation of hematoma. The control group included 120 patients who received conservative treatment. The patients were divided into two subgroups based on a bifurcation of the modified Rankin Scale (mRS) 90 days after clinical therapeutics: good outcome (mRS score 0–3) and poor outcome (mRS score 4–6). The differences in clinical and imaging data between the two subgroups were analyzed. Based on difference analysis results, a binary logistic regression model was constructed to analyze the influencing factors related to poor outcomes.ResultsThe difference analysis results in the surgery group showed statistically significant differences in age, sex, Glasgow Coma Score (GCS) on admission, coronary atherosclerosis, smoking, stroke history, blood glucose, D-dimer, hematoma size, deep cerebral hemorrhage, midline shift, hematoma burst into the ventricle, vortex sign, island sign, and black hole sign. Binary logistic regression analysis showed that deep cerebral hemorrhage, midline shift, and age > 58 years independently correlated with the poor outcomes of patients after surgery. The binary logistic regression results of the control group showed that age > 58 years and GCS ≤ 8 independently correlated with the poor outcomes of patients.ConclusionsDeep cerebral hemorrhage, midline shift, and age > 58 years significantly increased the risk of adverse prognosis in patients after surgery. The findings might help select the clinical treatment plan and evaluate the postoperative prognosis of patients.

Purpose This study aimed to develop novel nomogram models capable of predicting early neurological deterioration (END) and 90-day prognosis outcomes in acute ischemic stroke (AIS) patients treated with IV thrombolysis. Methods A retrospective derivation cohort comprising 298 AIS patients was enrolled from January 2021 to March 2024. A separate validation cohort of 94 patients was retrospectively enrolled between April 2024 and December 2024. END was defined as a sustained NIHSS increase of ≥ 2 points within 24 h, and poor prognosis outcome a mRS score of 3–6 at 90 days. Multivariate logistic regression analysis was employed to construct nomogram models for the prediction of outcomes. Results In the derivation cohort, 23.83% patients with END experienced a poor 90-day outcome, as compared to 12.42% of those from NO-END group. Independent risk factors for END included a lower initial NIHSS score, a delayed DNT, a reduced ASPECTS score, and incomplete Willis Artery. END patients were found to be at a significantly increased risk of poor 90-day prognosis (odds ratio 0.163, p  < 0.001). In addition, elevated initial NIHSS and glucose levels, the presence of nonlacunar infarction, and history of hypertension were predictive of poor prognosis. Two separate nomogram models, developed based on the previously identified risk factors to predict the occurrence of END and a poor 90-day prognosis, demonstrated AUC values of 0.740 (95% CI 0.686–0.789) and 0.859 (95% CI 0.814–0.896). These models also exhibited good discriminatory capacity in the validation cohort, with corresponding AUC values of 0.716 (95% CI 0.541–0.892) and 0.795 (95% CI 0.689–0.900). Conclusion This study has successfully constructed reliable nomogram models for forecasting END and poor 90-day outcomes in AIS patients treated with IV thrombolysis; thereby, facilitating personalized prediction of adverse outcomes and adjustment of treatment strategy.

Importance Eltrombopag has been recommended for pediatric immune thrombocytopenia (ITP). Response and adverse drug reactions (ADRs) varied widely between individuals, even at the same dose of eltrombopag. The appropriate eltrombopag concentration in ITP has not been reported. Objective This study aims to explore the appropriate eltrombopag concentration in pediatric ITP. Methods This was a single‐center, prospective cohort study. Children diagnosed with refractory persistent/chronic ITP and platelet count < 30×109/L were treated with eltrombopag and followed up for at least 2 months. Concentration was detected by high‐performance liquid chromatography‐mass spectrometry at least 2 weeks after eltrombopag. The clinical characteristics‐concentration, concentration‐response, and concentration‐ADRs were analyzed. Results A total of 30 patients were enrolled, comprising 13 males and 17 females, with a median age of 72 (45‒94) months. The median dose and concentration were 1.39 (1.09‒1.56) mg/kg and 2.70 (2.25‒4.13) mg/L, respectively. Of the enrolled patients, 14 responded to treatment, whereas 16 did not. Additionally, five experienced adverse drug reactions. No linear correlation was observed between eltrombopag concentration and clinical characteristics. The concentration was lower in the response group than in the nonresponse group, but there was no significant difference (t = 0.755, P = 0.457). Patients who experienced ADRs had a higher concentration than those without ADRs (t = 2.538, P = 0.017). The area under the receiver operating characteristic curve of ADRs was 0.78 (95% confidence interval: 0.56‒1.00). Youden's index identified the cutoff point as 4.33 mg/L, with a sensitivity of 88% and a specificity of 60%. Logistic regression analysis demonstrated that a higher platelet count before eltrombopag predicted a favorable response. Interpretation Eltrombopag proves efficacious and well‐tolerated for treating pediatric ITP. However, prolonged and high‐dose administration may increase the likelihood of ADRs. Thus, examining the appropriate eltrombopag concentration assists in directing individualized management of pediatric ITP.

