Objective: To explore the association between mental health and muscle strength among Chinese adolescents aged 13- 18, providing a theoretical foundation and intervention strategies for mental health promotion. Methods: Data were obtained from the 2019 Chinese National Survey on Students Constitution and Health, including 98 631 Chinese adolescents aged 13- 18. Psychological distress was assessed by using the Kessler Psychological Distress Scale (K10), and mental well being was measured with the Warwick-Edinburgh Mental Well being Scale (WEMWBS). Based on the gender and age specific Z scores of various test items [grip strength, standing long jump, pull ups (for males), and sit ups (for females)], muscle strength index (MSI) was constructed to evaluate the comprehensive level of muscle strength in adolescents. According to the Dual factor Model (DFM) of mental health, participants were categorized into four groups:troubled, symptomatic but content, vulnerable, and complete mental health. Gender differences were analyzed by using Chi-square tests, trends were tested with Cochran-Armitage tests, and multinomial Logistic regression models were applied to assess associations between muscle strength and mental health among adolescents. Results: In 2019, 37.4% of Chinese adolescents aged 13-18 were reported of high mental distress, and 59.9% were reported of low mental well being. Boys had significantly lower rates of high mental distress (35.3%) and low mental well being (55.6%) compared to girls (39.4%, 64.3%), and the differences were of statistical significance ( χ 2=176.13, 780.42, both P <0.05). In 2019, the rate of complete mental health among adolescents showed a downward trend with increasing age ( χ 2 trend = 258.47) and a gradual upward trend with increasing muscle strength levels ( χ 2 trend =123.14)，and both boys and girls exhibited similar trends ( χ 2 trend =103.83, 168.46; 57.00 , 67.34) (all P <0.05). The results of the unordered multiclass Logistic regression model showed that after controlling for confounding factors such as age and gender, when the completely pathological group as a reference, for every 1 unit increase in MSI in adolescents, the likelihood of being in a completely mental health state increased by 29% ( OR = 1.29); for every unit increase in the Z-score for pull ups, the likelihood of being in a completely mental health state increased by 6% ( OR =1.06) among boys; for every 1 unit increase in sit up Z score, the likelihood of being in a completely mental health state increased by 19% ( OR =1.19) among girls (all P <0.05). Conclusions The mental health status of Chinese adolescents is not good enough. Muscle strength is positively associated with mental health.

Objective:To investigate the effects of the Epley and Semont procedures with varying lateral angles of the head on posterior semicircular canal benign paroxysmal positional vertigo （PC-BPPV）. Methods:A total of 115 patients with unilateral PC-BPPV were randomly divided into five groups: Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group, with 23 patients in each group. Corresponding reduction treatments were performed. Results:The total effective rates for the Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group were 95.7% （22/23）, 4.3% （1/23）, 30.4% （7/23）, 52.2% （12/23）, and 87.0% （20/23） respectively. The inefficiencies were 4.3% （1/23）, 95.7% （22/23）, 69.6% （16/23）, 47.8% （11/23）, and 13.0% （3/23）. Statistically significant differences were observed in the total effective rates among the five groups （χ²=54.11, P<0.01）. The total effective rates in the Semont group, Semont+10° group, and Semont+20° group were significantly different from that of the Epley group （P<0.01）, while no statistically significant difference was found between the Semont+30° group and the Epley group （P= 0.608>0.012 5）. Conclusion:Among the four Semont methods with different lateral lying angles, the total effective rate of reduction treatment increased with the elevation of the lateral lying angle on the affected side. The efficacy of the Semont+30° group in treating PC-BPPV was not significantly different from the Epley group's reduction effect, which was markedly superior to that of the other four Semont methods at different angles. Therefore, the Semont+30° reduction technique is recommended for the treatment of PC-BPPV.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Benign Paroxysmal Positional Vertigo/therapy* ; Head ; Posture ; Semicircular Canals/physiopathology* ; Treatment Outcome

