A real-world study on the changing characteristics of measles antibodies in premature infants in China.

The waning of maternal antibodies may cause infants to lose protection against measles before receiving measles-containing vaccine (MCV). The aim of this study is to investigate the changing characteristics and influencing factors of measles antibodies in preterm infants (PT), and to provide scientific basis for optimizing MCV vaccination strategy of the target population. Blood samples were collected from PT and full-term infants (FT) at the chronological age (CA) of 3, 6, and 12 months. Measles antibodies were quantitatively detected by enzyme-linked immunosorbent assay. Demographic and vaccination information were both collected. Kruskal-Wallis rank sum test was used to compare the measles antibodies among different gestation age (GA) groups, and multiple linear regression was performed to identify the correlative factors for the antibodies. Measles antibodies of PT decreased significantly with age increasing before MCV vaccination. The positive rates of antibodies of PT were 10.80% and 3.30% at the age of 3 and 6 months, respectively (p < .001). At 12 months, the measles antibodies and seropositive rate in the infants who received MCV vaccination increased sharply (p < .001). Regression analyzes showed that the younger the GA or the older the age, the lower the antibodies at 3 months(p < .001，p = .018); while the lower measles antibody levels at 3 months and older age predicted the lower antibodies at 6 months(p < .001, p = .029). PT were susceptible to measles due to the low level of maternally derived antibodies before MCV vaccination. More efforts should be considered to protect the vulnerable population during their early postnatal life.

Health-related quality of life of children with Williams syndrome and caregivers in China.

Introduction: Williams syndrome (WS) is a rare genetic disorder that impacts multiple systems and may cause developmental delays. These medical and developmental issues impose a heavy burden on affected children and their families. However, there was no study on children's health-related quality of life (HRQoL) with WS and only two studies about family quality of life globally. Therefore, the primary purpose of this study was to assess the HRQoL of children with WS and their caregivers in China, and the secondary purpose was to identify the potential determinants of children's and caregivers' HRQoL. Methods: In total, 101 children and caregivers were included. We applied the proxy-reported PedsQL 4.0 Generic Core Module (PedsQL GCM) and PedsQL 3.0 Family Impact Module (FIM) to measure the HRQoL of children and caregivers. Additionally, we collected information on a comprehensive set of social demographic and clinical characteristics. Differences in HRQoL scores across subgroups were assessed by two-independent-samples t-tests, one-way ANOVA, and post hoc tests. We also calculated effect sizes to indicate clinical relevance. Multivariate linear regression models were applied to assess the potential determinants of HRQoL. Results: We found that the HRQoL of children with WS and their caregivers was dramatically worse than the norm average scores of the healthy controls of children published in previous studies. Paternal educational level, household income, and the perceived financial burden significantly influenced the HRQoL of both children and families (p-values < 0.05). Multivariate linear regression analysis showed that the perceived financial burden was independently associated with family quality of life (p-values < 0.05)., and the presence of sleeping problem was independently associated with children's HRQoL (p-value = 0.01). Conclusion: We call for attention from policymakers and other stakeholders on the health status and well-being of children with WS and their families. Supports are needed to relieve psychosocial distress and financial burden.

Real-world vaccination status of children with hematologic tumors before and after chemotherapy.

BACKGROUND: There is a high incidence and mortality rate in children with hematologic tumors (CHT), who are more prone to various infectious diseases. This study aims to clarify the real-world National Immunization Program (NIP) vaccination status of CHT before and after chemotherapy. METHODS: Medical records, NIP vaccination data, and the Adverse Event Following Immunization (AEFI) of CHT who were admitted to the Children's Hospital, Zhejiang University School of Medicine, from 1 January 2011 to 1 December 2021 were completely collected. RESULTS: A total of 2,874 CHT were included, and 1975 (68.7%) had vaccination records. Among the enrolled patients, the vaccination rate of all NIP vaccines was lower than 90% before diagnosis. Only 24.29% of CHT (410/1688) resumed vaccination after chemotherapy, and 69.02% (283/410) resumed vaccination more than 12 months after chemotherapy. No uncommon or serious side effects were reported. CONCLUSION: The vaccination rate of CHT after chemotherapy was lower than that before the disease was diagnosed. It is necessary to provide more evidence-based support and formulate specific regimens to perfect the vaccination procedure after chemotherapy so as to improve the quality of life of CHT.

Current vaccination status and safety of children with peripheral neuroblastoma in the real-world.

