Objective: To analyze the current status and influencing factors of postpartum depression symptoms among elderly multipara, so as to provide a basis for health management among elderly pregnant women. Methods: Multipara aged ≥35 years who underwent 42-day postpartum check-ups in Hangzhou Gynecology and Gynecology Hospital from October 2023 to October 2024 were selected as survey subjects using convenience sampling method. Demographic information, sleep quality and feeding methods data were collected using questionnaires. The postpartum depressive symptoms, parenting stress, and social support levels were assessed using the Chinese version of the Simplified Edinburgh Postnatal Depression Scale, Parenting Stress Inventory-Short Form, and Perceived Social Support Scale, respectively. Factors affecting postpartum depression symptoms among elderly multipara were analyzed through multivariable logistic regression model. Results: A total of 355 elderly multipara were surveyed. The average age was (38.19±2.10) years. There were 228 cesarean deliveries (64.23%) in this pregnancy. There were 21 cases (5.92%) of unplanned pregnancy and 21 cases (5.92%) of preterm birth. The parenting stress score was (72.56±11.08) points, and the social support score was (60.42±8.50) points. Postpartum depression symptoms was detected in 106 elderly multipara, with a detection rate of 29.86%. Multivariable logistic regression analysis showed that monthly household income per capita (≥5 000 yuan, OR=0.470, 95%CI: 0.281-0.785), unplanned pregnancy (yes, OR=2.619, 95%CI: 1.427-4.809), preterm delivery (yes,OR=4.105, 95%CI: 1.848-9.113), poor sleep quality (yes, OR=3.556, 95%CI: 1.659-7.595), feeding methods (mixed feeding, OR=1.483, 95%CI: 1.030-2.135; artificial feeding, OR=4.510, 95%CI: 2.018-10.070), parenting stress (OR=1.206, 95%CI: 1.162-1.441), and social support (OR=0.255, 95%CI: 0.111-0.420) were factors affecting postpartum depression symptoms among elderly multipara. Conclusion The detection rate of postpartum depression symptoms among elderly multiparas is relatively high, is associated with family economic status, pregnancy planning status, preterm delivery, sleep quality, feeding methods, parenting stress, and social support levels.

Objective To evaluate the association between self-reported neighborhood walkability environments and mortality in China.Methods The Prospective Urban Rural Epidemiology study in China(PURE-China)recruited 47 931 participants aged 35-70 from 12 provinces in China between 2005 and 2009.Neighborhood environmental indicators were collected using the Neighborhood Environment Walkability Scale(NEWS)questionnaire,with higher scores indicating better walkable environments.The primary outcomes were all-cause mortality and cardiovascular mortality,using Cox fragile model to evaluate the association between community walkability and outcomes,as well as exploring mediating pathways.Results Of 35 490 participants included in this study,60%were female,with a mean(SD)age of 51.5(9.6)years.The median follow-up was 11.7 years.This study found an association between higher community walkability score and reduced risk of all-cause mortality,with the total score(HR=0.85;95%CI,0.80-0.89),land-use mix(HR=0.84;95%CI,0.79-0.88),and crime safety(HR=0.84;95%CI,0.80-0.89)showing the most significant associations.NEWS can affect long-term adverse outcomes through lifestyle.Conclusions In the Chinese population,favorable community walkability is associated with lower all-cause mortality risk,which may support policymakers to take actions to mitigate the adverse effects of poor community en-vironments on health.

Objective To explore the value of integrating CT image features and quantitative dual-energy computed tomography(DECT)parameters in predicting cervical lymph nodes metastasis from laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC).Methods The clinical and imaging data of 99 patients with LHSCC confirmed by pathology were retrospectively analyzed.All patients were divided into metastatic group(41 cases)and non-metastatic group(58 cases).The CT image features,including location,size and depth,were analyzed,respectively.The quantitative DECT parameters in the arterial and venous phases including iodine concentration(IC)and normalized iodine concentration(NIC)were measured.The rank sum test or independent-samples t-test were used to compare the difference of CT image features and quantitative DECT parameters between the two groups.The multivariate logistic regression analysis was used to build the models based on CT image features(image feature model)and combination of CT image features and quantitative DECT parameters(combined model).The receiver operating characteristic(ROC)curve was performed to analyze and compare the difference of predictive efficiency between the two groups.Results There were significant differences in tumor location between the non-metastatic group and the metastatic group(χ2=21.736,P<0.001).Size(33.20 mm vs 24.95 mm,P<0.001),depth(21.10 mm vs 13.15 mm,P<0.001)and NIC in the arterial phase(0.18 vs 0.14,P<0.001)in the metastatic group were significantly higher than those in the non-metastatic group.The area under the curve(AUC),sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the combined model were 0.851,75.6%,82.8%,58.5%,87.9%and 75.8%for predicting cervical lymph nodes metastasis.The AUC,sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the image feature model were 0.792,95.1%,56.9%,53.7%,81.0%and 69.7%,respectively.The prediction performance of the combined model was better than that of the image feature model(Z=-2.028,P=0.043).Conclusion Integrating CT image features and quantitative DECT parameters has important value for predicting cervical lymph nodes metastasis from LHSCC.

