Regulating the interlayer SO42--induced rebound of SeO42- in green rust coupled with iron nanoparticles for groundwater remediation.

Green rust (GR) is an interlayer anion-containing Fe(II)/Fe(III) mineral material that is versatile in removing a series of ionic contaminants in water. Taking SeO42- (Se(VI)) as the target contaminant, this study identified that the removal processes of Se(VI) by GR could be divided into three stages: initial rapid interlayer exchange, followed by a rebound, and finally slow removal. In addition, as the percentage of SO42- in GR interlayer increased, the Se(VI) removal by GR gradually decreased. To mediate the SO42--induced rebound of Se(VI), the coupling of GR with iron nanoparticles (nFe0@GR) was proposed in this study and it was found that the removal efficiency of Se(VI) by nFe0@GR was 3.53 folds greater than that of GR. This study further revealed that the enhanced reactivity of nFe0@GR with Se(VI) could be attributed to the re-equilibration of SO42- driven by the formed GR in situ. Since it had a weaker electrostatic repulsion with interlayer SeO42- than pristine GR, the Se(VI) could be quickly removed by nFe0@GR without the rebound. Moreover, the nFe0@GR was demonstrated to be effective in immobilizing Se(VI) from simulated groundwater and has a great potential to reduce the risk of Se(VI) re-release into the environment.

Prevention and Management of Denosumab Discontinuation Rebound Fractures.

Denosumab rebound-associated fractures occur in approximately 1 out of 14 patients who discontinue denosumab therapy without sequential antiresorptive therapy. They occur due to excessive bone resorption after missed or delayed denosumab doses. The fractures are multiple and quality of life altering. This phenomenon occurs in all patient populations that use prolonged denosumab therapy. Average delay in denosumab dosing beyond 7 months or discontinuation of denosumab without sequential therapy is associated with increased mortality in retrospective studies. Multiple medication regimens used after the end of denosumab therapy have been shown to substantially reduce the risk of rebound vertebral fractures.

Rebound pain prevention after peripheral nerve block: A network meta-analysis comparing intravenous, perineural dexamethasone, and control.

STUDY OBJECTIVE: Peripheral nerve blocks (PNBs) are widely used for postoperative analgesia, but rebound pain following block resolution poses a significant clinical challenge. Dexamethasone, administered either intravenously (IV) or perineurally, has shown promise in reducing rebound pain incidence, but the optimal route remains unclear. This network meta-analysis (NMA) aims to compare the effectiveness of different routes of dexamethasone administration, including IV, perineural, and control, in reducing the incidence of rebound pain following PNBs. DESIGN: Network meta-analysis. SETTING: Operating room, postoperative recovery area and ward. PATIENTS: Seven randomized controlled trials involving 561 patients undergoing peripheral nerve block for postoperative pain management. INTERVENTIONS: Intravenous and perineural dexamethasone compared to control for preventing rebound pain. MEASUREMENTS: The primary outcome was the incidence of rebound pain. Secondary outcomes included median time to first analgesic request, rebound pain resolution time, difference in pain scores before and after PNB resolution, and nausea/vomiting. MAIN RESULTS: Both IV and perineural dexamethasone significantly reduced the incidence of rebound pain following peripheral nerve blocks compared to the control group. IV dexamethasone ranked first based on P-score (OR, 0.13; 95 % CI, 0.07-0.23; P-score, 0.92). Secondary outcomes, including time to the first analgesic request, pain score difference, and nausea/vomiting, also favored both IV and perineural dexamethasone over the control group. CONCLUSION: Both IV and perineural dexamethasone are preferred over no dexamethasone for preventing rebound pain after PNBs, with IV dexamethasone being the more effective route. Despite limitations, these findings provide valuable insights for clinical decision-making in postoperative pain management. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024530943.

Viral and symptom rebound following anti-SARS-CoV-2 monoclonal antibody therapy in a randomized placebo-controlled trial.