Avatrombopag (AVA), a second-generation thrombopoietin receptor agonist (TPO-RA), has demonstrated efficacy in pediatric persistent/chronic immune thrombocytopenia (ITP). However, critical evidence gaps persist regarding treatment-switching strategies between TPO-RAs, particularly when transitioning from eltrombopag (ELT) or hetrombopag (HET) to AVA. This multicenter cohort study evaluated 55 pediatric ITP patients unresponsive to or relapsing after ELT ( n  = 46) or HET ( n  = 9) who underwent AVA switch therapy. Outcomes included platelet response (≥ 30 × 10⁹/L without rescue therapy), bleeding events, concomitant medication reduction, and safety. Sustained response rates reached 48.4% (ELT-to-AVA) and 33.3% (HET-to-AVA), with median response durations of 10 and 7 days respectively. Platelet elevation during AVA treatment was resolved with dosage changes or discontinuation. AVA significantly reduced bleeding, ITP medications, and rescue therapy, with side effects such as gastrointestinal symptoms, headaches, and fatigue (grades 1–2). AVA demonstrates potential as a safe and effective bridging therapy for TPO-RA refractory pediatric ITP, offering hematological stabilization while reducing treatment burden. These findings address current evidence deficiencies in TPO-RA switching protocols.

Mycoplasma pneumoniae (M. pneumoniae), as one of the susceptible pathogens during childhood, may lead to severe mycoplasmal pneumonia and affect platelet fluctuations. We prospectively collected data on persistent/chronic ITP children who were infected with M. pneumoniae infection from August 2023 to December 2023. There were 64 patients (40 males) with a median age of 7.08 years (range 4.30 to 9.76) enrolled in this study. Overall, 33 (51.6%) children received TPO-RAs therapy and 31 (48.4%) received other treatments. The impact of M. pneumoniae infection on platelet count is bidirectional, but thrombocytopenia remains predominant. During M. pneumoniae infection, platelet changes in the TPO-RA group were higher than in the non-TPO-RA group. Thrombocytosis was observed in 6 patients (5 in the TPO-RA group vs. 1 in the non-TPO-RA group). Rescue treatment was implemented in 18 patients (7 in the TPO-RA group vs. 11 in the non-TPO-RA group). Monitoring platelets should be strengthened during M. pneumoniae infection.

This study aims to explore the value of a machine learning (ML) model based on radiomics features and clinical features in predicting the outcome of spontaneous supratentorial intracerebral hemorrhage (sICH) 90 days after surgery. A total of 348 patients with sICH underwent craniotomy evacuation of hematoma from three medical centers. One hundred and eight radiomics features were extracted from sICH lesions on baseline CT. Radiomics features were screened using 12 feature selection algorithms. Clinical features included age, gender, admission Glasgow Coma Scale (GCS), intraventricular hemorrhage (IVH), midline shift (MLS), and deep ICH. Nine ML models were constructed based on clinical feature, and clinical features + radiomics features, respectively. Grid search was performed on different combinations of feature selection and ML model for parameter tuning. The averaged receiver operating characteristics (ROC) area under curve (AUC) was calculated and the model with the largest AUC was selected. It was then tested using multicenter data. The combination of lasso regression feature selection and logistic regression model based on clinical features + radiomics features had the best performance (AUC: 0.87). The best model predicted an AUC of 0.85 (95%CI, 0.75–0.94) on the internal test set and 0.81 (95%CI, 0.64–0.99) and 0.83 (95%CI, 0.68–0.97) on the two external test sets, respectively. Twenty-two radiomics features were selected by lasso regression. The second-order feature gray level non-uniformity normalized was the most important radiomics feature. Age is the feature with the greatest contribution to prediction. The combination of clinical features and radiomics features using logistic regression models can improve the outcome prediction of patients with sICH 90 days after surgery.

