Vaccination in children with congenital heart disease: an observational study in a Beijing hospital.

INTRODUCTION: Underimmunization of CHD children is a public health concern in China. This study aimed to analyze the vaccination status of CHD children to provide additional evidence on optimal vaccination strategies and to make suggestions to promote appropriate vaccination services for these children. METHODS: This cross-sectional study evaluated 155 CHD children who received at least one vaccine at Peking University First Hospital. Vaccine-specific immunization rates were calculated. A telephone questionnaire survey was conducted that covered the following: the prognosis, reasons for delayed vaccinations and getting vaccination in the hospital. All statistical analyses were performed using the SPSS version 22 software. RESULTS: The left-to-right shunt group involved 138 children, while the other type CHD group involved 17. The vaccination rate was the highest for MPSV-AC (87.1%) and the lowest for DTaP (40.1%). The most frequent reason for vaccination in the hospital was refusal from community health centers (61.5%). No participant reported vaccine-related adverse effects. CONCLUSIONS: The age-appropriate vaccine-specific immunization rates in CHD children are low, with the lowest for DTaP. Refusal of community health centers was the primary reason. Our findings support that clinically stable CHD children may be safely vaccinated on a schedule similar to that of ordinary children in China. IMPACT: From our investigation, we found that the age-appropriate vaccine-specific immunization rates in children with CHD in China are low, with the lowest for diphtheria and tetanus toxoid and acellular pertussis. Refusal of community health centers to vaccinate was the primary reason for the low rates. We believe our study provides additional evidence on optimal vaccination strategies for children with CHD and it can be used to develop strategies to promote appropriate vaccination services for these children.

Impact of maternal neuraxial labor analgesia exposure on offspring's neurodevelopment: A longitudinal prospective cohort study with propensity score matching.

Background: Neuraxial analgesia is widely used to relieve labor pain; its effects on long-term neurodevelopment of offspring remain unclear. This study was designed to investigate the influence of maternal neuraxial labor analgesia on offspring mental development. Methods: This was a predefined secondary analysis of a 2-year prospective longitudinal study. Nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery self-selected neuraxial analgesia or not during labor. Mothers and their offspring were followed up 2 years later. children's mental development was assessed with the bayley scales of infant development. A multivariable logistic model was used to identify factors associated with below-average mental development (Mental Development Index <90). Results: A Total of 508 pairs of mothers and children completed a 2-year follow-up. after propensity score matching, 387 pairs were included in the analysis. In both cohorts, the proportions with below-average mental development were slightly lower in children whose mothers received neuraxial labor analgesia, although not statistically significant [in the full cohort: 9.8 % (36/368) vs. 15.7% (22/140), P = 0.060; In the matched cohort: 8.3% (21/254) vs. 14.3% (19/133), P = 0.065]. A higher 2-year depression score (in the full cohort: Odds Ratio 1.15, 95% CI 1.08-1.22, P < 0.001; In the matched cohort: Odds Ratio 1.09, 95% CI 1.01-1.18, P = 0.037), but not neuraxial analgesia exposure, was associated with an increased risk of below-average mental development. Conclusions: Maternal depression at 2 years was associated with the risk of below-average mental development, whereas maternal exposure to neuraxial labor analgesia was not. Clinical Trial Registration: The study was registered with www.chictr.org.cn (ChiCTR-OCH-14004888) and ClinicalTrials.gov (NCT02823418).

[The related factors influencing development of language understanding and expression of early-children].

OBJECTIVE: To assess the level of language understanding and expression of healthy children aged from 8 to 16 months in urban Beijing and to investigate the children's physical and psychological development conditions and social and economic status of children's family as to identifying the related factors to children's language development and providing a basis for instructing parents child-rearing and promoting early children language development. METHODS: A quantitative Cross-sectional Study was made. The parents or care givers of 636 healthy young children, randomly stratified and selected in two districts in Beijing were interviewed. T-test was used to compare the scores of language understanding and expression between boys and girls in the same age. Single and multiple factors analysis were used so as to find out the related factors. RESULTS: For boys, the average scores of language were respectively 115.0 for 8 months, 243.0 for 12 months and 410.6 for 16 months; for girls the average scores were respectively 109.9 for 8 months, 286.4 for 12 months and 456.2 for 16 months. The average score of language understanding of boys was higher than that of girls only in the 11 month group. The average scores of language expression of girls were higher than those of boys in 11, 12, 14, 15 month groups. Multiple factors analysis showed that parent-child book reading, parent-child tape listening, higher education level of grandmothers, children' extroversion personality, child being able to speak one word and children's age were positively related to the children' language score. CONCLUSION: Providing rich language environment should be helpful to early children's language development.

[Individual and family factors influencing vocabulary development in toddlers].