We explored viral and symptom rebound after COVID-19 amubarvimab/romlusevimab monoclonal antibody therapy vs placebo in the randomized ACTIV-2/A5401 trial. Participants underwent nasal SARS-CoV-2 PCR at study days 3, 7, 14, and 28. Viral rebound was defined as RNA ≥3 and ≥0.5 log10 copies/mL increase from day 3 or 7, and symptom rebound as hospitalization or any moderate/severe symptom for ≥2 days after initial symptom improvement. There was no difference in viral rebound (∼5%/arm) (analysis population n=713) or symptom rebound among participants who initially improved (hazard ratio 0.95 (95% CI 0.52, 1.75, analysis population) n=574); <1% had both viral/symptom rebound.

Rebound effect of hypothalamic-pituitary thyreotropic activity: a new model to better understand hypothyroidism.

PURPOSE: Hypothalamic-pituitary thyrotropic activity (HPta) is crucial since TSH is the mainstay for evaluating primary hypothyroidism (hT) and replacement therapy in clinical practice. Despite TSH values, some patients experience symptoms and metabolic alterations, raising several issues about hT. The aim of the study was to investigate factors influencing the TSH values achieved after a period of hT induced in a standardized and controlled manner (TSH_time1). METHODS: Our institutional database was searched to extract records of differentiated thyroid cancer (DTC) patients undergoing a LT4 withdrawal protocol prior to radioiodine (RAI) administration. We collected clinical and biochemical parameters before LT4 discontinuation and after one month of induced hT. We performed Mann-Whitney U-test and linear regression analyses. RESULTS: We included 102 patients, with a median age of 44 years. In univariate analyses, TSH_time1 was correlated with age (p 0.005) and the dose pro Kg/die of LT4 assumed until the discontinuation of LT4 (LT4_dose) (p 0.023). The higher the age, the lower the TSH_time1 level. The higher the LT4_dose, the higher the TSH_time1 level. After multivariate analysis, the fittest model included age, BMI, LT4_dose, and systemic inflammation response index with an adjusted R2 of 0.4. CONCLUSION: The study highlights new mechanisms that influence HPta. HPta progressively reduces with age, and this must be considered when evaluating TSH values in the elderly. Furthermore, we report for the first time a rebound effect of HPta, determined by the dose pro Kg/die of LT4 taken prior to its discontinuation. Inflammation and metabolic status also affect these phenomena.

Outcomes after Functional Nasal Surgery in Patients with Versus without Rhinitis Medicamentosa.

OBJECTIVE: Topical nasal decongestants (TNDs) are used to reduce nasal soft tissue edema and obstruction. However, after frequent TND use, patients can develop rhinitis medicamentosa (RM) with rebound nasal edema and obstruction. Management of RM has centered largely on TND cessation ± intranasal corticosteroids. The purpose of this study was to compare nasal obstruction outcomes following nasal obstruction surgery in patients with versus without RM. METHODS: A retrospective case-control study was conducted with adult patients who underwent bilateral inferior turbinate reduction (ITR) with or without septoplasty and nasal valve repair. Patients with versus without RM were assessed. RM was defined as at least daily TND use for ≥4 weeks. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores, and long-term TND cessation rates were collected. NOSE score changes were compared between patients with versus without RM. RESULTS: Of the 36 RM patients, mean age was 52.0 years, and 63.9% were male. Of 116 non-RM patients, mean age was 41.6 years, and 46.6% were male. Postoperative NOSE scores were collected at a mean 972.1 days postoperatively for RM patients, and 565.0 days for non-RM patients. Mean NOSE score reductions were - 9.8 for RM and - 8.6 for non-RM patients, both of which were significant (p < 0.0001). NOSE score reductions were not significantly between the two groups (p = 0.2438). Long-term TND cessation was maintained in 86.1% of RM patients. CONCLUSION: Patients with and without RM achieved similar long-term significant NOSE score reductions following nasal obstruction surgery, and 86.1% of RM patients maintained long-term TND cessation. LEVEL OF EVIDENCE: Level 3 evidence Laryngoscope, 2024.

Efficacy in myopia control-The impact of rebound.

