To identify risk factors, mechanisms, and develop a validated predictive model for platelet transfusion refractoriness (PTR) in pediatric oncology to optimize transfusion outcomes. This retrospective cohort analyzed pediatric oncology patients receiving platelet transfusions, stratified by response (effective vs. refractory). Statistically significant indicators from t-tests underwent multivariable logistic regression to determine independent PTR predictors [platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D)]. A combined predictor derived via logistic regression was evaluated using ROC analysis. A Nomogram integrating PLT, hemoglobin (Hb), PT, APTT, and D-D was developed, with calibration (calibration curves) and clinical utility (decision curve analysis, DCA) rigorously validated. Multivariable logistic regression revealed an inverse association between elevated PLT and PTR risk (OR = 1.396), while elevated PT, APTT, and D-D were directly associated with increased PTR risk (OR: 0.794, 0.943, and < 0.001, respectively). The combined predictor demonstrated excellent discriminatory power (AUC = 0.962). The nomogram model exhibited high calibration accuracy in both training and validation sets, as evidenced by well-fitted calibration curves. DCA confirmed superior net benefit compared to alternative strategies. High AUC values (training set: 0.9723; validation set: 0.9639) indicated robust discrimination of PTR risk. PLT, PT, APTT, and D-dimer are key modulators of PTR risk in pediatric oncology. The developed nomogram model demonstrates favorable calibration, strong discriminatory ability, and significant clinical utility. It enables quantitative PTR risk stratification and guides pathway-targeted interventions, providing a precision tool for optimizing platelet transfusion management in this vulnerable population.

Longitudinal assessment of hemostatic adaptations in pregnant mares: Evidence of a physiological hypercoagulable state.

Alopecia areata (AA) is a chronic, immune-mediated disorder characterized by nonscarring hair loss. Emerging evidence suggests that AA is associated with systemic inflammation, metabolic dysregulation, and coagulation abnormalities. However, data on these associations in the Indian population remain limited. To evaluate coagulation parameters, metabolic profiles, and inflammatory markers in Indian patients with AA and assess their correlation with disease severity. A case-control study was conducted at a tertiary care center in North India, including 110 AA patients and 110 age- and sex-matched healthy controls. Coagulation parameters (D-dimer, fibrinogen, prothrombin time, and activated partial thromboplastin time), metabolic markers [fasting blood glucose, lipid profile, body mass index (BMI)], and inflammatory markers [C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)] were analyzed. Disease severity was assessed using the Severity of Alopecia Tool (SALT) score. Correlation and multivariate regression analyses were performed to identify predictors of severe AA. AA patients exhibited significantly elevated D-dimer ( P < 0.001) and fibrinogen levels ( P < 0.001) compared to controls, indicating a hypercoagulable state. The prothrombin time was also prolonged ( P = 0.03). Metabolic abnormalities, including higher fasting blood glucose ( P < 0.001) and total cholesterol ( P = 0.008), were observed. Inflammatory markers (CRP and ESR) were significantly elevated in AA patients. A strong positive correlation was found between SALT scores and D-dimer levels (r = 0.64, P < 0.001). Multivariate regression analysis identified D-dimer (95% CI: 1.58-4.20), fibrinogen (95% CI: 1.41-3.11), CRP (95% CI: 1.23-2.97), and BMI (95% CI: 1.18-2.46) as independent predictors of severe AA. Cross-sectional study design and lack of longitudinal follow-up. Indian AA patients exhibit significant coagulation abnormalities, metabolic dysregulation, and systemic inflammation, with these factors correlating with disease severity. These findings suggest that AA extends beyond a localized dermatological disorder and may have systemic implications. These associations imply a link rather than causality due to the cross-sectional nature of the study. Further research is warranted to explore the role of targeted therapies in mitigating these risks.