PurposeLumbar interbody fusion (LIF) is a treatment option for low back pain secondary to lumbar instability and/or deformity. This review highlights recent studies of surgical techniques and bone healing strategies for LIF.MethodsRelevant articles were identified by searching the PubMed database from January 1948 to April 2020, with a focus on the last 5 years, using the following keywords: LIF approach, LIF cage, stem cells for LIF, biomaterials for LIF, and osteobiologics for LIF.ResultsLIF procedures were traditionally performed through either a posterior approach (PLIF), or an anterior approach. Later, the transforaminal LIF approach gained popularity over the PLIF as it entailed less nerve retraction. To minimize paraspinal muscle dissections, alternative approaches including lateral LIF, oblique LIF, and minimally invasive approaches have been developed and utilized. These modifications have improved the surgical outcomes of LIF. However, the most recent rates of non-union after LIF procedures still ranged from 7 to 20% with an even higher incidence in patients with osteoporosis. This review summarizes the advantages and disadvantages of each surgical approach and current efforts to enhance LIF by improving fusion cage material properties and developing novel osteobiologic products that contain nanomaterials for controlled release of effective osteogenic proteins and mesenchymal stem cells.ConclusionsThere have been significant advances in surgical technologies for LIF over the past decades. Post-operative non-union remains a major challenge, which could be addressed by development of more effective surgical techniques, fusion cages, and bone healing products through joint efforts from spine surgeons, bone biologists, and material engineers.

Digital food-ordering apps make it simple to buy indulgent drinks yet hard to judge their health risks. We conducted five online experiments (N = 1048) to compare two messages for sugary beverages: self-promotion that stresses taste and self-disclosure that plainly warns “high sugar/high calories”. Brands that chose self-disclosure were seen as more socially responsible and transparent, which in turn raised trust and lifted purchase intent. These gains were strongest for users who care deeply about the category or the brand and remained robust even among highly health-conscious shoppers. The results show that, for “vice” foods, honest warnings can outperform glossy claims. Our study extends signaling and attribution theories to digital food markets and offers managers a straightforward playbook for complying with new labeling rules while still driving sales.

Background and purposeStroke is the leading cause of mortality and disability in China. Precise aetiological classification, imaging and biological markers may predict the prognosis of stroke. The Third China National Stroke Registry (CNSR-III), a nationwide registry of ischaemic stroke or transient ischaemic attack (TIA) in China based on aetiology, imaging and biology markers, will be considered to clarify the pathogenesis and prognostic factors of ischaemic stroke.MethodsBetween August 2015 and March 2018, the CNSR-III recruited consecutive patients with ischaemic stroke or TIA from 201 hospitals that cover 22 provinces and four municipalities in China. Clinical data were collected prospectively using an electronic data capture system by face-to-face interviews. Patients were followed for clinical outcomes at 3 months, 6 months and 1–5 year annually. Brain imaging, including brain MRI and CT, were completed at baseline. Blood samples were collected and biomarkers were tested at baseline.ResultsA total of 15 166 stroke patients were enrolled, among which 31.7% patients were women with the average age of 62.2±11.3 years. Ischaemic stroke was predominant (93.3%, n=14 146) and 1020 (6.7%) TIAs were enrolled.ConclusionsCNSR-III is a large scale nationwide registry in China. Data from this prospective registry may provide opportunity to evaluate imaging and biomarker prognostic determinants of stroke.

Zinc toxicity affects crop productivity and threatens food security and human health worldwide. Unfortunately, the accumulation patterns of zinc and the harmful effects of excessive zinc on sweet potato have not been well explored. In the present research, two genotypes of sweet potato varieties with different accumulation patterns of zinc were selected to analyze the effects of excessive zinc on sweet potato via hydroponic and field cultivation experiments. The results indicated that the transfer coefficient was closely related to the zinc concentration in the storage roots of sweet potato. Excessive zinc inhibited the growth of sweet potato plants by causing imbalanced mineral concentrations, destroying the cellular structure and reducing photosynthesis. Furthermore, a total of 17,945 differentially expressed genes were identified in the two genotypes under zinc stress by transcriptomic analysis. Differentially expressed genes involved in the absorption and transport of zinc, defense networks and transcription factors played important roles in the response to zinc stress. In conclusion, this study provides a reference for the selection of sweet potato varieties in zinc contaminated soil and lays a foundation for investigating the tolerance of sweet potato to excessive zinc, which is meaningful for environmental safety and human health.