PURPOSE: When myopia control treatment is discontinued, progression will increase, but does it revert to expected values based on the age and race of the child or does it accelerate further? The latter scenario is considered a rebound. METHODS: A PubMed search was conducted with the words 'rebound' and 'myopia control', identifying further papers from reviews. Inclusion was limited to prospective studies with ≥6 months of treatment, ≥3 months of data following cessation and with axial length data, which allowed calculation of rebound. Nineteen studies were identified, comprising 24 treatment groups. In 10 studies, untreated control children were followed both throughout the treatment and cessation periods, allowing for a concurrent comparison group. In three studies, a control group was followed for 1 or 2 years and thereafter received the treatment under evaluation. Later, treatment ceased in the originally treated children. Finally, six studies were cross-over designs. For these latter two study designs, initial axial elongation and myopia progression in the control group were extrapolated to the cessation period, accounting for annual slowing. Values from durations of <1 year were annualised. RESULTS: The mean annualised rebound was +0.05 ± 0.10 mm and -0.09 ± 0.24 D for axial length and myopia progression, respectively, and these were correlated (r2 = 0.59, p < 0.001). Rebound was associated with 1-year treatment efficacy (r2 = 0.43, p < 0.001). The mean annualised rebound with optical corrections was -0.01 ± 0.03 mm. Five of the six highest rebound values (≥0.14 mm) were from red light therapy and atropine studies. Rebound ranged from +0.03 to +0.14 mm for overnight orthokeratology. CONCLUSIONS: Consistent with previous statements, no evidence for rebound was found for myopia control spectacles and soft contact lenses. Future research should explore the influence of age and magnitude of treatment efficacy on rebound.

Longitudinal assessments of viral rebound among people with HIV in South Carolina: a population-based cohort study.

Routinely monitoring viral rebound (VR) is important in the life course of people with HIV (PWH). This study examined risk factors for time to the first VR, the number of VRs and their association with VR history in men who have sex with men (MSM). It includes 8176 adult PWH diagnosed from January 2005 to December 2018, followed until July 2021. We used the Cox model for time to the first VR, the Poisson model for a number of VRs, and logistic regression for VR history in MSM. Younger individuals (50-59 years vs 18-29 years, aHR: 0.43, 95% CI: [0.34, 0.55]) were more likely to experience VR. Black individuals (Black vs White, IRR: 1.61, 95% CI [1.38, 1.88]) had more VR, while MSM (MSM vs Heterosexual, IRR: 0.68, 95% CI: [0.57, 0.81]) was negatively associated with number of VsR. Furthermore, individuals engaging illicit drug use (IDU) (aOR: 1.50, 95% CI: [1.03, 2.17]) were more likely to experience VR in the MSM subgroup. This study highlighted the alarming risk factors related to VR among PWH. Tailored intervention should also be deployed for young, Black MSM patients with substance use for more effective and targeted public health strategies concerning VR.

Associations of 1.5- and 3-year Phthalate Exposure Levels with Early Adiposity Rebound and Overweight/Obesity in Japanese Children: An Adjunct Study of the Japan Environment and Children's Study.

The relationship between early childhood phthalate exposure and early adiposity rebound is unclear. This study aimed to investigate the association between 1.5- and 3-year phthalate exposure and EAR and overweight/obesity in 7.5-year-old Japanese children. A total of 452 mother-child pairs were enrolled from the Aichi Regional Cohort of the Japan Environment and Children's Study. The children were followed up at birth and at 1.5, 2, 3, 4, 5, 6, and 7.5 years of age for physical examination. Human biomonitoring of 16 urinary metabolites of eight phthalates was performed at 1.5 and 3 years of age. Latent class mixed models, binary logistic regression, and quantile g-computation were performed to identify body mass index (BMI) trajectories and investigate the relationships of single or mixed phthalate exposure with EAR and overweight/obesity. A one-unit increase in log10-transformed 3-year-old Σdi(2-ethylhexyl) phthalate (ΣDEHP) exposure levels was significantly associated with 6-year-old BMI in girls. The 1.5-year mono-iso-butyl phthalate and 3-year Σdi-isodecyl phthalate exposure levels were significantly associated with the repeated measures of longitudinal BMIs in girls. Single phthalate exposure showed null associations with EAR or overweight/obesity in the 7.5-year-old children. Σdi-isononyl phthalate, ΣDEHP, and mono-n-butyl phthalate exhibited the highest proportion of partial positive weights of being in the EAR trajectory after confounder adjustment. Phthalate mixture exposure in 1.5- and 3-year-old children was not significantly associated with EAR. Early childhood phthalate exposure was not related to EAR or overweight/obesity in 7.5-year-old Japanese children. However, few phthalates were positively associated with longitudinal BMIs in girls.