Background: peripheral neuroblastic tumors (pNT) have high incidence and mortality, and infants are prone to various infectious diseases. The purpose of this study is to understand the immunization status of children with pNT in the real-world and the incidence of adverse reactions after vaccination, and to evaluate the feasibility of vaccination and the influencing factors of vaccination. Methods: Children with pNT treated in the Children's Hospital Affiliated to Zhejiang University from January 1, 2011 to December 1, 2021 were included. By referring to medical records, the vaccination history of the national immunization program (NIP) vaccines and the occurrence of adverse events following immunization(AEFI), current status and safety of immunization in children with pNT in the real-world were analyzed. Results: Among 784 children with pNT, 394 were able to obtain the history of vaccination. The overall vaccination rate of NIP vaccines was 71.49% before chemotherapy and 37.67% after chemotherapy, and the recovery time of vaccination after treatment was 16.00 (6.00,24.00) months. Age, time of tumor diagnosis and disease classification were significantly correlated with vaccination. AEFI reported an incidence of 0.23‰. Conclusion: The vaccination rate of children with pNT is generally low, especially the vaccination rate after chemotherapy. The vaccination safety is good, children should be encouraged to immunize.

The impact of breast milk feeding on early brain development in preterm infants in China: An observational study.

BACKGROUND: The prevailing consensus from large epidemiological studies is that breastfeeding is associated with improved IQ and cognitive functioning in later childhood and adolescence. Current research is exploring the association between breastfeeding and early brain development in preterm infants. OBJECTIVE: To explore the differences in brain gray matter between breastmilk-fed and formula-fed preterm infants using structural and functional magnetic resonance imaging. METHODS: A convenience sample of breastmilk-fed preterm infants(n = 34) and formula-fed infants (n = 22) aged approximately 32 weeks. At near term-equivalent age, MR scanning was performed. Gray matter structural and functional differences between the two groups were assessed using MATLAB software for voxel-based morphometry (VBM) and amplitude of low-frequency fluctuation (ALFF) analysis. RESULTS: Maternal and neonatal demographic characteristics showed no significant difference between the two groups. Breastmilk-fed infants had greater regional gray matter volume on MRI than formula-fed infants in multiple brain regions, including the bilateral frontal lobe (BA11, BA46), right temporal lobe (BA37), and left caudate nucleus, at a statistical threshold of p<0.01 (AlphaSim corrected) with a cluster size of >40 voxels. Compared with formula-fed infants, breastmilk-fed infants showed increased brain activation on fMRI in the right superior temporal gyrus (BA41). CONCLUSION: Breastmilk-fed infants had greater regional gray matter development and increased regional gray matter function compared with formula-fed infants at near term-equivalent age, suggesting breastmilk feeding in the early period after birth may have some degree of influence on early brain development in preterm infants.

Clinical phenotypes study of 231 children with Williams syndrome in China: A single-center retrospective study.

BACKGROUND: Williams syndrome (WS) is a multisystem neurodevelopmental disorder caused by microdeletions in 7q11.23. This study aims to characterize the clinical phenotypes of Chinese children with WS to help for the early diagnosis and intervention of this disease. METHODS: 231 children diagnosed with WS were retrospectively recruited to the study. Clinical data were analyzed to obtain the incidence of different clinical phenotypes. The occurrence of phenotypes and the influence of gender and age on the incidence of different phenotypes were analyzed. RESULTS: All WS exhibited facial dysmorphism (100.0%). The majority had neurodevelopmental disorder (91.8%), hoarseness (87.4%) and cardiovascular anomalies (85.7%). The incidence of short stature (46.9%), inguinal hernia (47.2%), hypercalciuria (29.10%), hypercalcemia (9.1%), subclinical hypothyroidism (26.4%) and hypothyroidism (7.4%) were relatively higher. Gender differences were found in supravalvular aortic stenosis (SVAS, p < .001), ventricular septal defect (VSD, p < .05), inguinal hernia (p < .001), superior pulmonary stenosis (SVPS, p < .05) and neurodevelopmental disorder (p < .05). The incidence of neurodevelopmental disorder in WS increased with age (p < .05) while cardiovascular anomalies (p < .001), short stature (p < .001), hypercalciuria (p < .001) and hypercalcemia (p < .01) decreased with age. CONCLUSIONS: Facial dysmorphism, neurodevelopmental disorder, hoarseness and cardiovascular anomalies were the most common phenotypes. Genetic testing should be suggested to confirm the diagnosis for children with the above abnormalities. Gender and age should be taken into account when making diagnosis and intervention.