Objective:To explore the correlation between color Doppler ultrasound, Cyfra21-1, Fer and malignant ovarian lesions and the value of combined model identification.Methods:A total of 108 patients with suspected ovarian cancer admitted to our hospital from Jan. 2021 to Dec. 2023 were selected as subjects. All patients were tested by color Doppler ultrasound, Cyfra21-1 and Fer, and were divided into malignant group (61 cases) and benign group (47 cases) according to the pathological test results. The baseline data, ultrasound parameters, Cyfra21-1 and Fer levels of the two groups were compared, and multivariate regression analysis was performed to establish a multi-factor combined model, and ROC curve was used to evaluate the differential efficacy of the combined model.Results:There was no significant difference in baseline data such as age and course of disease between the two groups ( P>0.05). In the malignant group, the lesion diameter was (7.66±1.24) cm, with solid echo detection in 37 cases and inner wall with nipple detection in 38 cases. In the benign group, the lesion diameter was (5.14±1.03) cm, with solid echo detection in 18 cases and inner wall with nipple detection in 17 cases. In the malignant group, PS was (22.94±4.61) cm/s, EDV was (15.67±3.42) cm/s, VM was (12.43±3.15) cm/s. PS, EDV and VM in benign group were (15.63±4.24) cm/s, (8.95±3.04) cm/s and (17.08±4.21) cm/s respectively, and those in malignant group were higher than those in benign group ( P<0.05). RI in the malignant group was 0.35±0.06, RI in the benign group was 0.58±0.13, and RI in the malignant group was lower than that in the benign group ( P<0.05). Multivariate regression analysis showed that lesion diameter, solid echo, inner wall with papilla, PS, EDV, VM, Cyfra21-1, Fer and RI were all independent risk factors for ovarian malignant lesions, and lesion diameter, solid echo, inner wall with papilla, PS, EDV, VM, Cyfra21-1 and Fer were positively correlated with ovarian malignant lesions. RI was negatively correlated with ovarian malignant lesions ( P<0.05). ROC curve results showed that the diagnostic efficiency of the combined model was higher than that of the single use of Doppler ultrasound, Cyfra21-1 and Fer. Conclusion:The combined diagnosis model of color Doppler ultrasound, Cyfra21-1 and Fer is helpful to improve the diagnostic efficiency of ovarian malignant lesions.

Objective Corruption is the most common cadaver phenomenon in forensic practice and an important basis for inferring time of death(PMI),but the definition of corruption degree and the construction of model inference models have always been difficult in the practice of forensic science.Methods In this study,the late postmortem phenomena were observed.Meanwhile,the microbial flora structure of gut and gravesoil and the nature of gravesoil were detected,for analyzing the changes before and after the key moment of abdominal rupture which naturally happened during the cadaver decay.Results The results found that from the macroscopic and microscopic levels,there were significant differences in cadaver decay,including microbial flora structure and gravesoil properties before and after the key moment of the natural abdominal rupture during cadaver decay.The phenomena are highly observable and can be accurately judged by forensic examinations,as well as related means in the field of biology and physiochemistry.In this study,this critical event was called Rupture Point.Conclusion The Rupture Point can be used as an important node for the assessment of cadaver decay degree in the practice of forensic medicine.It can be utilized for a cut-off point as well when constructing PMI inference models based on microbial flora structure changes.The accuracy of PMI inference models can be improved when the models were constructed in segments.

Objective:To evaluate the qualitative and quantitative diagnostic value of transvaginal contrast-enhanced ultrasonography for benign and malignant adnexal masses.Methods:Forty-nine patients with adnexal masses detected by routine ultrasound examination at Wenzhou People's Hospital from January 2021 to December 2022 were included in this study. Initially, transvaginal two-dimensional ultrasound, two-dimensional ultrasound integrated with color Doppler, and contrast-enhanced ultrasonography were used to accurately classify the masses as benign or malignant. Using postoperative pathology as the gold standard, the qualitative diagnostic accuracy of various detection methods was compared. Subsequently, the receiver operating characteristic curve analysis was performed to assess the quantitative diagnostic accuracy of transvaginal contrast-enhanced ultrasonography-related parameters in distinguishing between benign and malignant adnexal masses.Results:Among the 49 patients, 10 were diagnosed with malignant tumors. The diagnostic accuracy of contrast-enhanced ultrasonography was 93.88% (46/49), with a sensitivity of 90.00% (9/10), a specificity of 94.87% (37/39), a positive predictive value of 81.82% (9/11), and a negative predictive value of 97.37% (37/38). The results of the diagnostic difference assessment (McNemar test) revealed that there was no significant difference between two-dimensional ultrasound ( χ2 = 0.37, P = 0.546), two-dimensional ultrasound combined with color Doppler ( χ2 = 0.17, P = 0.683), and contrast-enhanced ultrasonography ( χ2 = 0.00, P = 1.000), and the gold standard test results. The consistency assessment (Kappa test) revealed that the diagnostic results of contrast-enhanced ultrasonography exhibited the highest concordance with the gold standard, with a Kappa value of 0.82 ( P < 0.001). Furthermore, the receiver operating characteristic curve analysis indicated that the initial increase time, peak intensity, and mean transit time in contrast-enhanced ultrasonography demonstrated high quantitative diagnostic accuracy. The areas under the curve were 0.83, 0.82, and 0.84, respectively, and the diagnostic cutoff values were 17.30 s, 21.65 dB, and 92.60 seconds, respectively. Conclusion:Contrast-enhanced ultrasonography exhibits diagnostic value in the differential diagnosis of benign and malignant adnexal masses, both qualitatively and quantitatively. This method can provide valuable insights for further treatment.