Efficacy of Direct Versus Peripheral Adjuvant Dexamethasone on Duration and Rebound Pain in Regional Anesthesia for Outpatient Distal Radius Fracture Fixation: A Prospective Randomized Controlled Blinded Study.

BACKGROUND: Despite increasingly wider use, there remains controversy among anesthesiologists regarding preferred formulations and the role of steroid adjuvants in regional anesthesia. There is also uncertainty in the role of dexamethasone when administered directly versus peripherally. We hypothesize that directly mixing dexamethasone into the regional nerve block rather than peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy concerning duration and rebound pain, decreased postoperative pain scores, or opioid consumption within the short-term postoperative period. METHODS: A prospective, randomized controlled blinded study was conducted for patients undergoing open reduction and internal fixation with a volar plate technique for distal radius fractures. Patients were randomized for their preoperative anesthesia. One group had ultrasound-guided supraclavicular block with ropivacaine with a direct mix of dexamethasone 4 mg (Direct group), while the other group had ultrasound-guided supraclavicular block with ropivacaine and peripheral intravenous dexamethasone 4 mg (Indirect group). Data was collected pre, intra, and postoperatively. RESULTS: Fifty patients consented and participated in the study, with 27 participants in the direct group and 23 participants in the indirect group. Compared to intravenous administration, directly administered dexamethasone demonstrated a significant difference in the average time for the block to fade, onset of motor and sensory recovery, and block resolution. CONCLUSION: Our findings prove that directly mixing dexamethasone compared to peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy with regards to duration and rebound pain, but do not prove that there will be a difference in decreased postoperative pain scores or opioid consumption within the 24-hour postoperative period. LEVEL OF EVIDENCE: Prognosis Level I.

Clinical rebound after treatment with nirmatrelvir/ritonavir in COVID-19.

BACKGROUND: Nirmatrelvir/ritonavir (NM/r) is a safe and effective oral antiviral therapeutic used for treatment of mild-to-moderate COVID-19. Case reports described a clinical rebound syndrome whereby individuals experience a relapse of symptoms shortly after completing successful treatment. There is a lack of information on frequency of COVID-19 rebound after NM/r in routine clinical care, contributing factors, and clinical outcomes. METHODS: We reviewed electronic medical records to verify COVID-19 diagnosis, symptoms, and treatment with NM/r from January-June 2022. We defined COVID-19 clinical rebound as clear improvement in symptoms followed by recurrence or worsening of symptoms within 30 days of a five-day course of NM/r. RESULTS: We studied 268 adults with median age 57 (IQR 47, 68), 80% White race, 85% non-Hispanic ethnicity, 55% female, 80% vaccinated and boosted against SARS-CoV-2, and 68% with any co-morbidity. Sixteen (6.0%) of studied patients were determined to have COVID-19 clinical rebound. The median time from starting NM/r to rebound was 11 days (IQR 9, 13). Notable demographic and clinical factors with higher proportion (not statistically significant) among COVID-19 rebound patients were female sex (75% rebound vs. 54.5% no rebound), Black race (12.5% rebound vs. 4.9% no rebound), presence of at least one co-morbidity (81.3% rebound vs. 67.5% no rebound), and lack of prior SARS-CoV-2 infection (100% rebound vs. 92.9% no rebound). Only one patient (6.25%) was hospitalized after COVID-19 rebound. CONCLUSIONS: COVID-19 clinical rebound after treatment with NM/r is mild with favorable outcomes and more common than previously reported from real-world clinical care studies.