[Early motor development in children with Williams syndrome]. / Williams综合征儿童早期运动发育特征.

OBJECTIVES: To study the early motor development of children with William syndrome (WS). METHODS: The medical data of 59 children with WS (40 males and 19 females) aged 0-24 months from September 2018 to August 2021 were retrospectively analyzed. Based on the test results of the Peabody Developmental Motor Scale II, the motor development ability of the children of different ages was analyzed. RESULTS: There was no significant difference in age and motor quotient between boys and girls (P>0.05). For the age groups of <6 months, 6 to <12 months, 12 to <18 months, and 18 to 24 months, the gross-motor quotients were 94±5, 78±11, 71±8, and 63±8, respectively, and the fine-motor quotients were 94±5, 80±10, 74±9, and 65±9, respectively. Both the gross- and fine-motor quotients significantly decreased with age (P<0.05). For the above age groups, the rates of gross-motor abnormalities were 0%, 53%, 87%, and 93%, respectively, and the rates of fine-motor development abnormalities were 0%, 47%, 67%, and 93%, respectively. The rates of gross- and fine-motor development abnormalities increased significantly with age (P<0.05). CONCLUSIONS: Children with WS have no obvious motor delays within 6 months of age, but present with decreasing motor ability and an increasing incidence of motor delays with age. Therefore, it is necessary to follow up their motor abilities and provide early intervention to decrease the incidence of motor developmental delays.

Developmental pattern of association fibers and their interaction with associated cortical microstructures in 0-5-month-old infants.

Association fibers connect the cortical regions and experience rapid development involving myelination and axonal growth during infancy. Yet, the spatiotemporal patterns of microstructural changes along these tracts, as well as the developmental interaction between the white matter (WM) tracts and the cortical gray matter (cGM) connected to them, are mostly unknown during infancy. In this study, we performed a diffusion MRI-based tractography and microstructure study in a cohort of 89 healthy preterm-born infants with gestational age at birth between 28.1∼36.4 weeks and postmenstrual age at scan between 39.9∼59.9 weeks. Results revealed that several C-shaped fibers, such as the arcuate fasciculus, cingulum, and uncinate fasciculus, demonstrated symmetrical along-tract profiles; and the horizontally oriented running fibers, including the inferior fronto-occipital fasciculus and the inferior longitudinal fasciculus, demonstrated an anterior-posterior developmental gradient. This study characterized the along-tract profiles using fixel-based analysis and revealed that the fiber cross-section (FC) of all five association fibers demonstrated a fluctuating increase with age, while the fiber density (FD) monotonically increase with age. NODDI was utilized to analyze the microstructural development of cGM and indicated cGM connected to the anterior end of the association fibers developed faster than that of the posterior end during 0-5 months. Notably, a mediation analysis was used to explore the relation between the development of WM and associated cGM, and demonstrated a partial mediation effect of FD in WM on the development of intracellular volume (ICV) in cGM and a full mediation effect of ICV on the growth of FD in most fibers, suggesting a predominant mediation of cGM on the WM development. Furthermore, for assessing whether those results were biased by prematurity, we compared preterm- and term-born neonates with matched scan age, gender, and multiple births from the developing human connectome project (dHCP) dataset to assess the effect of preterm-birth, and the results indicated a similar developmental pattern of the association fibers and their attached cGM. These findings presented a comprehensive picture of the major association fibers during early infancy and deciphered the developmental interaction between WM and cGM in this period.

Early Development and the Functional Correlation of Brain Structural Connectivity in Preterm-Born Infants.

Exuberant axon growth and competitive pruning lead to dramatic and comprehensive changes in white matter pathways of the infant brain during the first few postnatal months, yet the development of structural configuration in early infancy has not been fully characterized. This study aimed to investigate the developmental trajectory of structural connectivity reflecting relative fiber density in 43 preterm-born infants aged 0-3 months of corrected age without any complications utilizing probabilistic tractography based on fiber orientation distribution and to explore the potential function correlation associated with the network properties based on the Chinese Communication Development of Infant at 10 months of corrected age. The findings revealed significant increases in global efficiency, local efficiency, normalized clustering coefficient, and small-worldness (p adj < 0.001 for each), while the normalized characteristic path length showed a non-significant decrease with age (p adj = 0.118). Furthermore, those findings were validated by another parcelation strategy. In addition, the early local efficiency was found to be significantly correlated with words understood at 10 months of corrected age. A unique developmental pattern of structural networks with enhancing efficiency and the small-world property was found in early infancy, which was different from those of neonates or toddlers. In addition, this study revealed a significant correlation between local efficiency and late language comprehension, which indicated that enhanced structural connectivity may lay the structural foundation for language specialization.