Objective To explore the application of the Montreal cognitive assessment(MoCA)scale in the early postoperative cognitive function of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 181 patients with aSAH hospitalized in Department of Neurosurgery,First Affiliated Hospital of Wenzhou Medical University from November 2021 to May 2022 were collected,and the scores of each dimension of the patients were evaluated using MoCA scale;Using gender,age,educational level,hypertension,responsible aneurysm diameter,Hunt-Hess grade,and surgical method as variables,the relationship between these factors and the scores of each dimension of the MoCA scale was studied.Logistic regression was used to analyze the influencing factors of low score dimensions and postoperative cognitive function.Results 61 cases(36.31％)had normal cognitive function(≥26 points).The results of multifactorial analysis of language dimensions showed that there was a statistically significant difference in the comparison of educational background,age,surgical method,Hunt-Hess grade,and the presence or absence of cognitive dysfunction(P<0.05);The results of multifactor analysis of delayed memory showed that there was a statistically significant difference in the occurrence of cognitive dysfunction among educational background,Hunt-Hess classification,alcoholism,family history of stroke,and surgical methods(P<0.05).Conclusion The incidence of early postoperative cognitive dysfunction in patients with aSAH is high;The scores of language and delayed memory were the lowest;Low cultural background,advanced age,craniotomy methods,and high Hunt-Hess scores are more likely to cause damage to language and delayed memory dimensions.

Objective:To investigate the situation of continuing medical education (CME) among obstetricians and gynecologists from Beijing's general hospitals at the secondary level or above in 2018 and 2023, and to provide a reference for standardizing CME for obstetricians and gynecologists in the future.Methods:We performed questionnaire surveys and interviews with 164 obstetricians and gynecologists in Beijing to investigate the status of completion of CME, the reasons for incompletion, the preferred modes to complete CME, and the preferred contents and forms of CME. SPSS 26.0 software was used for data analysis. The rate was compared using the chi-squared test.Results:Due to the impact of coronavirus disease 2019, the 2023 survey showed that 79 (48.17%) participants completed CME in an online mode, and 76 (46.34%) participants completed CME in an mostly online mode, with a significantly increased degree of satisfaction with CME compared with the 2018 survey ( P<0.05); 49 (29.88%) participants believe that online education is superior to traditional CME, and 69 (42.07%) participants believe that online education is comparable to traditional CME. The main advantages of the online education mode are flexible time and location and cost savings. "Hoping to improve my professional level" is the main purpose to participate in CME in both 2018 and 2023 surveys [124 (75.61%) vs. 127 (77.44%)]. "Professional skills and techniques" and "New advances in the specialty" are the contents of most interest. Conclusions:Obstetricians and gynecologists should raise the awareness to participant in CME. Relevant departments should establish a standardized system and an effective supervision and management mechanism, and take flexible education modes with the use of the Internet. Online education can achieve similar teaching effects and also improve learners' satisfaction.