ICT and energy rebound effect: Empirical analysis based on data from Chinese cities.

Information and communication technology (ICT) is predicted to emerge as a new driver of economic growth in the future and has been identified as a significant strategic emerging industry. It is of great theoretical and practical significance to include ICT in the energy rebound measurement framework. Based on Chinese city-level data from 2006 to 2019, this paper incorporates ICT into an improved stochastic frontier (SFA) model of energy consumption to measure the energy rebound effect (ERE) in 252 prefecture-level cities, and further investigates the formation mechanism of ICT affecting the ERE. The results show that when ICT is included in the energy rebound measurement framework, the average value of ERE in each region of China ranges from 0.4627 to 0.6458, with an overall average value of 0.5532, indicating that China's actual reduction in energy consumption is only about 40% of that expected. In terms of distributional characteristics, the mean value of ERE increases from coastal to inland, with the center of gravity always deviating from mainland China's geometric center (103°50'E, 36°N), the degree of spatial imbalance in the east-west direction is much greater than in the north-south direction. It is worth noting that ICT has a significant dampening effect on ERE, and the conclusion still holds after a series of robustness tests. In addition, the mechanisms by which ICT affects energy rebound include breaking through geographical and administrative barriers and reducing the impact of market segmentation on factor mobility.

Comparison of three methodologies for measuring intraocular pressure in healthy cats.

Background and Aim: Measuring intraocular pressure (IOP) is crucial for identifying potentially damaging changes in the eyes, including diseases as glaucoma and uveitis. This study compared intraocular pressure (IOP) measurements in cats using the Tonovet and Tonovet Plus (rebound), Tono-Pen Avia Vet (applanation), and Kowa HA-2 (Goldman's methodology applanation) tonometers. Materials and Methods: 55 healthy cats (108 eyes) were assessed through three distinct studies: An ex vivo experiment (10 eyes of five cats) to correlate IOP manometry and tonometry values and ascertain the correlation coefficient (r2); an in vivo study (10 eyes of five sedated cats) to contrast manometer and tonometer readings; and an outpatient clinical trial (80 eyes of 45 cats) to analyze only tonometer measurements. Results: The r 2 values observed in the ex vivo study were Tonovet (0.923), Tonovet Plus (0.925), Tono-Pen Avia Vet (0.877), and Kowa HA-2 (0.901). The IOP values in mmHg in the in vivo study were as follows: Manometer (16.1 ± 2.7), Tonovet (21.1 ± 3.6), Tonovet Plus (19.7 ± 7.2), Tono-Pen Avia Vet (17.6 ± 7.9), and Kowa HA-2 (16.8 ± 2.0). In the outpatient clinical study, the IOP values in mmHg were as follows: Tonovet (19.7 ± 6.6), Tonovet Plus (17.1 ± 5.4), Tono-Pen Avia Vet (16.3 ± 4.3), and Kowa HA-2 (14.5 ± 2.2). Conclusion: IOP and manometry readings were strongly correlated by all tonometers. In the clinical setting, the most and least IOP measurements were recorded using Tonovet and Kowa HA-2, respectively, stressing the importance of an IOP reference table for each tonometer in feline practice.

Does the rebound effect offset low-carbon gains from technological progress in China's transportation sector?

As a major contributor to carbon emissions, the transportation sector faces immense pressure to align with China's carbon peak and neutrality goals. Technological progress is a crucial strategy for achieving these goals. However, rebound effects can make technological progress a double-edged sword in terms of reducing emissions. A deep understanding of the carbon rebound effect (CRE) in the transportation sector is crucial for fully leveraging the role of technological progress on carbon reduction. This study uses nonparametric frontier methods to calculate and analyze the CRE of the transportation sector related to technological progress in 30 provinces of China from 2006 to 2021 for the first time. The relevant findings are threefold. (1) During the sample period, the estimated CRE ranged from 20 % to 210 %, averaging 69.19 %. Half of provinces exhibited backfire effects, that is, rebound emissions exceeded the low-carbon gains. (2) CRE exhibits fluctuations over time and is significantly affected by economic policy shocks. Technological progress is a significant driver of transportation carbon emissions reduction. (3) CRE varies considerably across regions, with the eastern coastal provinces exhibiting the lowest CRE, averaging 57.96 %. The central regions followed with an average of 81.54 %, while the western regions had the highest CRE of 111.85 %. This study has crucial implications for enabling policymakers to better understand CRE in the transportation sector and strategically develop subsequent policies that are specifically tailored to regional conditions.

