Abstract:Objective To investigate the impact of simulated ejection on blood pressure and heart rate of fighter pilots of different age groups in order to provide data for flight training and formulation of ejection protection measures.Methods Fighter pilots were divided into groups ages 20-24,25-29,30-34,and＞34 years.Ejection experiments were conducted using an ejection seat simulator,and blood pressure and heart rate were recorded before and after ejection.The blood pressure,heart rate,and their changes(ΔSBP,ΔDBP,ΔHR)before and after ejection were compared across age groups.Results The systolic blood pressure(SBP)of pilots in groups ages 20-24,25-29,and 30-34 increased after simulated ejection training(t=2.418,2.278,2.270,P=0.020,0.025,0.028),but decreased in the group above 34(t=2.195,P=0.042).The diastolic blood pressure(DBP)of pilots in the group ages 30 to 34 was higher after training(t=2.078,P=0.043),so was the heart rate(HR)of pilots in the group ages 25-29(t=2.099,P=0.038).Pearson correlation analysis showed a negative correlation between age and ΔSBP(r=-0.172,P=0.011).Significant differences in ΔSBP and ΔDBP were observed between the four groups(F=4.132,3.689,P=0.007,0.013).The ΔSBP and ΔDBP of pilots in the first three age groups were higher than in the＞34 age group(all P＜0.05).Conclusion Age-related physiological changes affect the cardiovascular adaptation mechanisms of pilots during ejection.Before high-stress training such as simulated ejection,the age and physical condition of pilots should be taken into consideration to adjust the levels of difficulty and risk of training so as to ensure that their physiological and psychological states meet the requirements of training.

Abstract:Objective To investigate the distribution of serum Helicobacter pylori IgG antibodies and its impact on PG Ⅰ,PGⅡand PGR level in aircrew.Methods A total of 325 military aircrew who underwent health examinations at the Lintong Rehabilitation and Convalescent Center from April 2017 to August 2017 were enrolled in the study.Based on Helicobacter pylori antibody test results,they were divided into the positive group(107 cases)and the negative group(218 cases).Additionally,92 ground crews who underwent health examinations from December 2016 to December 2017 were selected as the control group.Differences in Helicobacter pylori antibody positivity rates among aircrew members of varying ages and aircraft types were analyzed.Furthermore,serum pepsinogen levels were compared across different Helicobacter pylori antibody positivity statuses.Results Positive results Helicobacter pylori IgG antibodies test in aircrew accounts for 32.92％,with the statistically significant difference among all groups(x2=11.957,P=0.008).Infection rate in the age 41～50 group were significantly higher than the group of age less than 30(P＜0.05).Positive results of Helicobacter pylori IgG antibodies test in ground crews accounts for 29.35％with no statistically significant difference among all groups.There was no significant difference between different aircrafts(P＞0.05).Additionally,positive Helicobacter pylori IgG antibodies group showed significantly higher level of PGⅡ and lower PGR values(Z=3.072,3.224,P=0.002,0.001).Conclusion Infection with Helicobacter pylori might have an influence on the level of serum pepsinogen.The analysis of serum Helicobacter pylori IgG antibodies and pepsinogen may give us the guidance in evaluating the gastric mucosal status.

