Objective:To summarize the abnormalities in brain magnetic resonance imaging (MRI) and clinical manifestations of children with infantile spasms (IS) in the course of Vigabatrin (VGB) treatment.Methods:The imaging features of children with IS who took VGB orally and presented with brain MRI changes in Peking University First Hospital between September 2016 and June 2018 were analyzed retrospectively.Their use of VGB and the imaging findings were followed up.Meanwhile, the imaging and clinical features of 83 cases described in literature were summarized.Results:(1) Ten children diagnosed as IS were included.The average duration of VGB treatment at the time of imaging changes was 4.1 months, the average age was 11.8 months, and the average maximum dose was 90.6 mg/(kg·d). Brain MRI showed hyperintensities in bilateral thalamus, brainstem, basal ganglia and dentate nucleus diffusion-weight imaging (DWI), with or without T2WI, and T2 fluid attenuated inversion recovery(FLAIR) or slight hyperintensities.Brain MRI repeated in 5 patients 7-12 months later revealed that the original abnormal signals completely disappeared.Among them, 4 patients stopped using VGB and 1 patient continued to take VGB.(2) Literature review: 83 cases with IS treated with VGB from 16 literatures were reviewed, and the incidence of abnormal brain MRI was 22%-32%.The average age at initial VGB treatment was 8.0 months, and the average dose of VGB was 157.1 mg/(kg·d) when the brain MRI abnormalities were found.The MRI imaging showed high DWI signals in bilateral symmetrical thalamus, brainstem, basal ganglia (mainly pallidum) and dentate nucleus.During the follow-up of the 41 cases, no imaging abnormality was observed in 36 cases, improvement in 4 cases, and no significant change in 1 case.When MRI abnormalities were identified, 12.0%(10/83 cases) of the patients presented new clinical symptoms mainly in the extrapyramidal system, and the clinical symptoms of all children disappeared during the follow-up.Conclusions:During the course of VGB treatment of infantile spasms, brain MRI may suggest hyperintensities of DWI in the thalamus, brainstem, basal ganglia and dentate nucleus, but most are reversible.

Objective To evaluate the antigenicity of two proteins of Mycobacteium tuberculosis (M. tuberculosis), Dnak(Rv0350) and MPT83(Rv2873), in order to provide a scientific basis for immuno-logical diagnosis of tuberculosis and research on vaccines. Methods The two antigen proteins, Dnak (Rv0350) and MPT83(Rv2873), were cloned, expressed and purified using the methods of genetic recom-bination and protein purification technology. Blood samples were collected from subjects including tuberculo-sis patients ( TB) , non-tuberculosis patients with other pulmonary diseases ( non-TB) and healthy volunteers (HV). To analyze the immunological properties of the recombinant Dnak (Rv0350) and MPT83 (Rv2873) proteins, they were used as antigens to detect humoral and cellular immunity in the subjects with enzyme linked immunosorbent assay ( ELISA ) and effector T cell enzyme-linked immunospot assay ( ELISPOT ) . Results The recombinant and purified Dnak (Rv0350) and MPT83 (Rv2873) proteins of M. tuberculosis were successfully obtained and used as antigens in the detection of humoral and cellular immunity in the sub-jects. Specific antibodies ( IgG) in the serum samples of 135 TB, 56 non-TB and 94 HV were tested with ELISA. The results showed that the sensitivity, specificity and accuracy of Dnak ( Rv0350 ) protein were 77. 80％ (105/135), 56. 70％ (85/150) and 66. 67％ (190/285). Similarly, the sensitivity, specificity and accuracy of MPT83 (Rv2873) protein were 76. 30％ (103/135), 43. 30％ (65/150) and 58. 95％(168/285). Cellular immunity was tested with the levels of IFN-γproduced by effector T lymphocytes after stimulating peripheral blood monouclear cells ( PBMC) collected form subjects of 59 TB, 65 non-TB and 64 HV with Dnak (Rv0350) and MPT83 (Rv2873) protein antigens. The results showed that the sensitivity, specificity and accuracy of Dnak (Rv0350) and MPT83 (Rv2873) proteins were 66. 10％ (39/59), 62. 79％ (81/129) and 63. 83％ (120/188), and 47. 46％ (28/59), 79. 84％ (103/129) and 69. 68％(131/188), respectively. Conclusions M. tuberculosis Dnak (Rv0350) and MPT83 (Rv2873) proteins have good antigenicity and could stimulate T cells to produce stronger immune responses. The two proteins used in combination might have promising potential in the research of immunodiagnosis of tuberculosis and the development of new anti-tuberculosis vaccines.

