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Infant botulism in a 4-month-old boy in China who continued to excrete toxins for over a month despite antitoxin therapy was further treated with fecal microbiota transplantation. After treatment, we noted increased gut microbial diversity and altered fecal metabolites, which may help reduce intestinal pH and enhance anti-inflammatory capabilities.

Background: Acute necrotizing encephalopathy (ANE) is a rare but devastating neurological disorder in children that is typically triggered by viral infections such as influenza, sudden acute respiratory syndrome coronavirus 2, and human herpesvirus-6. ANE is characterized by cytokine storm and associated with high mortality; however, optimal immunomodulatory strategies remain undefined.Purpose: To evaluate the effectiveness of multiple immunomodulatory strategies, including high-dose methylprednisolone (MP), plasma exchange (PLEX), and tocilizumab, at reducing short-term mortality among pediatric patients with ANE stratified by disease severity using the ANE severity score (ANE-SS).Methods: We retrospectively reviewed 65 pediatric patients (median age, 4.8 years; interquartile range, 2.8–7.7 years) diagnosed with ANE at Beijing Children’s Hospital from 2016 to 2024. Patients were stratified by ANE-SS at admission into low- to medium-risk (ANE-SS<5) and high-risk (ANE-SS≥5) groups. Immunomodulatory treatments included different doses of MP, intravenous immunoglobulin, PLEX, and tocilizumab. The primary outcome was the 28-day postdischarge mortality. Multivariate logistic regression was used to identify the treatment strategies that were independently associated with improved survival.Results: The overall 28-day postdischarge mortality rate was 45.9%, significantly higher in patients with ANE-SS ≥5 (65.7%) than in those with ANE-SS<5 (16.7%; P<0.001). A notable decline in mortality has been observed since 2022, coinciding with the increased use of high-dose MP (20 and 30 mg/kg/day) and tocilizumab. The annual mortality rate will drop to 38.9% in 2022, 36.8% in 2023, and 16.7% in 2024. In low- to medium-risk patients (ANE-SS<5), both 20-mg/kg/day and 30-mg/kg/day MP were associated with improved outcomes. In high-risk patients (ANE-SS≥5), the combination of 30-mg/kg/day MP and tocilizumab provided the greatest survival benefit. Multivariable logistic regression analysis identified that this combined therapy was independently associated with reduced mortality (odds ratio, 0.04; 95% confidence interval, 0.01–0.18; P<0.001). No significant survival benefit was observed following PLEX treatment.Conclusion: In low- to moderate-risk patients, the 20- and 30-mg/kg/day MP regimens were effective. In high-risk patients with ANE, high-dose MP (30 mg/kg/day), particularly when combined with tocilizumab, may improve survival and possibly long-term neurological recovery. These findings support the use of a severity-based immunotherapy strategy for pediatric patients with ANE.

Importance Acute necrotizing encephalopathy (ANE) is a rare but life‐threatening pediatric neurological disorder characterized by rapid progression and high mortality. Tocilizumab, an interleukin‐6 receptor antagonist, combined with high‐dose methylprednisolone [MP, ≥20 mg/(kg·day)], may improve outcomes, yet the optimal MP dosing strategy remains uncertain. Objective To evaluate the comparative effectiveness and safety of two high‐dose MP regimens [20 mg/(kg·day) vs. 30 mg/(kg·day)], each in combination with tocilizumab for ANE. Methods This retrospective cohort study included 23 ANE patients treated with tocilizumab and high‐dose MP at Beijing Children's Hospital from January 2023 to January 2025. Patients were divided into two groups based on the initial MP dosage: 20 mg/(kg·day) (n = 11) and 30 mg/(kg·day) (n = 12). Primary outcomes included mortality and anti‐inflammatory response. Secondary outcomes were the incidence of severe neurological sequelae, assessed using the pediatric overall performance category (POPC) score, and the frequency of treatment‐related adverse events. Results Overall mortality rate was 26.1% with a lower rate observed in the 30 mg/(kg·day) group (16.7%) compared to the 20 mg/(kg·day) group (36.4%). Most patients (78.3%) had severe ANE (ANE Severity Score ≥5), and 91.3% presented with multi‐organ dysfunction and brainstem involvement. Both groups demonstrated significant reductions in procalcitonin, cerebrospinal fluid protein, and cerebrospinal cytokines after 3 days of MP therapy (P < 0.05). Compared with the 20 mg/(kg·day) group, the 30 mg/(kg·day) MP group had significantly lower rates of severe neurological sequelae (POPC score 4–6) at discharge (41.7% vs. 90.9%; P = 0.027) and at 6–12 months follow‐up (30.0% vs. 85.7%; P = 0.050). No statistically significant differences in adverse event rates were observed between the two groups (P > 0.05), and no tocilizumab‐related adverse events were reported. Interpretation In pediatric ANE, tocilizumab combined with 30 mg/(kg·day) MP was associated with improved neurological outcomes compared with 20 mg/(kg·day), with comparable mortality and safety profiles. These findings suggest that a higher initial MP dose may offer neuroprotective advantages, warranting further validation in prospective, multicenter studies. Tocilizumab combined with high‐dose methylprednisolone improved outcomes in children with acute necrotizing encephalopathy. A dose of 30 mg/(kg·day) may be more effective than 20 mg/(kg·day).