Sepsis-associated acute kidney injury (SAKI) is a heterogeneous condition that lacks disease-modifying treatments, and precision medicine approaches are needed. We previously derived two reproducible pediatric SAKI subphenotypes (pSAKI-1 and pSAKI-2) from readily available clinical data. We aimed to externally validate the prognostic relevance of these subphenotypes, evaluate their molecular signatures, and assess for heterogeneity of treatment effect (HTE) across subphenotypes with sepsis therapies. Secondary analysis of an ongoing multicenter, prospective, observational study of children. Ten PICUs in the United States from January 2002 to February 2025. Patients 1 week to 18 years old with early (day 1-2) SAKI. None. Among 871 patients, 665 (76%) were assigned pSAKI-1 and 206 (24%) to pSAKI-2. On day 1-2, the pSAKI-2 cohort had greater severity of illness, including higher acute kidney injury stage and vasoactive burden, lower platelet counts, and higher lactate values and International Normalized Ratios. These pSAKI-2 patients also had uniformly worse outcomes, including independently higher odds of day 7 severe acute kidney injury (adjusted odds ratio [aOR] 3.2; 95% CI, 2.1-4.7; p < 0.001), death (aOR 2.7; 95% CI, 1.6-4.4; p < 0.001), and fewer PICU-free and vasoactive-free days ( p < 0.001). The biomarker signature of pSAKI-2 was characterized by greater inflammation, endothelial dysfunction, and hyperreninemia. On propensity score matched (PSM) analysis, pSAKI-1 patients who received corticosteroids had more day 7 severe acute kidney injury (28% vs. 19%, p = 0.023), 2 fewer PICU-free days ( p = 0.04) and greater mortality (10% vs. 3.7%, p = 0.008); no differences were seen in pSAKI-2 patients. Although no HTE was identified on PSM analysis for vasopressin, inverse probability treatment weighting analysis demonstrated a significant interaction between subphenotype-, vasopressin- and vasoactive-free days ( p = 0.003). We externally validated the prognostic relevance of two pSAKI subphenotypes derived from readily available data. These subphenotypes have unique biomarker signatures and differential responses to treatment, representing a potential mechanism for bedside enrichment.

Uncontrolled hemorrhage remains the leading preventable cause of death after trauma. Current prehospital strategies emphasize rapid bleeding control, yet benchmark kaolin-based dressings may impair distal perfusion through intraluminal thrombosis. Polyphosphate (PolyP)-based dressings could offer effective hemostasis while maintaining arterial flow. In a prospective, randomized, controlled large-animal extremity trauma model with hemorrhagic shock, PolyP gauze was compared with kaolin-based Combat Gauze (CG) under a standardized compression and resuscitation protocol. Primary endpoints were survival time and survival proportion; secondary endpoints included distal femoral flow, blood loss, hemodynamics, metabolic status, and coagulation. Outcome assessment was investigator blinded. Baseline characteristics were comparable between groups (n = 11 per group). Survival at 120 minutes (PolyP 90.9% vs. CG 81.8%) and total blood loss (1,780 ± 219 vs. 1,847 ± 484 mL, p = 0.72) did not differ significantly. First-pass hemostasis was achieved in 63.6% of PolyP- and 81.8% of CG-treated animals (p = 0.64). In contrast, distal pulsatile femoral flow was restored in 90.9% of PolyP-treated animals compared with 27.3% after CG (p = 0.0075). Hemodynamics, metabolic markers (lactate, base excess, pH, hemoglobin), and systemic coagulation assays (prothrombin time, fibrinogen, activated partial thromboplastin time) evolved similarly across groups. In this swine extremity trauma model with shock, PolyP gauze provided hemostasis equivalent to the current benchmark while significantly improving distal arterial perfusion. These findings support expanding performance benchmarks for prehospital hemostatic dressings to include downstream perfusion and justify further translational and field evaluation. (J Trauma Acute Care Surg. 2026;101: 129-135. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).

Single-domain antibodies to reverse the effects of factor Xa inhibitors on coagulation tests.

A review of past, present and emerging techniques for detection of Mycoplasma pneumoniae.