Objective:To summarize the clinical characteristics of children with severe pneumonia requiring mechanical ventilation due to human Boca virus infection.Methods:Clinical data of children with severe human Boca virus pneumonia required mechanical ventilation who were admitted to the emergency intensive care unit at Beijing Children's Hospital Affiliated to Capital Medical University from October 2022 to June 2023 were retrospectively analyzed.Results:A total of ten children with human Boca virus pneumonia required mechanical ventilation were included,including seven males with a median age of 21.5(10.0-42.0) months and six children less than two years old.Six patients were admitted to hospital in the fall of 2022 and four were in the summer of 2023.All cases had cough,wheezing and fever.The wheezes could be heard in all patients admitted to hospital for physical examination.Respiratory sounds were reduced in six cases,and moist crackles were heard in two cases.Two patients had thrush.One patient with bronchial lavage culture showed streptococcus pneumoniae and staphylococcus aureus.One patient had human herpesvirus type 6 infection on day 5 of the course of disease,and one child had rhinovirus.There was no evidence of co-infection in the remaining five cases.All patients were given mechanical ventilation for respiratory failure,and the median mechanical ventilation time was 85 (46-165) hours.Each patient was examined by bronchoscope for 1-3 times.Bronchoscopy manifested endobronchial inflammation,mucosal swelling,increased secretions (10/10),mucous thrombus formation (8/10) and scattered necrotic epithelium (4/10).All patients were discharged after improvement and the median length of administration was 9 (6-14) days.Conclusion:Human Boca virus is one of the important pathogens of severe pneumonia in children,with severe cough,wheezing and feve,which can lead to endobronchial trachea inflammation,easy to form mucous embolus and mucosal necrosis.In severe cases,mechanical ventilation and bronchoscopy are required,and most of them have good prognosis.

Objective To investigate the impact of various distribution of bone cement on the early clinical outcomes in osteoporotic vertebral compression fracture (OVCF) patients treated with percutaneous kyphoplasty (PKP).Methods A total of 312 patients (54 males and 258 females,mean age 69.37 years) who diagnosed as OVCF and received PKP treatment from January 2015 to July 2017 were enrolled in the present study.All subjects were divided into two groups according to different distribution of bone cement:the shaped "O" distribution (group O,113 cases),in which bone cement in the vertebral body presented whole crumb,no separation or loss of bone cement,and the shaped "H" distribution (group H,199 cases),in which bone cement in the vertebral body presented two briquettes,connected with or without a small amount of bone cement.Demographic data,surgical details,radiographic data,and clinical outcomes (at preoperatively,two-days and one-year follow-up) were compared between the two groups.Results There was no significant difference in bone mineral density (BMD),operation duration,blood loss,and occurrence of leakage of bone cement between two groups.In comparison with group O,group H was accompanied with higher volume of injected bone cement and higher proportion of bilateral approach (P＜0.05).Both groups achieved significant improvement of VAS scores after surgery,while the group H had a dramatical reduction of VAS scores at one-year follow-up compared with two-days follow-up (P＜0.05).In addition,group H had a better restoration of VAS scores at one-year follow-up than group O (P＜0.05),though no significant difference was observed at preoperative and two-days follow-up.Both groups achieved significant improvement of radiographic data after surgery (P＜0.05) with similar effects of correction.Conclusion Either shaped "H" or shaped"O" distribution of bone cement can obtain satisfied early clinical effects of PKP for the treatment of OVCF.Compared with shaped "O" distribution,shaped "H" distribution can achieve better pain relief at early follow-up.

Objective:To investigate the clinical presentations and early recognition features of infant botulism(IB).Methods:Retrospective case analysis.The clinical data of 14 patients with IB admitted to the Department of Emergency of Beijing Children′s Hospital Affiliated to Capital Medical University between January 2019 and June 2023 were retrospectively analyzed.Results:The age of onset was 4.2(1.9-8.6) months.Ten cases(71.4%) were under 6 months, 9 of whom had a toxic trigger.The median time of first visit was 1(0-8) day.Thirteen cases(92.9%) complained of poor feeding/milk refusal, of whom pupillary light reflex was sluggish/absent in 12(85.7%) infants, 11(78.6%) had constipation, 10(71.4%) had weakness and/or lethargy, and 9(64.3%) had myasthenia of limbs and/or reduced movement of the extremities, decreased muscle tone and strength of the extremities occurred in all infants, and bowel sounds were diminished or vanished in 10 infants(71.4%).Only 2 infants were suspected of IB at the first visit.The mouse bioassay showed positive fecal specimens in all 14 infants, with a time of diagnosis of 3(1-10) days.Eleven cases(84.6%) had varying degrees of intestinal stasis, and 1 case had reduced physiologic pneumatosis in the small intestine.Ten infants underwent the neostigmine test: one was positive, and one was suspiciously positive.Ten cases(71.4%) required mechanical ventilation, 7(50.0%) of whom used invasive respiratory support.The median length of hospital stay was 26(11-61) days.All the infants were essentially cured by the time they left the hospital.Conclusions:If infants are previously fit and conscious but have an acute onset of illness with parental complaints of poor appetite, weak reactions, and weakness of the extremities and are found to have cranial nerve palsy, signs of acute flaccid paralysis, abdominal distension, and diminished bowel sounds during the examination, the possibility of IB should be considered, and a fecal specimen should be sent for botulinum toxin assay as soon as possible.