Three dinuclear Pd(II) complexes (1, 2, and 3) with intense red phosphorescence at room temperature are here synthesized using strong ligand field strength compounds. All three complexes are characterized by nuclear magnetic resonance, high‐resolution mass spectrometry, and elemental analyses. Complexes 2 and 3 are characterized by single‐crystal X‐ray diffraction. The crystalline data of 2 and 3 reveal complex double‐layer structures, with Pd–Pd distances of 2.8690(9) Å and 2.8584(17) Å, respectively. Furthermore, complexes 1, 2, and 3 show phosphorescence at room temperature in their solid states at the wavelengths of 678, 601, and 672 nm, respectively. In addition, they show phosphorescence at 634, 635, and 582 nm, respectively, in the 2 wt.% (PMMA) films, and phosphorescence at 670, 675, and 589 nm, respectively, in the deoxygenated CH2Cl2 solutions. Among three complexes, complex 1 shows red emission at 634 nm with phosphorescent quantum yield Ф = 67% in the 2 wt.% PMMA film. Furthermore, complex 1‐based organic light‐emitting diode is fabricated using a vapor‐phase deposition process, and their maximum external quantum efficiency reaches 20.52%, which is the highest percentage obtained by using the dinuclear Pd(II) complex triplet emitters with the CIE coordinates of (0.62, 0.38). Red emitters of PdII–PdII are prepared with the highest quantum yield of 67% and their organic light‐emitting diode (OLED) maximum external quantum efficiency of 20.52% for the first time. These excellent performances indicate PdII–PdII emitters’ great particle value in the OLED industry.

Adenoviruses are highly prevalent pathogens responsible for a wide range of clinical diseases, including respiratory tract infection, acute gastroenteritis, and conjunctivitis. However, adenovirus infection is rarely associated with central nervous system involvement. Here, we report a fatal viral sepsis and encephalitis in a child caused by a human adenovirus type 7 infection. We detected human adenovirus type 7 in the patient’s nasopharyngeal swab, blood, and cerebrospinal fluid. Our findings indicate clinicians should be aware of the possible central nervous system involvement in adenovirus infection.

Objective This study aimed to assess the efficacy and safety of using tocilizumab in children with febrile infection‐related epilepsy syndrome (FIRES) and explore tocilizumab‐related changes in interleukin (IL)‐6 levels. Methods Patients with FIRES admitted to the Intensive Care Unit (ICU) of Beijing Children's Hospital were retrospectively included and categorized into tocilizumab and control groups based on whether tocilizumab was administered to compare prognostic differences and drug safety. Patients in the tocilizumab group were further classified into response (characterized by ≥ 50% reduction in seizure frequency on electroencephalogram within one‐week post‐treatment) and no‐response groups for intergroup comparison of tocilizumab regimens and clinical outcomes. Serum and CSF IL‐6 levels were collected before and after the first tocilizumab dose to analyze the dynamics. Results Of 58 enrolled patients with FIRES, 23 received tocilizumab. The tocilizumab group showed higher rates of consciousness recovery and favorable Pediatric Cerebral Performance Category scores (p < 0.05). The incidence of post‐FIRES epilepsy was lower in the tocilizumab group (p < 0.001). The response group (9 patients) received earlier tocilizumab treatment, had shorter mechanical ventilation and ICU durations, and experienced higher consciousness recovery rates (p < 0.05). Serum IL‐6 levels increased post‐treatment (p = 0.003), while CSF IL‐6 levels showed a non‐significant decline (p = 0.080). There was no significant difference in the rates of combined infection, liver function impairment, and total cholesterol elevation between the tocilizumab and control groups (p > 0.05). Interpretation Early tocilizumab administration may improve outcomes in patients with FIRES, with a clinically acceptable safety profile.