OBJECTIVE: Many researchers have conducted studies on child language development and relevant risk factors, but most of these studies were about English-speaking children and few of them were on Chinese-speaking children, and less reports of studies on language development of infants or toddlers are available as compared to those on children above 3 years of age. The objective of this study was to assess the level of vocabulary development of healthy toddlers in urban Beijing and to investigate toddlers' physical and psychological development and socioeconomic status of toddlers' family so as to identify factors related to toddlers' language development and provide basis for instructing parents child-rearing. METHOD: This is a quantitative cross-sectional study. Using Chinese Communicative Development Inventory mandarin version, (CCDI) and related background questionnaire, a survey was conducted among the parents or care givers of 1056 healthy toddlers (16 approximately 30 months), randomly stratified and selected from two areas of four urban districts in Beijing. The children who were born prematurely, who had low birth weight, or who were deaf, dumb or with disability, were excluded from this study. The mothers who were deaf, dumb or having disability were not included in this study, either. Rank sum test was used to compare the vocabulary scores between boys and girls at the same age. Single and multiple factors analysis were used to find related factors. RESULTS: By 16 months of age, boys could speak about 22 words and girls 84 words on the CCDI. By 29 - 30 months of age, boys could speak about 725 words and girls 752 words on the CCDI. The level of vocabulary development of healthy toddlers in urban Beijing was higher than that reported in previous studies of English-speaking children. Girls had higher vocabulary scores than boys in a few different age groups. Single factor analysis showed that the ages of father and mother, income of father, the language used by care-givers and GDP of the families were factors related to families of toddlers and the age, gender, height, weight and the age at which the toddlers began to speak were factors related to individuals. Multiple factors analysis showed that higher education level of mothers, younger father, earlier beginning of children to speak, toddlers' amiable disposition and emotion, girls, toddlers' age and height positively correlated with toddlers' vocabulary score. CONCLUSION: The level of vocabulary development of healthy toddlers in urban Beijing is on the high side. Certain individual and familial factors may influence toddlers' language development. It is suggested that health workers should pay attention to the toddlers' language development. The toddlers' parents and caregivers should be taught how to interact with and talk to their children and how to promote children to develop healthy disposition and emotion.

Antibody-mediated CNS demyelination II. Focal spinal cord lesions induced by implantation of an IgM antisulfatide-secreting hybridoma.

We showed previously that spinal cord implants of hybridoma cells (O1) that secrete an IgM antigalactocerebroside cause focal multiple-sclerosis-like plaques of demyelination followed by remyelination to form "shadow plaques" (Rosenbluth et al., 1999). The antibody in that case was directed against a glycolipid present in mature oligodendrocytes and myelin but not in precursor cells. We now report the effects of implanting a different hybridoma (O4) that secretes IgM antibodies directed against sulfatide, a constituent not only of mature myelin and oligodendrocytes but also of late precursor cells, in order to determine whether this hybridoma too would generate focal demyelination and would, in addition, block remyelination. Our results show that focal plaques of demyelination indeed appear after O4 implantation, and that remyelination does occur, but only in cases where the hybridoma cells have degenerated, probably through host rejection. The occurrence of remyelination suggests that oligodendrocyte precursor cells are capable of migrating in rapidly from adjacent areas or that early precursors, not yet expressing sulfatide, remain undamaged within the lesions. In cases where intact hybridoma cells persist at lesion sites, remyelination does not occur. Failure of remyelination in this model thus appears to result from the continuing presence of antimyelin antibodies rather than from depletion of oligodendrocyte precursors.

Distribution and morphology of transgenic mouse oligodendroglial-lineage cells following transplantation into normal and myelin-deficient rat CNS.

Glial cells from neonatal MbetaP5 transgenic mice, which express bacterial beta-galactosidase (lacZ) under control of the myelin basic protein (MBP) promoter (Gow et al, 1992), were transplanted into the spinal cord or cerebral hemisphere of immunosuppressed normal and myelin-deficient (md) rats in order to assess the ability of the donor cells to survive, migrate, and differentiate within normal compared with myelin-deficient central nervous system (CNS). LacZ+ cells were detected as early as 6-7 days after transplantation into the low thoracic cord and by 10 days had spread rostrally to the brainstem and caudally to the sacral spinal cord. Initially, compact lacZ+ cells, lacking processes, were found associated with small blood vessels and with the glia limitans. Cells of this type persisted throughout the experiment. Later, lacZ+ cells with processes were seen along fiber tracts in the dorsal columns and, after intracerebral injection, subjacent to ventricular ependyma, as well as scattered in cerebral white and gray parenchyma. The extent of spread was comparable in md and normal rats, but in the md group, the success rate was higher, and more cells differentiated into process-bearing oligodendrocytes. Acceptance of xenografts in immunosuppressed recipients equaled that of allografts. The overall spread of grafted cells exceeded that of injected charcoal, indicating active migration. In contrast to earlier studies that identified oligodendrocytes based on morphology alone, this study has allowed us to identify and track oligodendrocytes based on myelin gene expression. We show some oligodendrocytes whose morphology is consistent with classical morphological descriptions, some that resemble astrocytes, and a class of compact perivascular oligodendrocyte-lineage cells that we suggest are migratory.