Objective To explore the value of integrating CT image features and quantitative dual-energy computed tomography(DECT)parameters in predicting cervical lymph nodes metastasis from laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC).Methods The clinical and imaging data of 99 patients with LHSCC confirmed by pathology were retrospectively analyzed.All patients were divided into metastatic group(41 cases)and non-metastatic group(58 cases).The CT image features,including location,size and depth,were analyzed,respectively.The quantitative DECT parameters in the arterial and venous phases including iodine concentration(IC)and normalized iodine concentration(NIC)were measured.The rank sum test or independent-samples t-test were used to compare the difference of CT image features and quantitative DECT parameters between the two groups.The multivariate logistic regression analysis was used to build the models based on CT image features(image feature model)and combination of CT image features and quantitative DECT parameters(combined model).The receiver operating characteristic(ROC)curve was performed to analyze and compare the difference of predictive efficiency between the two groups.Results There were significant differences in tumor location between the non-metastatic group and the metastatic group(χ2=21.736,P<0.001).Size(33.20 mm vs 24.95 mm,P<0.001),depth(21.10 mm vs 13.15 mm,P<0.001)and NIC in the arterial phase(0.18 vs 0.14,P<0.001)in the metastatic group were significantly higher than those in the non-metastatic group.The area under the curve(AUC),sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the combined model were 0.851,75.6%,82.8%,58.5%,87.9%and 75.8%for predicting cervical lymph nodes metastasis.The AUC,sensitivity,specificity,positive predictive value,negative predictive value,accuracy of the image feature model were 0.792,95.1%,56.9%,53.7%,81.0%and 69.7%,respectively.The prediction performance of the combined model was better than that of the image feature model(Z=-2.028,P=0.043).Conclusion Integrating CT image features and quantitative DECT parameters has important value for predicting cervical lymph nodes metastasis from LHSCC.

Objective To establish the methods of galvanic vestibular stimulation-vestibular evoked myogenic potentials(GVS-VEMPs)in healthy children and to obtain the normal value of GVS-cVEMP and GVS-oVEMP in these children in China.Methods Twenty(3～14 years)healthy children and 24 healthy adults(18～30 years)were enrolled for conventional examinations of GVS-cVEMP and GVS-oVEMP.Using the galvanic stimulation in-tensity under 3 mA/1 ms for children and 5 mA/1 ms for adults.The characteristics of elicitation and parameter re-sults of GVS-cVEMP and GVS-oVEMP in children and adults,as well as the pain scores and the elicitation of differ-ent stimulus intensities in the two age groups were recorded.Results The elicitation of GVS-cVEMP and GVS-oVEMP were both 100.0％in children and adult groups.The p1 latency,n1 latency and p1-n1 interval latency of GVS-cVEMP were 10.46±1.84 ms,16.98±2.12 ms and 6.52±1.42 ms respectively in children group,the n1 la-tency and p1-n1 interval latency were significantly shorter than the adult group(P＜0.05).The n1 latency,p1 la-tency and p1-n1 interval latency of GVS-oVEMP were 8.87±1.40 ms,12.25±1.80 ms and 3.39±1.07 ms re-spectively in children group with no significant difference between the two groups.The thresholds of GVS-cVEMP and GVS-oVEMP in children group were significantly lower than adult group(P＜0.01),but no differences were found in adult group regarding on the amplitude and interaural amplitude asymmetry ratio.In addition,with the in-crease of the intensity of galvanic stimulation,the correlation between pain scores and the elicitation rates of GVS-cVEMP and GVS-oVEMP also increased.Conclusion Using appropriate stimulus intensity and recording methods,GVS-cVEMP and GVS-oVEMP could be successfully assessed and detected in healthy children over 3 years old and adolescents.The latency of GVS-cVEMP in children is slightly shorter than that in adults,therefore we recommend selecting the matched age group for assessment in the children group.