Du, C, Xu, H, Shi, J, Wei, J, Quan, H, and Zhu, T. Internal load and fatigue characteristics in male cross-country skiers during summer training. J Strength Cond Res 40(7): e727-e735, 2026-This study aims to measure the internal load and fatigue responses of cross-country skiers during a 3-week summer training period, comparing differences across various training methods and their combinations. Twelve male cross-country skiers participated in this longitudinal observational study. We recorded the internal load for each training session via Firstbeat sport devices on the basis of the Banister training impulse (bTRIMP) model. The fatigue assessment metrics included the resting heart rate (RHR) and quick recovery test percentage (QRT%). Physiological performance was assessed by measuring maximal oxygen consumption (V̇ o2 max). Statistical significance was considered at p < 0.05. The internal load progressively decreased over the 3-week period. The bTRIMP during the competition session was significantly greater than that during the routine training session ( p < 0.05). Among the different training modalities and their combinations, strength-related sessions produced the lowest bTRIMP values, followed by running and competition, whereas roller skiing presented the highest values. Resting heart rate and QRT% displayed different temporal patterns. No significant differences in RHR were found after different training modalities ( p > 0.05). However, the postcompetition QRT% was significantly lower than the post-training value ( p < 0.05). Neither RHR nor QRT% significantly differed after various combined training sessions ( p > 0.05). A moderate negative correlation was observed between RHR and QRT% ( r = -0.361, p < 0.001). V̇ o2 max did not significantly differ ( p > 0.05). Overall, although there was considerable variation in the internal load across different types of sessions, no significant cumulative signs of fatigue were detected.

Analysis of risk factors for mortality in patients with mushroom poisoning-induced hepatic failure.

Using clinical and thrombus characteristics to predict the etiology of ischemic stroke: An analysis of the INSIGHT registry.

To explore effect of Peiyuan Fubai decoction ()on P-selectin/P-selectin glycoprotein ligand-1 (PSGL-1) pathway after total knee arthroplasty(TKA). From May 2024 to April 2025, 68 patients who underwent TKA were selected and divided into combined group and western medicine group based on different treatment methods. There were 34 patients in western medicine group, including 7 males and 27 females;aged from 54 to 79 years old with an average of (67.44±5.34) years old;12 patients with grade Ⅲ and 22 patients with grade Ⅳ according to Kellgren-Lawrance(K-L) grade;oral rivaroxaban tablets were started 12 h after surgery and continued until 28 days after surgery. There were 34 patients in combined group, including 4 males and 30 females;aged from 59 to 83 years old with an average of (68.32±5.51) years old;10 patients with grade Ⅲ and 24 patients with grade Ⅳ according to K-L grade; Peiyuan Fubai decoction ()was orally administered starting from the first day until 28 days after surgery on the basis of western medicine group. The knee joint function was evaluated by visual analogue scale (VAS) and Hospital for Special Surgery (HSS) score before operation and 3, 7, 14, and 42 days after operation;the changes in hemoglobin (Hb), platelet count (PLT), activated partial thromboplastin time (APTT), and prothrombin time (PT) were compared between two groups;the expressions of P-selectin, PSGL-1, histone H3 citrullination (H3Cit), and von Willebrand factor (vWF) in plasma between two groups were compared before operation, 1 and 7 days after operation, and postoperative complications were recorded and compared. Both groups were followed up for 6 weeks. At 7 days after operation, VAS and HSS scores of combined group were 3.00 (2.00, 4.00) and (66.71±5.37) points respectively, which were better than those of western medicine group 4.00 (3.00, 5.00) and (64.03±5.57) points, and the differences were statistically significant (P<0.05). Hb of combined group at 7, 14, and 42 days after operation were (110.09±13.21), (113.19±12.08), and (129.58±12.50) g·L-1 respectively, while those of western medicine group were (106.91±12.88), (111.72±10.29), and (131.71±12.64) g·L-1 respectively;postoperative Hb of both groups at 7 and 14 days were lower than those before operation and 42 days after operation, and the differences were statistically significant (P<0.05). Postoperative PLT levels of combined group at 7, 14, and 42 days were(234.12±74.03), (292.09±71.32), and 217.50 (185.75, 248.75) × 109·L-1, respectively;while western medicine group were (246.03±56.84), (322.06±78.72), and 213.00 (183.50, 257.50)×109·L-1, respectively;postoperative PLT levels of both groups at 14 days were higher than those before operation, 7 and 42 days after operation, and the differences were statistically significant (P<0.05). Postoperative PT and APTT of combined group at 7 and 14 days were 13.30(12.30, 14.20), 12.95(12.30, 14.05) and 32.20 (28.75, 34.60), 30.80 (28.48, 34.88), respectively;which were higher than those of western medicine group 12.50(11.85, 13.20), 12.15 (11.80, 12.70) and 29.50 (26.25, 33.25), 28.10 (26.80, 29.55);postoperative PT and APTT of both groups at 7 and 14 days were higher than those before operation and 42 days after operation, and the differences were statistically significant (P<0.05). At 7 days after operation, the levels of P-selectin, PSGL-1 and H3Cit in combined group were (5 559.00±378.79), 504.22 (485.58, 529.89), and 267.60(256.22, 296.49) respectively, which were lower than those in western medicine group (5, 814.87±442.42), 551.04 (509.64, 585.21), and 288.20 (269.46, 310.03), the differences were statistically significant (P<0.05);vWF level in combined treatment group (484.65±35.15) was higher than that in western medicine group (461.08±31.16), and the difference was statistically significant (P<0.05). The number of intermuscular venous thrombosis in combined group at 14 and 42 days after operation was 4 (11.76%) and 1 (2.94%), respectively, while in western medicine group was 9 (26.47%) and 2 (5.89%), respectively. Relative risk(RR) analysis values at 14 and 42 days were 2.7[95%CI (0.742, 9.827)] and 2.06 [95%CI (0.178, 23.882)]. Peiyuan Fubai decoction () combined with rivaroxaban could prolong PT and APTT. By regulating P-selectin/PSGL-1 pathway and reducing expression of H3Cit, it could effectively prevent thrombosis formation after TKA, alleviate postoperative pain, promote functional recovery.