Effects of Daily Iron Supplementation on Motor Development and Brain Connectivity in Preterm Infants: A Diffusion Magnetic Resonance Study.

Objectives: The aim of the study is to demonstrate the characteristic of motor development and MRI changes of related brain regions in preterm infants with different iron statuses and to determine whether the daily iron supplementation can promote motor development for preterm in early infancy. Methods: The 63 preterm infants were grouped into non-anemia with higher serum ferritin (NA-HF) group and anemia with lower serum ferritin (A-LF) group according to their lowest serum Hb level in the neonatal period as well as the sFer at 3 months old. Forty-nine participants underwent MRI scans and Infant Neurological International Battery (INFANIB) at their 3 months. At 6 months of corrected age, these infants received the assessment of Peabody Developmental Motor Scales (PDMS) after 2 mg/kg/day iron supplementation. Results: In total, 19 preterm infants were assigned to the NA-HF group while 44 preterm infants to the A-LF groups. The serum ferritin (sFer) level of the infants in A-LF group was lower than that in NA-HF group (44.0 ± 2.8 mg/L vs. 65.1 ± 2.8 mg/L, p < 0.05) and was with poorer scores of INFANIB (66.8 ± 0.9 vs. 64.4 ± 0.6, p < 0.05) at 3 months old. The structural connectivity between cerebellum and ipsilateral thalamus in the NA-HF group was significantly stronger than that in the A-LF group (n = 17, 109.76 ± 23.8 vs. n = 32, 70.4 ± 6.6, p < 0.05). The decreased brain structural connectivity was positively associated with the scores of PDMS (r = 0.347, p < 0.05). After 6 months of routine iron supplementation, no difference in Hb, MCV, MCHC, RDW, and sFer was detected between A-LF and NA-HF groups as well as the motor scores of PDMS-2 assessments. Conclusion: Iron status at early postnatal period of preterm infant is related to motor development and the enrichment of brain structural connectivity. The decrease in brain structural connectivity is related to the motor delay. After supplying 2 mg/kg of iron per day for 6 months, the differences in the iron status and motor ability between the A-LF and NA-HF groups were eliminated.

Vaccination deferral among children with seizures in Zhejiang: influence, recommendation, safety and implications.

OBJECTIVES: Delayed vaccination in children with seizures was common in China. This study aims to describe the vaccination status, reasons for vaccination deferral, vaccination recommendations and the safety for these patients in Zhejiang. METHODS: 1539 children included were divided into febrile seizure (FS) group, epilepsy (EP) group, unclassified seizure group and other symptomatic seizure group. Medical records and reasons for the vaccination deferral were collected by questionnaire. Vaccination data and Adverse Event Following Immunization were retrieved from vaccination booklets. RESULTS: The main diseases of children enrolled were FS (756, 49.1%) and EP (443, 28.8%). Most of them (95.6%) were vaccinated on time before the onset of seizure, but their vaccination was delayed after seizure occurred. 76.1% were recommended to receive vaccines normally, of which the FS group accounted for the highest proportion (90.3%). 88.73% of them were vaccinated as recommended, and no serious side effects or seizure occurred. The main reason for vaccination deferral was providers' and parents' hesitation to have them vaccinated. CONCLUSION: Seizures were overestimated as a contraindication for vaccination in China. Routine vaccination was safe in most circumstances. It is essential to educate providers and parents about the benefits and contraindications of vaccination in children with seizures.

Diffusion MRI of the infant brain reveals unique asymmetry patterns during the first-half-year of development.