Objective:To investigate the value of magnetization transfer imaging (MTI) and fat suppression T 2WI (FS-T 2WI) in predicting the clinical activity of Graves ophthalmopathy (GO). Methods:From October 2020 to July 2021, 64 GO patients were prospectively enrolled in the First Affiliated Hospital of Nanjing Medical University. According to the clinical activity score (CAS), the patients were divided into active group (CAS≥3, 39 patients and 78 eyes) and inactive group (CAS<3, 25 patients and 50 eyes). The coronal MTI and FS-T 2WI were scanned for pre-treatment assessment. Magnetization transfer ratio (MTR) of extraocular muscles, and signal intensity ratio (SIR) between extraocular muscles and temporalis were measured, respectively. The independent-sample t-test was used to compare the MTR and SIR between two groups. The correlations between MRI parameters and CAS were analyzed using Spearman correlation analysis. The receiver operating characteristic (ROC) curve was performed to evaluate the value of each and combined parameters for predicting the clinical activity of GO. The DeLong test was used to compare the area under the curve (AUC). Results:The MTR of active group and inactive group were 0.45±0.04 and 0.51±0.04, respectively, the difference was statistically significant ( t=7.62, P<0.001). The SIR were 3.4±0.6 and 2.6±0.5, respectively, and the difference was also statistically significant ( t=-8.20, P<0.001). MTR was negatively correlated with CAS ( r=-0.46, P<0.001), while SIR was positively correlated with CAS ( r=0.63, P<0.001). The AUC of MTR, SIR and the combination of MTR and SIR for predicting the clinical activity of GO were 0.840, 0.845 and 0.905, respectively. The combination of MTR and SIR showed higher performance than MTR or SIR alone, and the differences were statistically significant ( Z=2.61, P=0.009; Z=2.15, P=0.032). Conclusions:The quantitative parameters of MTI and FS-T 2WI, namely MTR and SIR, can be used to evaluate the clinical activity of GO. Integrating MTI and FS-T 2WI can improve the diagnostic efficiency.

Objective:To analyze the etiological spatialtemporal distribution characteristics of coxsackievirus A16 (CoxA16) and enterovirus 71 (EV71) in children with hand, foot, and mouth disease (HFMD) in Dali Bai Autonomous Prefecture, and to provide references for its prevention and control.Methods:Real-time polymerase chain reaction(PCR) was used to detect the etiology of children with HFMD in Dali Bai Autonomous Prefecture from January 1, 2013 to December 31, 2018, including CoxA16 and EV71. Spatialtemporal correlation analysis of CoxA16 and EV71 were performed by ArcGIS 10 and SaTScanv 9.6 softwares.Results:Among 3 527 pathogen samples, EV71 was dominant with 12.0%(91/758) in 2013, 40.4%(180/446) in 2014, and 26.7%(155/581) in 2017. CoxA16 was the dominant pathogen with 29.9%(162/541) in 2015, 40.0%(219/547) in 2016, and 13.8%(90/654) in 2018. According to the pathogen detection data from 2013 to 2018, the detection rate of CoxA16 pathogen was higher than that of EV71 ( χ2=1 128.72, P<0.05). CoxA16 and EV71 were aggregated from summer to autumn. CoxA16 was presented with clustered distribution ( Moran′ s index=0.344, P<0.05), and the hot spots of CoxA16 were Xiangyun County ( Z=2.72, P<0.01) and Midu County ( Z=1.68, P<0.1). The radius radiates was 39.00 km from the center of Xiangyun County (log likelihood ratio ( LLR)=40.178, P<0.05). EV71 was presented with discretely distribution ( Moran′ s index=-0.194, P>0.05), and the hot spots of EV71 were Heqing County ( Z=2.14, P<0.05), Jianchuan County ( Z=1.76, P<0.1) and Dali City ( Z=1.71, P<0.1). The main gathering area was the radiation radius of 64.21 km centered of Eryuan County ( LLR=39.376, P<0.05). Conclusions:There are spatiotemporal aggregations of CoxA16 and EV71 in childhood cases with HFMD. The monitoring should be strengthened, and the disease should be scientifically prevented and controlled.