This study utilized two indirect methods to establish reference intervals (RIs) for four coagulation parameters for the adult population in Tibet, a high-altitude region in Western China. Coagulation Data, Including Activated Partial Thromboplastin Time (APTT), prothrombin Time (PT), thrombin Time (TT), and Fibrinogen (FIB) Obtained From the People's Hospital of Tibet Autonomous Region Between 2019 and 2023, Were Subjected to Box-Cox Transformation for Normalization and Tukey Method for Outlier Removal. the RIs Were Calculated Using Hoffmann and refineR Methods, Respectively. A total of 5086, 5282, 5386, and 5377 test results for APTT, PT, TT, and FIB were included. The Hoffmann and refineR method yielded the following total RIs: APTT 30.54-46.32 and 30.14-44.30 s; PT 10.54-14.51 and 10.32-13.89 s; TT 14.92-19.46 and 14.88-18.93 s; FIB 2.05-4.68 and 2.02-4.40 g/L, respectively. Gender-partitioned RIs were calculated for all four parameters, while age-partitioned RIs were specifically calculated for PT and FIB based on bias ratio values. The lower limits of RIs estimated by the two methods remained consistent. The established RIs for APTT and FIB were significantly higher than those utilized in the plain area and those provided by the manufacturer, whereas the established RIs of TT were significantly lower. The RIs for coagulation parameters in the population living on the Tibetan Plateau exhibited significant divergence from those utilized in the plain area. Specific RIs for high-altitude regions should be established to accurately evaluate the presence of coagulation disorders.

Acute pancreatitis (AP) is a common and rapidly progressing disease of the digestive system. The occurrence of coagulation dysfunction is closely related to the severity of AP. Therefore, this study aims to explore the correlation and mechanism of early clinical coagulation function indicators in AP patients with the severity of the condition. Between January 2021 and May 2023, 60 cases of AP patients were divided into 2 groups: mild AP and severe AP. Coagulation parameters, including prothrombin time (PT), activated partial thromboplastin time, fibrinogen (FIB), and D-dimer (DD) levels, were measured. The Acute Physiology and Chronic Health Evaluation II score, Ranson score, and computerized tomography severity index score were used for Spearman linear correlation analysis of PT, activated partial thromboplastin time, FIB, and DD. Multifactor logistic stepwise regression analysis was conducted to identify the risk factors influencing the severity of AP. Receiver operating characteristic curve analysis was used to evaluate the diagnostic value of various indicators between the severe AP group and the mild AP group. Through bioinformatics methods, genes with significant differential expression and the pathophysiological processes associated with these genes were analyzed to explore the potential mechanisms and key genes involved in the progression of AP. PT > 12.2 seconds, FIB > 3.124 g/L, and DD > 0.97 mg/L are significantly correlated with the severity of AP and can serve as valuable indicators for assessing disease severity. Their potential mechanism may involve the CD177 and ALOX15/15-HETE signaling pathway, which affects the occurrence and development of AP by regulating coagulation function.