Circular economy, economic growth, and e-waste generation in EU27 countries: Further evidence from the novel circular economy index and threshold effect.

The circular economy has been identified as a critical keyword for achieving the Sustainable Development Goals. Nevertheless, there is a lack of in-depth empirical literature on the impact mechanisms of the circular economy (CE) and economic growth (GDP) in mitigating e-waste generation (waste electrical and electronic equipment - WEEE). Given Europe's leading position in e-waste generation per capita, the study aims to scrutinize the interplay between CE, GDP, and WEEE for 2010-2020. The research applies advanced econometric methods, primarily centered around the system generalized method of moment and dynamic panel threshold. It was noteworthy that different CE indicators exhibited varying effects on WEEE through the econometric analysis. Therefore, the research uniquely utilized the entropy weight method to compute a holistic composite index for the circular economy (CEI) and gained some interesting findings. Firstly, CEI significantly reduced WEEE, while GDP drove its increase. However, an overly developed CEI of 0.7616 counteracted its beneficial effect. Secondly, the synergy of CEI*GDP engendered the circular economy rebound effect, diminishing environmental benefits. Thirdly, in the circular context, the environmental Kuznets curve was validated, showcasing an inverted U-shaped pattern. Finally, the study found CEI to have different threshold effects, with thresholds of 0.2161 to inhibit WEEE, 0.2114 to avert the circular economy rebound effect, and 0.2360 to leverage GDP in reducing WEEE. These outcomes give insights to policymakers in designing sound policies targeting circular economy development and decoupling e-waste generation from economic growth towards the United Nations' SDGs.

The difference of dynamic elasticity characteristics and stroke effect between two types of new material seamed plastic table tennis ball.

The diameter and weight of different brands of table tennis ball will affect the ball's elasticity and stroke. The purpose of this study is to analyze the difference of the dynamic elasticity and stroke effect between the two brands of new plastic ball. A self-made experiment was designed to test the dynamic elasticity characteristics of DHS D40 + and Nittaku 40+. Table tennis players (N = 18) were randomly selected from the China Table Tennis College (Mage = 15.16 ± 2.41; Mheight = 1.59 ± 0.32 m; Mweight = 45.72 ± 5.17 kg). Each participant was righthand shake-hands grip. A speedometer was used to record the ball speed and a high-speed camera was used to measure the spin speed. Data normality was verified by using the Kolmogorov-Smirnov test. The independent t-test was conducted to assess the differences of the dynamic elasticity and stroke effect between the two types of plastic ball. Results showed that the rebound speed and decrement rate of DHS D40 + and Nittaku 40 + both increased with the increased falling speed, respectively. When falling at high speed, there was a significant difference of dynamic elasticity between DHS D40 + and Nittaku 40+ (p < 0.01). There was also a significant difference in the ball speed and spin speed between the two types of new material seamed plastic ball during the backhand backspin stroke (p = 0.041, p = 0.022, respectively), and the ball speed and spin speed of DHS D40 + were higher than that of Nittaku 40 + ball. Compared with the DHS D40+, the Nittaku 40 + has a faster rebound speed, higher rebound height, and better dynamic elasticity. Therefore, under same striking conditions, when hitting the Nittaku 40 + ball, players need to increase the swing distance and hit the ball with more strength to improve the ball speed and rotation speed; increase the spin and decrease the ball's rebound height of the serve.

Medication-Overuse Headache: Update on Management.

