Expert consensus on protocol of rehabilitation for COVID-19 patients using framework and approaches of WHO International Family Classifications.

Coronavirus disease 2019 (COVID-19) has widely spread all over the world and the numbers of patients and deaths are increasing. According to the epidemiology, virology, and clinical practice, there are varying degrees of changes in patients, involving the human body structure and function and the activity and participation. Based on the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) and its biopsychosocial model of functioning, we use the WHO Family of International Classifications (WHO-FICs) framework to form an expert consensus on the COVID-19 rehabilitation program, focusing on the diagnosis and evaluation of disease and functioning, and service delivery of rehabilitation, and to establish a standard rehabilitation framework, terminology system, and evaluation and intervention systems based the WHO-FICs.

Hearing loss in children with e-waste lead and cadmium exposure.

Environmental chemical exposure can cause neurotoxicity and has been recently linked to hearing loss in general population, but data are limited in early life exposure to lead (Pb) and cadmium (Cd) especially for children. We aimed to evaluate the association of their exposure with pediatric hearing ability. Blood Pb and urinary Cd were collected form 234 preschool children in 3-7years of age from an electronic waste (e-waste) recycling area and a reference area matched in Shantou of southern China. Pure-tone air conduction (PTA) was used to test child hearing thresholds at frequencies of 0.25, 0.5, 1, 2, 4 and 8kHz. A PTA≥25dB was defined as hearing loss. A higher median blood Pb level was found in the exposed group (4.94±0.20 vs 3.85±1.81µg/dL, p<0.001), while no significance was found for creatinine-adjusted Cd. Compared with the reference group, the exposed group had a higher prevalence of hearing loss (28.8% vs 13.6%, p<0.001). The PTA in the left, right and both ears, and hearing thresholds at average low and high frequency, and single frequency of 0.5, 1 and 2kHz were all increased in the exposed group. Positive correlations of child age and nail biting habit with Pb, and negative correlations of parent education level and child washing hands before dinner with Pb and Cd exposure were observed. Logistic regression analyses showed the adjusted OR of hearing loss for Pb exposure was 1.24 (95% CI: 1.029, 1.486). Our data suggest that early childhood exposure to Pb may be an important risk factor for hearing loss, and the developmental auditory system might be affected in e-waste polluted areas.

Diffusion Tensor Imaging of the Auditory Neural Pathway for Clinical Outcome of Cochlear Implantation in Pediatric Congenital Sensorineural Hearing Loss Patients.

Although conventional structural MRI provides vital information in the evaluation of congenital sensorineural hearing loss (SNHL), it is relatively insensitive to white matter microstructure. Our objective was to evaluate possible changes in microstructure of the auditory pathway in children with congenital sensorineural hearing loss (SNHL), and the possible distinction between good and poor outcome of cochlear implantation (CI) patients by using diffusion tensor imaging (DTI). Twenty-four patients with congenital SNHL and 20 healthy controls underwent conventional MRI and DTI examination using a 1.5T MR scanner. The DTI metrics of fractional anisotropy (FA) and mean diffusivity (MD) of six regions of interest (ROIs) positioned along the auditory pathway-the trapezoid body, superior olivary nucleus, inferior colliculus, medial geniculate body, auditory radiation and white matter of Heschl's gyrus-was measured in all subjects. Among the 24 patients, 8 patients with a categorie of auditory performance (CAP) score over 6 were classified into the good outcome group, and 16 patients with a CAP score below 6 were classified into the poor outcome group. A significant decrease was observed in FA values while MD values remained unchanged at the six ROIs of SNHL patients compared with healthy controls. Compared to good outcome subjects, poor outcome subjects displayed decreased FA values at all of the ROIs. No changes were observed in MD values. Correlation analyses only revealed strong correlations between FA values and CAP scores, and strong correlations between CAP scores and age at implant were also found. No correlations of FA values with age at implant were observed. Our results show that preoperative DTI can be used to evaluate microstructural alterations in the auditory pathway that are not detectable by conventional MR imaging, and may play an important role in evaluating the outcome of CI. Early cochlear implantation might be more effectively to restore hearing in SNHL patients.

[Assessment of short-term results of Tos modified combined approach tympanoplasty].

OBJECTIVE: To observe the short-term results of Tos modified combined approach tympanoplasty (MCAT) in chronic suppurative otitis media. METHOD: This study is an observational study. The data of 26 patients (28 ears) underwent MCAT were collected. The surgical techniques, complications and preoperative and postoperative air-bone gap (ABG) were analyzed. RESULT: Of 28 ears, 26 ears (92.86%) get dry after surgery. 3 ears (10.71%)repaired tympanic membranes and reperforate postoperatively in which 2 minimal perforations were cured to close up patient treatment. One ear develops posterosuperior retraction pocket and one ear re-occurs cholesteatoma. One ear occurs blunting in the anterior sulcus and one ear has lateralization of the tympanic membrane. There are no hearing worsen and facial nerve palsy. For hearing, the postoperative pure tone threshold is better than preoperation (42.8 +/- 17.97 vs 47.49 +/- 18.01, P < 0.05) and postoperative ABG shrinks significantly (19.76 +/- 7. 49 vs 30.65 +/- 10.02, P < 0.01). CONCLUSION: Based on the short-term results, Tos' MCAT can successfully dissect the diseases of tympanic cavity and mastoid and develop a stable aerating middle ear with a complete hearing conduction. It is safe and feasible in the treatment of chronic suppurative otitis media, as well as in the poor-pneumatic mastoid.

[Expression of six gene proteins in laryngeal carcinomas and their significance].

OBJECTIVE: To investigate the expression of p15, p16, Rb, p27,p53 and PCNA gene proteins in different clinical stage, different position and different histological types of laryngeal carcinomas and their significance. METHOD: p15, p16, Rb, p27, p53 and PCNA gene proteins were examined with immunohistochemical SP method in the paraffin-embedded specimens of 65 cases with LSCC and 30 cases of normal or proliferative mucosas of larynx as a contrast. The result was analyzed by chi-square test. RESULT: The expression of the six gene proteins in LSCC and in laryngeal with normal or proliferative mucosas was different, the difference was significant (P < 0.01); the expression of p15 and p27 was significantly related with the position/clinical stage/histological types of LSCC (P < 0.01); the expression of p16 was significantly negative but the PCNA was positive correlated with th histological types of LSCC (P < 0.01). Two of them did not correlate with the position or clinical stage of LSCC (P > 0.05). There was trend of the decreasing Rb expression or increasing p53 expression with increasing clinical stages of LSCC, and the expression of p53 was also positive correlated with the histological types of LSCC. CONCLUSION: p15 and p27 play an important role in the development and progression of LSCC, and can be used as markers for assessment the treatment and prognosis of LSCC. The expression of p16 and PCNA can reflect the proliferation activity in the tumor cells, and is correlated with the development of tumor, but it does not correlate with the progression of tumor. The expression of Rb and p53 were more correlated with the progression of tumor.