Impact of early fresh frozen plasma administration on clinical outcomes in snakebite-induced coagulopathy: A systematic review.

This study aimed to evaluate changes in activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB), and D-dimer (DD) levels during different trimesters of pregnancy in healthy pregnant women. The objective was to establish trimester-specific reference intervals for these coagulation parameters using the non-parametric percentile method as recommended by the Clinical and Laboratory Standards Institute (CLSI) C28-A3 guideline, thereby providing a basis for accurate clinical assessment of coagulation status during pregnancy. A total of 2,657 healthy pregnant women were selected from Sichuan JinxinXinan Women and Children Hospital from January 2024 to December 2024. Of these women, 646 were included in the first-trimester group; 1,128 were included in the second-trimester group; and 883 were included in the third-trimester group. In addition,198 healthy non-pregnant women were included in the control group. The coagulation indicators of each group were detected and analyzed, and differences in these indicators across different age groups were assessed. Following the CLSI C28-A3 guidelines, reference intervals were established using the non-parametric percentile method (P2.5-P97.5 for APTT, PT, TT, and FIB; P95 for DD). The established reference intervals were validated using an independent sample of 20 healthy pregnant women per trimester. No significant differences were observed in any coagulation indicators between pregnant women aged < 30 years and those aged ≥ 30 years in the first-, second-, and third-trimester groups(P > 0.01).APTT, PT, and TT decreased with the advancement of gestational age, and the differences between the periods of each gestation were statistically significant (P < 0.01).FIB and DD levels increased with the advancement of gestational age, and the differences were statistically significant between each trimester(P < 0.01).The established reference intervals for the first trimester were: APTT 25.20-36.48s, PT 11.10-13.00s, TT 15.00-17.70s, FIB 2.58-5.04g/L, and DD ≤ 1.11µg/mL. For the second trimester: APTT 24.40-34.56s, PT 10.90-12.60s, TT 14.70-17.20s, FIB 2.95-5.27g/L, and DD ≤ 2.94µg/mL. For the third trimester: APTT 24.70-33.40s, PT 10.60-12.40s, TT 14.60-16.80s, FIB 3.39-5.90g/L, and DD ≤ 4.62µg/mL. Compared with previously published reference intervals from other populations, our findings show similar trends but with notable differences in absolute values, particularly for FIB and DD, which may be attributed to geographical and ethnic variations. The biological reference intervals of all five coagulation indicators were successfully validated. Trimester-specific reference intervals were successfully established for five coagulation indicators using the non-parametric approach recommended by CLSI C28-A3. These intervals provide a crucial tool for accurate clinical diagnosis and prevention of coagulation disorders during pregnancy, potentially reducing misdiagnosis and unnecessary interventions associated with using non-pregnancy reference intervals. However, multicenter validation studies are needed to confirm the generalizability of these findings to other populations.