Objective To explore the feasibility and safety of submucosal tunneling endoscopic resection(STER)for the treatment of giant(long diameter≥3.5 cm)symptomatic submucosal tumors(SMT)originating from the esophageal and cardiac muscularis propria layer.Methods A retrospective analysis was conducted on patients with giant symptomatic SMT of the esophagus and cardia treated with STER at the Endoscopy Center of Zhongshan Hospital,Fudan University from January 2017 to January 2020.Clinical characteristics and follow-up data of patients were collected.The efficacy of STER was evaluated by complete resection rate,recurrence rate,and residual rate.The safety of the procedure was assessed by the occurrence of procedure-related complications.Results A total of 111 patients with SMT were included,including 65 males and 46 females,with an average age of(43.2±11.6)years old.Among them,11 patients(9.9％)presented with typical symptoms.Leiomyomas accounted for 105 cases,gastrointestinal stromal tumors for 2 cases,and schwannoma for 4 cases.The median long diameter of the tumors was 5 cm,and the median short diameter was 3 cm.The median operation time was 70 minutes,and the median time of hospital stay was 3 days.The success rate of STER was 100％,with a complete resection rate of 73.9％.Intraoperative mucosal injury was observed in 18 cases(16.2％),postoperative complications occurred in 16 cases(14.4％),including severe pneumothorax/pleural effusion requiring drainage in 10 cases(9.0％),delayed bleeding in 1 case(0.9％),moderate or severe fever in 4 cases(3.6％),and infection in tunnel in 1 case(0.9％).Follow-up at 1-18 months showed no tumor residue,recurrence,esophageal stenosis,diverticula or other long-term complications.Conclusions STER is a safe and effective treatment for giant symptomatic SMT of the esophagus and cardia.

Objective We investigated the effects of ICAM5 in the hippocampus on the alcohol drinking preference of mice,and the potential mechanisms.Methods An alcohol two-bottle choice model was developed in 8-week-old male C57BL/6J mice,which were randomly divided to two groups:water group and alcohol group.The protein expression of ICAM5 in the hippocampus,amygdala,and medial prefrontal cortex was detected.An ICAM5-overexpressing adeno-associated virus was constructed and injected into the hippocampus by stereotaxic method.The expression level of ICAM5 protein in the hippocampus was detected by immunofluorescence and Western blot.We then detected the alcohol preference and locomotor activity of mice with a conditioned place preference(CPP)experiment,open field test,and loss-of-righting reflex test.Western blot analysis was used to identify the neuron F-actin/G-actin ratio.Using Golgi staining,the morphology of dendritic spines was identified.Results The expression of ICAM5 in the hippocampus of alcohol two-bottle choice model mice in the alcohol group was considerably lower than that of the water group(P＜0.001).The specific expression of ICAM5 in the hippocampus of mice was observed by fluorescence microscopy.In the open field experiment,the staying time and moving distance of the AAV-ICAM5 group were significantly increased compared with those of the control group(P＜0.01).In the CPP experiment,the residence time of AAV-ICAM5 mice in the alcohol-paired compartment was significantly lower than that of control mice(P＜0.001).In the loss-of-righting reflex experiment,overexpression of ICAM5 significantly reduced sedation latency(P＜0.01),but significantly shortened the duration of sedation(P＜0.001).Compared with AAV-mCherry+Water group,the ratio of F-actin/G-actin in the hippocampus was significantly increased after drinking(P＜0.01),but after ICAM5 overexpression,their F-actin/G-actin ratio was significantly decreased(P＜0.001).Compared with AAV-mCherry+Water group,the density of dendritic spines in the hippocampal CAI region was increased(P＜0.001),but the density of dendritic spines in the AAV-ICAM5+Alcohol group was significantly decreased(P＜0.01).Conclusions ICAM5 modulated the expression of cytoskeleton proteins to change the structural plasticity of dendritic spines,which contributed to alcohol-drinking and locomotor behavioral changes in mice.

Objective To establish a scientifically rigorous,standardized,and comprehensive evaluation index system for the emergency response competency of'Internet+'nurses,and to provide references for the access,training and assessment of'Internet+'nurses.Methods Between November 2022 and July 2023,a draft of the evaluation index system was developed based on theoretical analysis,literature reviews and semi-structured interviews.Delphi expert consultation and analytic hierarchy process were used to determine the evaluation index system for emergency response competence of'Internet+'nurses.Results The response rates of 2 rounds were 90.48％and 100％;the opinion rates were 63.16％and 10.53％;the authority coefficients of the experts were 0.855 and 0.850;the Kendall's coefficients of concordance were 0.175 and 0.182.Finally,the evaluation index system for emergency response competency of'Internet+'nurses was formed,which consists of 4 first-level indexes(including prevention capacity,preparedness capacity,response capacity and recovery capacity),13 second-level indexes and 40 third-level indexes.Conclusion The evaluation index system for the emergency response competency of'Internet+'nurses is highly scientific and practical,which has guiding significance for the access,training and assessment of'Internet+'nurses.