Importance Acute necrotizing encephalopathy (ANE) is a rare disease with high mortality. Plasma exchange (PLEX) has recently been reported to treat ANE of childhood (ANEC), but its efficacy is uncertain. Objective This study aimed to investigate the effectiveness of PLEX on ANEC. Methods A retrospective study was conducted in four pediatric intensive care units from December 2014 to December 2020. All patients who were diagnosed with ANEC were included; however, these patients were excluded if their length of stay was less than 24 h. Participants were classified into PLEX and non‐PLEX groups. Results Twenty‐nine patients with ANEC were identified, 10 in the PLEX group and 19 in the non‐PLEX group. In the PLEX group, C‐reactive protein, procalcitonin, alanine aminotransferase, and aspartate aminotransaminase levels were significantly lower after 3 days of treatment than before treatment (13.1 vs. 8.0, P = 0.043; 9.8 vs. 1.5, P = 0.028; 133.4 vs. 31.9, P = 0.028; 282.4 vs. 50.5, P = 0.046, respectively). Nine patients (31.0%, 9/29) died at discharge, and a significantly difference was found between the PLEX group and non‐PLEX group [0 vs. 47.4% (9/19), P = 0.011]. The median follow‐up period was 27 months, and three patients were lost to follow‐up. Thirteen patients (50.0%, 13/26) died at the last follow‐up, comprising three (33.3%, 3/9) in the PLEX group and ten (58.8%, 10/17) in the non‐PLEX group, but there was no significant difference between the two groups (P = 0.411). Three patients (10.3%, 3/29) fully recovered. Interpretation PLEX may reduce serum C‐reactive protein and procalcitonin levels and improve liver function in the short term. PLEX may improve the prognosis of ANEC, and further studies are needed.

Chromene as the efficient biothiol recognition site was widely used to develop fluorescent probes based on thiol-chromene click reaction. However, chromene-based fluorescent probes with the both properties of ratiometric measurement and mitochondria-targeted function have not been reported and remain challenging. In this paper, we skillfully designed and synthesized the first mitochondria-targeted ratiometric fluorescent probe (Probe 1) for biothiols based on chromene. Upon addition of biothiols (Cys, Hcy, and GSH), the absorption and fluorescence spectra of Probe 1 changed from 490 to 426 nm and from 567 to 498 nm respectively, accompanied by color changes from orange to pale yellow under natural light and from orange to blue under a 365-nm UV lamp, which can be attributed to the click reaction of biothiols with α,β-unsaturated ketone of chromene moiety, subsequent pyran ring-opening, and phenol formation as well as 1,6-elimination of p-hydroxybenzyl moiety. Probe 1 not only exhibited high sensitivity (LODs of 149 nM, 133 nM, and 116 nM for Cys, GSH, and Hcy respectively), rapid response, and excellent selectivity for biothiols (Cys, Hcy, and GSH), but also could target in mitochondria and ratiometrically image the fluctuation of intracellular biothiols. Moreover, the novel design strategy of modifying chromene to the N atom of pyridine was proposed for the first time.

Three dinuclear Pd(II) complexes ( 1 , 2, and 3 ) with intense red phosphorescence at room temperature are here synthesized using strong ligand field strength compounds. All three complexes are characterized by nuclear magnetic resonance, high‐resolution mass spectrometry, and elemental analyses. Complexes 2 and 3 are characterized by single‐crystal X‐ray diffraction. The crystalline data of 2 and 3 reveal complex double‐layer structures, with Pd–Pd distances of 2.8690(9) Å and 2.8584(17) Å, respectively. Furthermore, complexes 1 , 2 , and 3 show phosphorescence at room temperature in their solid states at the wavelengths of 678, 601, and 672 nm, respectively. In addition, they show phosphorescence at 634, 635, and 582 nm, respectively, in the 2 wt.% (PMMA) films, and phosphorescence at 670, 675, and 589 nm, respectively, in the deoxygenated CH 2 Cl 2 solutions. Among three complexes, complex 1 shows red emission at 634 nm with phosphorescent quantum yield Ф = 67% in the 2 wt.% PMMA film. Furthermore, complex 1 ‐based organic light‐emitting diode is fabricated using a vapor‐phase deposition process, and their maximum external quantum efficiency reaches 20.52%, which is the highest percentage obtained by using the dinuclear Pd(II) complex triplet emitters with the CIE coordinates of (0.62, 0.38).