Objective:The aim of this study was to design and perform "Tap-hammer"system that can be used to elicit vestibular evoked myogenic potentials (VEMP) in normal adults and to report the preliminary results of this system.Methods:A triggered Tap-hammer was designed, made and connected with an electric recording system, to form as a system for Tap-VEMP recording. Twenty healthy adult volunteers (7 males and 13 females, aged 20 to 37 years, 40 ears in total) were recruited for air-conducted sound VEMP (ACS-VEMP) and Tap-VEMP examinations. Waveforms and parameters of both VEMPs were recorded and analyzed. SPSS 22.0 software was used for statistical analysis.Results:The response rates of ACS-, Tap-ocular VEMP (oVEMP) and ACS-, Tap-cervical VEMP (cVEMP) were both 100% (40/40). The mean±SD n1 latency, p1 latency, n1-p1 interval, amplitude, and asymmetry ratio (AR%) of Tap-oVEMP were (9.80±2.51)ms, (13.90±3.26)ms, (4.09±1.43)ms, (16.43±9.61)μV, (22.68±17.35)% respectively. The mean±SD p1 latency, n1 latency, p1-n1 interval, amplitude, and asymmetry ratio (AR%) of Tap-cVEMP were (13.26±2.07)ms, (21.84±2.89)ms, (8.58±2.10)ms, (457.65±274.94)μV, (20.42±13.46)% respectively. Both n1 latency and p1 latency of Tap-VEMPs were shorter than those in ACS-VEMPs ( P<0.05). No statistical difference could be found between the two stimulation methods in the parameters of n1-p1 interval, amplitude, and asymmetry ratio( P>0.05). Conclusion:The Tap-hammer system can elicit VEMP responses in healthy young people. This system can be used as an alternative stimulation method for bone conduction VEMP.

Objective: To introduce the method of galvanic vestibular stimulation-vestibular evoked myogenic potentials (GVS-VEMP) as well as to observe and analyze the parameters and elicited rate of GVS-cVEMP and GVS-oVEMP in healthy young people in China. Methods: Twenty six normal young subjects were recruited for conventional examinations of GVS-VEMP. The subjects were 21-37 years old, average age was (25.8±3.7) years old, including 13 males and 13 females. The galvanic stimulation intensity of 3 mA/1 ms was used to evoke cVEMP and oVEMP on the sternocleidomastoid and inferior extraocular muscles respectively, and the intensity of stimulus was decreased until the response disappeared, the threshold, latency, amplitude, interval phase and interaural amplitude ratio(IAR) were calculated. SPSS18.0 software was used for statistical analysis. Results: All subjects were elicited normal GVS-cVEMP and GVS-oVEMP under 3 mA/1 ms, the elicited rate was 100%. The threshold of GVS-cVEMP was (1.18±0.47) mA, p1 latency was (10.43±1.54) ms, n1 latency was (17.91±1.20) ms, the amplitude was (102.47±56.77) uV and IAR was (0.26±0.20). The threshold of GVS-oVEMP was (1.12±0.50) mA, n1 latency was (8.46±1.05) ms, p1 latency was (11.83±1.27) ms, the amplitude was (9.12±6.82) uV and IAR was (0.25±0.20). In terms of gender and lateral comparison, only the GVS-oVEMP amplitude was higher for male than for female, which had significant statistical difference (P<0.05), and there was no statistical difference in the other parameters between GVS-cVEMP and GVS-oVEMP. Conclusion GVS-cVEMP and GVS-oVEMP could be elicited in healthy youth population, and the parameters could provide reference for subsequent vestibular function evaluation.

Objective Toinvestigatetheclinicalvalueofreadoutsegmentationoflongvariableecho-trainsdiffusion-weightedimaging (RESOLVE-DWI)inthediagnosisandstagingofthyroid-associatedophthalmopathy(TAO).Methods Atotalof30consecutivepatientswith TAOand30healthycontrols(HCs)whounderwentRESOLVE-DWIwereenrolledinourstudy.ADCvaluesofextraocularmuscles (superiorrectus,inferiorrectus,medialrectusandlateralrectus)were measuredandcomparedbetween TAOsand HCs,active TAOsandinactiveTAOs,orinactiveTAOsandHCs.ROCanalysiswasperformedtoevaluatethediagnosticvalueofsignificantparametersfor discriminatingactivefrominactiveTAOs.Results TheADCvaluesofallextraocularmusclesinTAOsweresignificantlyhigherthan thoseinHCs(P<0.05).Meanwhile,alltheextraocularmusclesinactiveTAOsshowedsignificantlyhigherADCvaluesthanthose ininactiveTAOs(P<0.05),exceptlateralrectus(P=0.267).WhilstnosignificantdifferenceswerefoundontheADCvaluesofall extraocularmusclesbetweeninactiveTAOsandHCs(P>0.05).ROCanalysisresultsindicatedthattheADCvalueofmedialrectus showedtheoptimalstagingefficacy(cutoffvalue,1.40×10-3 mm2/s;AUC,0.766;sensitivity,92.1%;specificity,59.1%).Conclusion RESOLVE-DWIanditsderivedADCvaluesofextraocularmusclescanassistinthediagnosisofTAO.TheADCvalueofmedial rectushastheoptimalefficacyontheevaluationofitsclinicalactivity.