The human brain demonstrates anatomical and functional lateralization/asymmetry between the left and right hemispheres, and such asymmetry is known to start from the early age of life. However, how the asymmetry changes with brain development during infancy remained unknown. In this study, we aimed to systematically investigate the spatiotemporal pattern of brain asymmetry in healthy preterm-born infants during the first-half-year of development, using high angular resolution diffusion MRI. Sixty-five healthy preterm-born infants (gestational age between 25.3-36.6 weeks) were scanned with postmenstrual age (PMA) ranging from term-equivalent age (TEA) to 6-months. At the regional level, we performed a region-of-interest-based analysis by segmenting the brain into 63 symmetrical pairs of regions, based on which the laterality index was assessed and correlated with PMA. At the voxel level, we performed a fixel-based analysis of each fiber component between the native and left-right flipped data, separately in TEA-1 month, 1-3 months, and 3-6 months groups. The infant brains demonstrated extensive regions with structural asymmetry during their first half-of-year of life. A distinct central-peripheral asymmetry pattern was observed in mean diffusivity, namely, leftward lateralization in the neocortex and rightward asymmetry in the deep brain regions. Besides, the posterior brain demonstrated a higher lateralization index compared with the anterior brain in all metrics, which is congruent with the brain developmental pattern from caudal to rostral. Regionally, language processing regions showed a rightward asymmetry, while visuospatial processing regions exhibited leftward lateralization in fractional anisotropy, fibre density, and fibre cross-section measurements, and most white matter regions were lateralized to the left in these measurements. The laterality index of several regions (12 out 63) demonstrated significant developmental changes in mean diffusivity. At the fixel level, the fiber cross-section of inferior fronto-occipital fasciculus showed significant leftward asymmetry and the extent of asymmetry increased with PMA. In summary, the results revealed unique spatiotemporal patterns of macro- and micro-structural asymmetry in early life, which dynamically changed with age. These findings may contribute to the understanding of brain development during infancy.

Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants.

Objective: The aim of this study was to investigate the effects of unified iron supplementation and identify the factors related to the iron homeostasis among preterm infants. Method: A total of 250 preterm infants were divided into neonatal anemic (NA, n = 154) and non-neonatal anemic group (NNA, n = 96). Iron supplements at a dose of 2 mg/kg per day were given from 40 weeks' gestational age to 6 months. Iron status parameters were measured at 3 and 6 months, respectively. Prevalence of iron deficiency (ID) and iron deficiency anemia (IDA), and the correlated factors were analyzed. Growth and side-effects were monitored. Results: There were no significant differences for the prevalence of ID or IDA between the two groups. Multivariate regression analyses showed that higher Hb at birth and early treatment of blood transfusion reduced the risk of ID/IDA at 3 months (all p < 0.05); while higher level of Hb at 3 months (p = 0.004) and formula feeding reduced the occurrence of ID/IDA at 6 months (p < 0.05); males had a 3.35 times higher risk to develop ID/IDA than girls (p = 0.021). No differences in growth and side effects were found. Conclusion: A daily dose of 2 mg/kg iron supplement is beneficial to maintain iron homeostasis in majority preterm infants within 6 months regardless of their neonatal anemia history. Under the routine iron supplementation, Hb level at birth and at 3 months, early treatment of blood transfusion, gender and feeding patterns are the major factors affecting the prevalence of ID/IDA among preterm infants in infancy.

Reasons of the delayed vaccination, recommendations and safety of vaccination in children with congenital heart disease in Zhejiang, China.

There has been a considerable controversy about vaccination practices in Children with congenital heart disease (CHD) in China. This study aims to identify the reasons for deferring vaccination among the patient population attending the Vaccination Consultation Clinic in Zhejiang Province and the safety of their vaccination. We analyzed the data of 2442 children with CHD, who visited to our clinic from January 2016 to March 2019. A questionnaire survey was conducted to investigate the reasons for their delayed vaccination. Information about the following vaccination and Adverse Events Following Immunization (AEFI) was collected. Most of the enrolled children did not receive vaccines on time before consultation. The reasons for their deferring vaccination included: 1. Providers in the community health center refused to administer vaccines (77.6%); 2. Parents' concerns about the safety of vaccines (19.0%); 3. Parents' doubts about the efficiency of vaccines after certain drug applications (3.4%). According to the evaluation reports issued by the Vaccination Consultation Clinic, 83.7% of CHD children were recommended to be vaccinated on the nationally recommended schedule, 14.4% were recommended to defer some specific vaccination, and 1.9% were recommended to defer all vaccination. Among the group who received vaccines on nationally recommended schedule, the AEFI rate was 33.5/100 000. No rare or serious rare vaccine reactions were observed. Our study provides evidence that routine vaccination is safe in the majority of this patient population.

