[Imaging evaluation of cerebrospinal fluid otorrhea associated with inner ear malformation in children]

Objective: To explore the imaging evaluation of cerebrospinal fluid (CSF) otorrhea associated with inner ear malformation (IEM) in children. Methods: The clinical data of 28 children with CSF otorrhea associated with IEM confirmed by surgical exploration in Beijing Children's Hospital, from Nov, 2016 to Jan, 2021, were analyzed retrospectively,including 16 boys and 12 girls, aged from 8-month to 15-year and 8-month old, with a median age of 4-year old. The shapes of stapes were observed during the exploration surgery, and the imaging features of temporal bone high resolution CT(HRCT) and inner ear MRI pre- and post-operation were analyzed. Results: In 28 children with CSF otorrhea, 89.3%(25/28) had stapes footplates defect during exploration. Preoperative CT showed indirect signs such as IEM, tympanic membrane bulging, soft tissue in the tympanum and mastoid cavity. IEM included four kinds: incomplete partition type I (IP-Ⅰ), common cavity (CC), incomplete partition type Ⅱ (IP-Ⅱ), and cochlear aplasia (CA); 100%(28/28) presented with vestibule dilation; 85.7%(24/28) with a defect in the lamina cribrosa of the internal auditory canal. The direct diagnostic sign of CSF otorrrhea could be seen in 73.9%(17/23) pre-operative MRI: two T2-weighted hyperintense signals between vestibule and middle ear cavity were connected by slightly lower or mixed intense T2-weighted signals, and obvious in the coronal-plane; 100%(23/23) hyperintense T2-weighted signals in the tympanum connected with those in the Eustachian tube.In post-operative CT, the soft tissues in the tympanum and mastoid cavity decreased or disappeared as early as one week. In post-operative MRI, the hyperintense T2-weighted signals of tympanum and mastoid decreased or disappeared in 3 days to 1 month,soft tissues tamponade with moderate intense T2-weighted signal were seen in the vestibule in 1-4 months. Conclusions: IP-Ⅰ, CC, IP-Ⅱ and CA with dilated vestibule can lead to CSF otorrhea. Combined with special medical history, T2-weighted signal of inner ear MRI can provide diagnostic basie for most children with IEM and CSF otorrhea.HRCT and MRI of inner ear can also be used to evaluate the effect of surgery.

China's experience in COVID-19 prevention and control among children in its different regions

OBJECTIVE

To summarize the experience of three Chinese cities (Wuhan, Shanghai and Haikou) and provide a reference for global efforts to combat COVID-19 spread among children.

MATERIALS AND METHODS

Through collecting the measures and outcomes of preventing and controlling COVID-19 in China's three hospitals, we compared the effect of different strategies.

RESULTS

From January to March 2020, the number of suspected and confirmed COVID-19 cases in Wuhan increased exponentially, and Wuhan Children's Hospital as a whole was transformed into a designated quarantine and treatment facility, which is the "Wuhan Model". Shanghai has more children's hospitals with better capabilities to tackle public health emergency. Besides, it is far away from Wuhan and had a small caseload. Children's Hospital of Fudan University, a facility in Shanghai to treat pediatric infectious diseases, is famous for its well-equipped building for infectious disease treatment and professional medical team, and therefore no major transformation was required. That is the "Shanghai Model". Haikou is located on an island. Amid the outbreak, large numbers of tourists and travelers from Hubei had already arrived in Haikou. Hainan Women and Children's Medical Center, as the only pediatric care hospital in Hainan Province, did not have a separate building for infectious disease treatment. After a citywide survey of the medical resources and facilities available, a temporarily idle hospital 3 kilometers away from Hainan Women and Children's Medical Center was requisitioned as the quarantine and treatment facility for pediatric cases. That is the "Hainan Model". The three models enabled the treatment of all suspected and confirmed cases and no fatality was reported.

CONCLUSIONS

The COVID-19 coping strategies for children should be designed according to the existing conditions of the local children's hospitals and the risk levels of the epidemic.

Factors influencing the choice of hysterectomy

A retrospective review of women undergoing hysterectomy between May 1998 and April 2000 was performed. Multiple logistic regression analysis was used to identify factors influencing the choice of hysterectomy performed. Two independent factors, the surgeons' expertise and the concomitant adnexal surgery, had a strong influence on the decision-making process regarding type of hysterectomy Generalist gynaecologists tended to perform either an abdominal hysterectomy (AH) or a vaginal hysterectomy (VH) while non-generalist gynaecologists were more likely to perform laparoscopic hysterectomy (LH). Patients undergoing a hysterectomy along with adnexal surgery had a far greater chance of undergoing either an AH or a LH as opposed to a VH. In addition, patients who had bigger uterus were more likely to undergo an AH versus a VH as compared to those with a small uterus. Patients aged 50 or older had more chance of undergoing a VH than a LH.