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Co-transmission, the release of multiple neurotransmitters from a single neuron, is an increasingly recognized phenomenon in the nervous system. A particularly interesting combination of neurotransmitters exhibiting co-transmission is glutamate and GABA, which, when co-released from neurons, demonstrate complex biphasic activity patterns that vary depending on the time or amplitude differences from the excitatory (AMPA) or inhibitory (GABA_A) signals. Naively, the outcome signal produced by these differences can be functionally interpreted as simple mechanisms that only add or remove spikes by excitation or inhibition. However, the complex interaction of multiple time-scales and amplitudes may deliver a more complex temporal coding, which is experimentally difficult to access and interpret. In this work, we employ an extensive computational approach to distinguish these postsynaptic co-transmission patterns and how they interact with dendritic filtering and ionic currents. We specifically focus on modeling the summation patterns and their flexible dynamics that arise from the many combinations of temporal and amplitude co-transmission differences. Our results indicate a number of summation patterns that excite, inhibit, and act transiently, which have been previously attributed to the interplay between the intrinsic active and passive electrical properties of the postsynaptic dendritic membrane. Our computational framework provides an insight into the complex interplay that arises between co-transmission and dendritic filtering, allowing for a mechanistic understanding underlying the integration and processing of co-transmitted signals in neural circuits.

Supplementary information: The online version contains supplementary material available at 10.1007/s11571-025-10383-2.

As healthcare text data becomes increasingly complex, it is vital for sentiment analysis to capture local patterns and global contextual dependencies. In this paper, we propose a hybrid Swin Transformer-BiLSTM-Spatial MLP (Swin-MLP) model that leverages hierarchical attention, shifted-window mechanisms, and spatial MLP layers to extract features from domain-specific healthcare text better. The framework is tested on domain-specific datasets for Drug Review and Medical Text, and performance is assessed against baseline models (BERT, LSTM, and GRU). Our findings show that the Swin-MLP model performs significantly better overall, achieving superior metrics (accuracy, precision, recall, F1-score, and AUC) and improving mean accuracy by 1-2% over BERT. Statistical tests to assess significance (McNemar's test and paired t-test) indicate that improvements are statistically significant (p < 0.05), suggesting the efficacy of the architectural innovations. The results' implications indicate that the model is robust, efficiently converges to classification, and is potentially helpful for a wide range of domain-specific sentiment analyses in healthcare. We will examine future research directions into exploring lightweight attention mechanisms, cross-domain multimodal sentiment analysis, federated learning to protect privacy, and hardware implications for rapid training and inference.

Low molecular weight heparin (LMWH) is widely used for the treatment and prevention of many venous thromboembolic disorders. LMWH acts through its ability to potentiate inhibition of factor Xa. LMWH undergoes primary renal excretion and therefore its elimination can be severely impacted by kidney disease. We report on the case of an infant with stage 5 chronic kidney disease (CKD) who received a prolonged accidental overdose of dalteparin. The infant was symptomatic with a falling haemoglobin, perinephric hematoma, and oozing venipuncture sites. Given the inability to predict drug clearance in this infant and her significant risk of bleeding, she underwent a successful trial of continuous veno-venous hemofiltration (CVVH) for the treatment of LMWH overdose. Whilst on CVVH, a steady downward trend in anti-Xa levels over 24 h was observed.

Background: This retrospective, descriptive study, conducted in a single-center PICU from June 2014 to May 2023, aimed to analyze the efficacy of adjunctive regional citrate anticoagulation for continuous kidney replacement therapy (CKRT) circuits during extracorporeal membrane oxygenation (ECMO).

Methods: Patients were divided into two groups based on their CKRT anticoagulation strategy: those receiving regional citrate anticoagulation in addition to systemic heparin (UFH + RCA group) and those receiving only systemic heparin (UFH group). CKRT circuits were also classified as either UFH + RCA or UFH to analyze outcomes specific to each anticoagulation strategy. CKRT circuit lifespan estimation was calculated by dividing the total CKRT duration by the number of circuits used.