Decompensation in liver cirrhosis reduces survival and is driven by systemic inflammation and vascular dysfunction. Accurately diagnosing decompensated cirrhosis remains challenging due to the inherent subjectivity of traditional tools like the Child-Pugh score. In this prospectivity study conducted at a university-affiliated liver specialty hospital, we aimed to identify circulating biomarkers to refine diagnostic precision and establish an objective clinical framework. Through a rigorous selection pipeline-incorporating univariate analysis, correlation checks, and Least Absolute Shrinkage and Selection Operator (LASSO)-multivariate regression- Reticulocalbin 3 (RCN3), platelet-derived growth factor BB (PDGF-BB), and vascular cell adhesion molecule-1 (VCAM-1) were identified as key diagnostic indicators. Hepatocellular carcinoma (HCC) status was included as a critical covariate in all models to adjust for baseline imbalances as identified during the variable selection process. An integrated model combining these biomarkers with the Child-Pugh score achieved superior discriminative performance (AUC = 0.867), significantly outperforming the clinical baseline. Furthermore, to eliminate the inter-observer variability of clinical assessments, we developed an objective configuration by substituting subjective signs of ascites and encephalopathy with RCN3 alongside laboratory parameters (Total bilirubin, Serum Albumin, and Prothrombin Time) (AUC = 0.852). Our findings suggest that RCN3, PDGF-BB, and VCAM-1 provide critical insights into the pathophysiological state of cirrhosis. The proposed objective framework offers a standardized, reproducible alternative that optimizes cirrhosis staging while maintaining high diagnostic accuracy without clinical subjectivity.

This retrospective observational study aimed to compare the effects of short inter-treatment interval treatment (SIIT) versus long inter-treatment interval treatment (LIIT) using the artificial liver support system (ALSS) on liver function recovery and 90-day transplant-free mortality in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). We retrospectively analyzed 149 HBV-ACLF patients selected from 166 patients who received comprehensive internal medicine therapy combined with ALSS. Patients were categorized into the SIIT group and the LIIT group. Laboratory test data were recorded both before ALSS treatment and the seventh day after the last ALSS treatment. The 90-day transplant-free mortality was compared between the two groups. Biochemical indicators reflecting patient's liver function including alanine aminotransferase, aspartate aminotransferase, serum total bilirubin (TBIL), direct bilirubin (DBIL), total bile acid, and coagulation function (prothrombin time activity, PTA) were significantly improved at posttreatment than pretreatment in both groups (p < 0.05). At Day 7 after the last ALSS treatment, TBIL and DBIL levels were significantly lower in the SIIT group than in the LIIT group (p < 0.01). The 90-day transplant-free mortality in the SIIT group and LIIT group was 12.8% and 29.6%, respectively (p < 0.001). Higher baseline MELD score was associated with increased 90-day transplant-free mortality (OR = 1.815, 95% CI: 1.466-2.247, p < 0.001). In patients with HBV-ACLF, SIIT with ALSS was associated with reduced 90-day transplant-free mortality compared with LIIT, although prospective studies are required to confirm causality.

Anticoagulation with mechanistically distinct FXI/FXIa antibodies amrecibart (REGN9933A2) and cenvacibart (REGN7508Cat).

BackgroundCardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and devastating postoperative complication, particularly among older adults. Accurate risk stratification and early prediction of CSA-AKI are essential for guiding preventive strategies and optimizing clinical decision-making.MethodsIn this retrospective study, data from two centers (n=623) were utilized for model training and internal validation, whereas data from a third, distinct center (n=110) were reserved for external validation. CSA-AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) Serum creatinine criteria. Key predictors were identified using a consensus of four methods: Least Absolute Shrinkage and Selection Operator (LASSO), Recursive Feature Elimination (RFE), Boruta, and Random Forest-based filtering. Six machine learning (ML) models, including Logistic Regression (LR), K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM), were developed utilizing five-fold cross-validation. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanations (SHAP) approach was applied to interpret the best-performing model.ResultsDevelopment of CSA-AKI was noted in 177 patients (24.1%) during the first postoperative week. In terms of comparative performance, LightGBM exhibited the greatest AUC (0.784, 95% confidence interval [CI]: 0.702–0.859). The most influential features were lactate, surgical duration, activated partial thromboplastin time (APTT), transfusion volume, and Prothrombin Time (PT). SHAP-based summary and force plots interpreted the model at global and local levels. Furthermore, SHAP dependence plots elucidated non-linear effects of single features on CSA-AKI risk.ConclusionMachine learning models demonstrate high efficacy in predicting CSA-AKI risk in older adults. The LightGBM model outperformed other algorithms; coupled with interpretability tools, it can assist clinicians to identify high-risk patients earlier and optimize perioperative management.

Bridging Evidence and Practice: The role of implementation science to optimize plasma transfusion in cirrhosis.