Vaccination recommendations, immunization status and safety of vaccination for premature infants in Zhejiang, China.

OBJECTIVES: More and more premature infants were born worldwide that are suffering from various complications, vaccination for whom is often delayed in China. We aim to describe current vaccination recommendations in practice, immunization status, and vaccination safety for premature infants in Zhejiang. METHODS: The demographic information, medical records of treatments, and adverse events following immunization (AEFI) history were collected from infants' parents by questionnaire in the Vaccination Consultation Clinic(VCC). Vaccination data were retrieved from Zhejiang Provincial Immunization Information System. The information of AEFI was collected from the Chinese National Adverse Event Following Immunization Information System. RESULTS: A total of 1515 premature infants visiting the VCC were included in the study. The majority (65.94%) of them were under 7 months. 47.59% of premature infants were advised to receive normal vaccinations, while 45.94% were advised to defer a specific vaccination and 6.47% were advised to defer all vaccinations. A total of 807 infants received 7187 vaccine doses were administered and only seven cases experienced mild and self-limiting adverse reactions (9.74/10,000). No uncommon or serious side effects were reported. CONCLUSION: Most premature infants visiting the VCC did not receive vaccines on time. The majority of them can be safely vaccinated according to the national-recommended schedule.

Fto-modulated lipid niche regulates adult neurogenesis through modulating adenosine metabolism.

Adult neurogenesis is regulated by diverse factors including the local environment, i.e. the neurogenic niche. However, whether the lipid in the brain regulates adult neurogenesis and related mechanisms remains largely unknown. In the present study, we found that lipid accumulates in the brain during postnatal neuronal development. Conditional knockout of Fto (cKO) in lipid not only reduced the level of lipid in the brain but also impaired the learning and memory of mice. In addition, Fto deficiency in lipid did not affect the proliferation of adult neural stem cells (aNSCs), but it did inhibit adult neurogenesis by inducing cell apoptosis. Mechanistically, specific deleting Fto in lipid altered gene expression and increased adenosine secretion of adipocytes. The treatment of adenosine promoted the apoptosis of newborn neurons. As a whole, these results reveal the important function of the lipid niche and its associated mechanism in regulating adult neurogenesis.

A study on facial features of children with Williams syndrome in China based on three-dimensional anthropometric measurement technology.

To describe special facial features of children with Williams syndrome in China by using method of three-dimensional craniofacial anthropometry. Using three-dimensional stereo photogrammetric device, 14 craniofacial anthropometric measurements were performed and five indices were calculated in 52 children with Williams syndrome and 208 age and sex matched controls of Han Chinese ethnicity. Except intercanthal width, mouth breadth, morphological face height, nasal height-breadth index, nasal breadth-depth index, morphological ear index, the Williams syndrome group under 3 years old were smaller than the control group in the other 12 variables. Compared with the control group, the Williams syndrome group aged 3-5 years old had smaller biocular breadth, nasal length, nasorostral angle, bitragal breadth, ear width, morphological ear index and face depth. The Williams syndrome group aged above 6 years old had smaller biocular breadth, nasal breadth, bitragal breadth, ear width, ear length and face depth than the control group. The craniofacial variability index of the Williams syndrome group was greater than the control group. Greater variation was found among children with Williams syndrome than normal in China, specifically at eye, nose, ear and face shape, which demonstrate the usefulness of three-dimensional stereo photogrammetric analysis in supporting accurate diagnose of the patient with Williams syndrome.

Incomplete Vaccination Among Children With Special Health Care Needs in Zhejiang, China: Analysis of Retrospective Data.