Results: During the study period, 110 pediatric patients were treated with ECMO at our PICU. During ECMO, 64 (58.2%) of these patients required CKRT. Fluid overload and acute kidney injury were the primary indications for CKRT. While not statistically significant, the median estimate CKRT circuit lifespan was longer in the citrate group [84 (38.4-112.0)] than the heparin group [52 (12.0-408.0)]. Circuit changes due to clotting were significantly higher in the heparin group compared to the citrate group (58.1% vs. 31.7%, p = 0.00). Kaplan-Meier analysis revealed a statistically significant difference in the timing of clotting-related circuit changes, favoring UFH + RCA (p = 0.02).

Conclusions: To the best of our knowledge, our study represents the first comparison of UFH + RCA and UFH alone for CKRT in pediatric ECMO patients. Our findings suggest that using UFH + RCA might help the circuit last longer by decreasing changes caused by clotting. Prospective studies on this topic are needed.

Vertigo, a prevalent neurovestibular disorder, arises from dysfunction in the vestibular system and often lacks precise, personalized treatments. This study proposes a bio-inspired spiking neural network (SNN) model that simulates vestibular dysfunction and adaptive recovery using Leaky Integrate-and-Fire (LIF) neurons with spike-timing-dependent plasticity (STDP). The architecture mimics the vestibular pathway through biologically plausible layers: hair cells, afferents, and cerebellar integrators, and models pathological states such as hair cell hypofunction and synaptic disruption. A reinforcement-based feedback mechanism enables the simulation of therapy-induced plasticity, resulting in a 48-62% drop and 38% recovery in cerebellar spike activity during adaptation epochs. The model demonstrates real-time feasibility, with an average simulation runtime of  4 s per epoch on standard hardware. Its design is scalable and well-suited for future deployment on neuromorphic platforms (e.g., Loihi, SpiNNaker). Its modular and interpretable design enables in silico testing of rehabilitation strategies, real-time monitoring of dysfunction, and future personalization using clinical datasets. This work establishes a computational foundation for AI-driven vestibular therapy that is adaptive, explainable, and hardware compatible.

Supplementary information: The online version contains supplementary material available at 10.1007/s11571-025-10368-1.

Introduction: Evidence provides support for the therapeutic benefits of targeting avoidance in prolonged grief. However, it is not clear whether avoidance interferes with mourning through altered resilience to stress, as measured by heart rate variability (HRV).

Methods: Thirty-five adults (30 female; mean age: 39.2 years), who had been bereaved for more than one year, participated in this prospective, observational study. At each of the initial assessments and up to six-month follow-ups, grief symptoms were assessed using the Complicated Grief Questionnaire, and a resting electrocardiogram was recorded to extract the high-frequency component of HRV (HF-HRV). To differentiate avoidance from grief itself, principal component analysis was used.

Results: A nonlinear cross-sectional relationship was observed between avoidance and HF-HRV (coefficient = 0.29, p = .003); the lower the avoidance, the lower the HF-HRV in the low avoidance group. Grief improved only in the low avoidance group longitudinally. The observed relationship between increased HF-HRV and decreased grief was modified by the avoidance group, such that the low-avoidance group drove this association (estimate -0.53, 95% CI -0.86, -0.21, p = .001), while the high-avoidance group did not (estimate 0.44, 95% CI -0.32, 1.20, p = .26).

Conclusion: Despite its palliative gain, avoidance relates to the maintenance of grief longitudinally through attenuated autonomic resilience to stress.

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) and lupus nephritis (LN) are two major, life-threatening complications in childhood-onset SLE (cSLE). Data regarding the epidemiology and prognosis of children with concurrent NPSLE and LN remain scarce. This study aimed to investigate the clinical characteristics, associated factors, and outcomes of NPSLE in Chinese children with LN.

Methods: A retrospective cohort study was conducted at the Paediatric Nephrology Centre of Hong Kong Children's Hospital, including 95 Chinese children with biopsy-proven cLN. Comparisons were made between children with and without NPSLE.