Long-term frequent use of acute pain medication for the treatment of headaches has paradoxically been shown to increase the frequency of headaches. So-called medication-overuse headache (MOH) is particularly problematic in patients with migraine who overuse triptans and opioids. Prevention through education remains the most important management strategy. Once established, MOH can be difficult to treat. Although complete or near-complete withdrawal of acute pain medication for 8-12 weeks has been shown to benefit most patients, this can be hard to achieve. The use of OnabotulinumtoxinA and drugs that target the calcitonin gene-related peptide system for the prevention of migraines have been shown to benefit patients with MOH. Furthermore, the use of novel acute pain medication for migraines, including Gepants and Ditans, which do not cause MOH, are likely to improve patient outcomes. In this review article we examine the following: the burden of MOH; who develops MOH; the pathophysiological mechanisms; and the treatment strategies.

Tissue plasminogen activator for acute branch atheromatous disease exhibits transient improvement and worsening.

BACKGROUND: Tissue plasminogen activator (tPA) is an effective treatment for acute ischemic stroke. Although initial improvement is observed when administered for branch atheromatous disease (BAD), some cases subsequently worsen. Clinical data on the characteristics of these patients is lacking, and the benefits of tPA are unclear. OBJECTIVE: To analyze rebound cases and elucidate the clinical characteristics and outcomes associated with tPA administration in BAD. METHODS: This multicenter retrospective study was conducted in Japan. Worsening after initial improvement of a condition is termed as rebound, and such cases were compared with other types of ischemic stroke in patients with and without rebound. The characteristics of patients with BAD who rebounded were examined. RESULTS: The study included 93 patients. Among the patients who were administered tPA, the NIHSS scores at 24 h and 7 days post-tPA were significantly higher in patients with BAD than in patients with other types of infarcts. The group with BAD exhibited a significantly higher rate of rebound than other groups (37.5 % vs. 0 %, P < 0.001). However, no differences were observed in outcomes between patients who experienced rebound after tPA administration and those who did not. CONCLUSIONS: Reevaluation and changing the strategy of tPA use in patients with BAD may be necessary. However, this study does not totally discourage its use, as specific patients can benefit.

Development and validation of a prediction model for rebound hyperbilirubinemia: a Chinese neonatal cohort study.

Background: Rebound hyperbilirubinemia (HBB) is still present in as high as 10% of newborn babies. However, the applicability of established prediction models for rebound HBB to Chinese newborns is unclear. This study aimed to establish a model to predict HBB rebound after phototherapy among Chinese neonates. Methods: A retrospective cohort study was conducted on 1,035 HBB infants receiving phototherapy. Rebound HBB was defined as total serum bilirubin (TSB) returning to or above the American Academy of Pediatrics (AAP) phototherapy threshold within 72 hours after the end of phototherapy. The predictive effects of previously published two- and three-variable scores were verified. Neonates were randomly assigned in a 6:4 ratio to the training (n=621) group and the testing (n=414) group. All variables in the training set were used to select predictors by least absolute shrinkage and selection operator (LASSO) regression analysis. The internal validation of the prediction model was performed using the testing set. The model's predictive performance was evaluated by area under the curve (AUC), accuracy, sensitivity, and specificity, each with 95% confidence intervals (CIs). Receiver operating characteristic (ROC) and calibration curves were constructed to evaluate the discrimination ability and fitting effect of the prediction model, respectively. Results: Rebound HBB was observed in 210 patients (20.3%). The AUC for the two- and three-variable scores were 0.498 (95% CI: 0.455-0.540) and 0.498 (95% CI: 0.457-0.540), respectively. Predictive factors for the risk of rebound HBB included formula feeding (>3 times/day), standard phototherapy irradiation time, TSB levels and age at termination of phototherapy, neonatal weight, and differences between TSB levels at the phototherapy termination and phototherapy threshold. The prediction model's AUC was 0.935 (95% CI: 0.911-0.958), the sensitivity was 0.880 (95% CI: 0.809-0.950), the specificity was 0.831 (95% CI: 0.790-0.871), and the accuracy was 0.841 (95% CI: 0.805-0.876). Conclusions: The established model performed well in predicting rebound risk among Chinese infants with HBB, which may be beneficial in treating and managing HBB in infants.