Objective: There is a lack of data relating to vaccination of children with special health care needs (CSHCN) and its influencing factors in China. We investigated the disease spectrum of CSHCN at the Vaccination Consultation Clinic in Zhejiang province as well as the underlying factors of vaccination recommendations of these children. Methods: In this study, we retrospectively analyzed the data of 4,525 CSHCN, who visited to our clinic for a vaccination consultation from January 1, 2016 to May 30, 2018. Descriptive data were presented as mean ± standard deviation (SD) and percentages. Multivariate analysis was performed with non-conditional bivariate logistic regression to identify the underlying factors of vaccination recommendations. Subsequent information regarding the following vaccination and the occurrence of AEFI were also collected and analyzed. Results: The main diseases consulted were those relating to the circulatory and nervous systems as well as neonatal diseases. The distribution of diseases varied by age: 53.6% infants under 12 months were counseled for circulatory system diseases, while 44.6% children aged 12~24 months and 54.7% children over 25 months were counseled for nervous system diseases. According to the evaluation reports issued by the consultation clinic, 75.0% of CSHCN were recommended to be vaccinated normally, 21.2% were recommended to defer specific vaccination, while only 3.8% were recommended to defer all vaccinations. In logistic regression analysis, age, history of adverse events following immunization (AEFI) and the number of diseases combined were all strong correlative factors for vaccination recommendations. Children who were aged over 25-month-old (OR = 1.34, 95%CI: 1.11-1.61) or had a history of AEFI (OR = 3.77, 95%CI: 2.83~5.01) or those who had numerous diseases combined (OR = 2.00, 95%CI: 1.46~2.75) tended to have a higher rate of deferred vaccination recommendation. Among those CSHCN who received nationally-recommended vaccines, the estimated AEFI rate was 24.29/100 000. No uncommon or rare serious adverse reactions were detected. Conclusion: Age, history of AEFI, and the number of diseases combined were important factors that affected the vaccination recommendations of CSHCN. Most CSHCN can be safely vaccinated according to the nationally-recommended schedule.

Identification of promising prognostic genes for relapsed acute lymphoblastic leukemia.

PURPOSE: The present study aimed to identify the molecular mechanism of acute lymphoblastic leukemia (ALL), and explore valuable prognostic biomarkers for relapsed ALL. METHODS: Gene expression dataset including 59 samples from ALL survivals without recurrence (good group) and 114 samples from dead ALL patients died of recurrence (poor group) was downloaded from TCGA database. The differentially expressed genes (DEGs) were identified between good and poor groups, followed by pathway and functional enrichment analyses. Subsequently, logistic regression model and survival analysis were performed. RESULTS: In total, 637 up- and 578 down-regulated DEGs were revealed between good and poor groups. These DEGs were mainly enriched in functions including transcription and pathways like focal adhesion. Genes including alpha-protein kinase 1 (ALPK1), zinc finger protein 695 (ZNF695), actinin alpha 4 (ACTN4), calreticulin (CALR), and F-Box and leucine rich repeat protein 5 (FBXL5) were outstanding in survival analysis. CONCLUSION: Transcription and focal adhesion might play important roles in ALL progression. Furthermore, genes including ALPK1, ZNF695, ACTN4, CALR, and FBXL5 might be novel prognostic genes for relapsed ALL.

Prenatal exposure to the herbicide 2,4-D is associated with deficits in auditory processing during infancy.

INTRODUCTION: Despite widespread use, many herbicides and fungicides are not well studied for neurological effects. Fetal and infant brains are rapidly developing, yet the effects of early-life exposure to these classes of pesticides on visual and auditory function are unknown. Here we examined the effects of prenatal herbicide and fungicide exposure on infant grating visual acuity (VA) and auditory brainstem response (ABR). METHODS: 9 herbicides and 13 fungicides were measured in umbilical cord blood plasma from a cohort of infants in Fuyang County, China (n = 232). Grating VA and ABR latencies for waves I, III, V were measured at 3 time points: 6 weeks, 9 months, and 18 months. Outcomes included VA score, ABR wave V latency and ABR central conduction time (CCT [wave V- wave I]). Pesticides were analyzed as 3-level ordinal (non-detect [ND]/medium/high), or dichotomous (ND/detect), depending on detection rates. Linear mixed models were used to evaluate relations between pesticides and VA and ABR outcomes. RESULTS: 2,4-dichloroacetic acid (2,4-D), prometryn, simazine, and tetrahydrophthalamide (THPI, a metabolite of captan) were detected in 27%, 81%, 17%, and 16% of samples, respectively. Infants prenatally exposed to 2,4-D had slower auditory response times at 6 weeks. Infants with cord levels of 2,4-D > 1.17 ng/mL had wave V latencies that were 0.12 (95% CI: 0.03, 0.22) ms slower (p = 0.01) and overall CCTs that were 0.15 (95% CI:0.05, 0.25) ms slower (p = 0.003) than infants with non-detectable 2,4-D in their cord blood. No other statistically significant findings were observed for the other herbicides and fungicides or for the grating VA outcome. CONCLUSIONS: Prenatal exposure to the herbicide 2,4-D was associated with slower auditory signal transmission in early infancy. ABR latencies reflect auditory pathway maturation and longer latencies may indicate delayed auditory development.