Results: Of 95 Chinese children with cLN, 11 (12%) developed NPSLE, and 31 NPSLE events were reported. Estimated glomerular filtration rate < 30 mL/min/1.73 m² at diagnosis of LN (OR_adj 6.7, 95% CI 1.29-35.1) and higher maximal proteinuria during the observation period (OR_adj 1.07, 95% CI 1-1.13) were predictive of NPSLE upon multivariable analysis. Compared to children with LN who did not develop NPSLE, significantly more children who developed subsequent NPSLE flare following initial kidney involvement had a history of medication non-adherence (100% vs. 25%, p < 0.001), higher degree of proteinuria at the diagnosis of LN (urine protein/creatinine ratio, 5.7 vs. 2.4 mg/mg, p = 0.04) and during the entire observation period (urine protein/creatinine ratio, 13.2 vs. 3.3 mg/mg, p = 0.004). Patients with NPSLE had significantly lower complete remission rates for LN at 6- and 12-month post-induction (27.3% vs. 70.2%, p = 0.014; 45.5% vs. 83.3%, p = 0.01, respectively). Kaplan-Meier analysis showed that patients with NPSLE had worse kidney and patient survivals (log-rank test, p < 0.001, 0.0014, respectively) than those without NPSLE.

Conclusions: Worse kidney and patient survivals are observed in cLN patients with NPSLE. Severe LN manifestation and medication non-adherence are associated with the development of NPSLE.

Background: Nephrotic syndrome (NS) is a common pediatric kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. Leukotrienes (LTs), as inflammatory mediators, may contribute to NS pathogenesis and influence treatment response. This study aimed to assess urinary leukotriene E4 (LTE4) levels in children with an initial onset of NS and evaluate their potential as biomarkers for steroid responsiveness.

Methods: In this observational cohort study, 41 children with a first episode of NS and 41 age- and sex-matched healthy controls were enrolled. Patients were classified into steroid-sensitive NS (SSNS; n = 29) and steroid-resistant NS (SRNS; n = 12) groups following initial steroid therapy. Urinary LTE4 levels were measured prior to treatment, using enzyme-linked immunosorbent assay (ELISA).

Results: Urinary LTE4 levels were significantly elevated in children with NS compared to controls (p = 0.001). Although urinary LTE4 to urinary creatinine (U cr) ratios were also higher in patients, the difference did not reach statistical significance (p = 0.09). No significant correlations were observed between urinary LTE4 levels and urinary protein excretion or serum albumin. Furthermore, urinary LTE4 levels did not significantly differ between SSNS and SRNS groups. A receiver operating characteristic (ROC) curve analysis showed poor predictive value of urinary LTE4 for steroid responsiveness, with area-under-the-curve (AUC) values near 0.5.

Conclusions: While urinary LTE4 levels are elevated in children with NS, they failed to reliably differentiate between SSNS and SRNS. These findings suggest a limited role for urinary LTE4 as a predictive biomarker of steroid responsiveness in pediatric NS. However, future large-scale studies incorporating both plasma and urinary leukotriene profiles are warranted to validate its role in disease pathogenesis and treatment response.

Background: Kidney involvement in pediatric sarcoidosis is rare and often underrecognized, leading to diagnostic delays and treatment challenges. We report six patients with renal sarcoidosis to highlight their diverse presentations and outcomes and challenges in management.

Methods: Medical records of patients diagnosed with renal sarcoidosis during 2020-24 were reviewed. Sarcoidosis was diagnosed based on clinical and histological features and exclusion of alternative causes and managed according to unit protocols. Information on clinical features, laboratory and radiologic findings, histopathology, treatment, and follow-up were compiled.

Results: We present six patients with sarcoidosis, presenting with kidney involvement at the age of 1.5-14 years, and followed up for 7-138 months. All patients had acute kidney injury (AKI) of whom two required hemodialysis. Proteinuria was present in all patients, while four patients had microscopic hematuria or leukocyturia. Hypercalcemia with hypercalciuria, distal renal tubular acidosis, and nephrocalcinosis were seen in five, two, and one case, respectively. Granulomatous interstitial nephritis was confirmed histologically in all cases. While initial therapy with corticosteroids led to clinical remission in all cases, five patients had nine relapses, necessitating second-line immunosuppression with mycophenolate mofetil, azathioprine, or methotrexate; one patient received antitumor necrosis factor therapy. Median eGFR at last follow up was 59.7 (range 12.7-132) ml/min/1.73 m²; three progressed to chronic kidney disease (CKD) stages G3-G5.

Conclusions: Kidney involvement in pediatric sarcoidosis manifests in diverse forms, ranging from isolated biochemical abnormalities to severe AKI. While prompt immunosuppression might preserve kidney function, patients require close monitoring for relapses, and progression to CKD.