Abstract:Objective To investigate the effect of dexmedetomidine combined with etomidate on the incidence of perioperative neurocognitive disorder(PND)and hemodynamics in elderly orthopedic surgery patients.Methods Elderly patients ages 60 to 90 and undergoing elective orthopedic general anesthesia surgery at the Air Force Medical Centre between June 2022 and August 2023 were selected as the subjects,and randomly divided into the propofol group,etomidate group,and the dexmedetomidine combined with etomidate group(the combined group)using the random number table method.Neurocognitive function tests were performed on the 1st preoperative day,the 1st postoperative day and the 3rd postoperative day.The indexes of intraoperative heart rate,mean arterial pressure and depth of anesthesia changes were recorded and compared between these groups.Contributors to PND on postoperative days 1 and 3 were analyzed using univariate analysis and multifactorial logistic regression.Results A total of 208 patients were included in the study,with 69 in the propofol group,69 in the etomidate group,and 70 in the combined group.There was no statistically significant difference between the three groups of patients in terms of age,body mass index,and gender(all P＞0.05).The results of repeated measures ANOVA show that,the heart rate of the etomidate group was higher than that of the combined group,and the difference was statistically significant(P=0.007).The incidence rates of PND on the 1st and 3rd postoperative days in the combined group were both lower than those of the propofol group and the etomidate group,and the differences were of statistical significance(all P＜0.05).Multivariate logistic regression analysis indicated that the combination medication was a protective factor against PND on the 1st postoperative day(OR=0.388,95％CI:0.173-0.869).A preoperative history of diabetes(OR=3.765,95％CI:1.533-9.245),a pre-frail status(OR=8.877,95％CI:1.082-72.811),and a semi-sitting surgical position(OR=6.901,95％CI:1.035-45.995)were risk factors for PND on the 3rd postoperative day.The combination medication(OR=0.272,95％CI:0.090-0.824)and a higher preoperative Mini-Mental State Examination score(OR=0.754,95％CI:0.595-0.957)were protective factors against PND on the 3rd postoperative day.Conclusion Intravenous anesthesia with dexmedetomidine combined with etomidate can reduce the incidence of PND and effectively improve the quality of life of elderly patients undergoing orthopedic surgery.Intravenous anesthesia with etomidate can increase heart rate compared with the combination of dexmedetomidine and etomidate,but has less impact on circulation,suggesting that intravenous anesthetic drugs should be selected according to the patient's circulation and surgical needs.

Abstract:Objective To explore the clinical and imaging features of gastric-type endocervical adenocarcinomas(G-EAC)in order to improve the level of early diagnosis.Methods The clinical and imaging data of 16 patients with pathologically confirmed G-EAC who were admitted to the Air Force Medical Center between January 2021 and February 2025 was retrospectively analyzed.Results Among the 16 patients,7 had no abnormal gynecological symptoms while 9 had vaginal discharge and/or vaginal bleeding.HPV test was positive in 3 cases and 10 cases had abnormal tumor markers.The tumors were located in the upper half of the cervix in 5 cases,involved the entire cervix in 8 cases,and extended beyond the cervix in 3 cases.Four cases showed barrel-shaped growth and 11 cases were infiltrative,while 1 case presented as exophytic mass.All the 16 cases were accompanied by cysts,including 5 cases with large cysts,9 cases with small cysts and large ones,and 2 cases with small cysts.Four cases were complicated with a small amount of uterine cavity effusion.When the cystic component was predominant,multiple rounded lesions of varying sizes with long T1 and long T2 signals were observed.There was no or slight restriction in diffusion on DWI sequence,and slightly high signals in ADC image.When the solid component was predominant,slightly long T2 signal soft tissue shadows were seen,with restricted diffusion and low signals on the ADC map.CT images presented with enlarged cervixes,with mixed-density cystic and solid nodules or masses,and some lesions showed"honeycomb-like"changes.Enhanced scanning showed no obvious enhancement in cystic areas or uneven enhancement in solid areas.The preoperative accuracy rate of CT/MRI diagnosis of malignant lesions was 68.7％.Conclusion Most patients have elevated tumor markers,and some have vaginal discharge/bleeding.Imaging features such as tumor prevalence in the whole cervix(including the upper part),complications with cyst-like changes,and infiltrative growth can facilitate the early diagnosis of gastric-type adenocarcinomas of the cervix.

Abstract:Objective To retrospectively analyze the ultrasound diagnosis process,clinical treatment plan,and follow-up observation results of individuals with abnormal atrial septal structure in aircrews,and to summarize theaeromedical certification conclusions.Methods A retrospective analysis was conducted on 33 male aircrews who underwent contrast transthoracic echocardiography(cTTE)and transesophageal echocardiography(TEE)in the department of ultrasound diagnosis at the Air Force Medical Center between February 2023 and August 2024.The corresponding ultrasound examination protocols and clinical management strategies tailored to different types of atrial septal abnormalities and grades of right-to-left shunt(RLS)were analyzed.Their aeromedical certification conclusions and comprehensive evaluation results were also discussed.Results The 33 cases of abnormal atrial septal structure included 2 cases of atrial septal defect(ASD),23 cases of simple patent foramen ovale(PFO),5 cases of complex PFO,2 cases of atrial septal aneurysm(ASA),and 1 case of thin atrial septum.The distribution of RLS grades on cTTE differed significantly between the resting state(Grade 0:15 cases,Grade Ⅰ:2 cases,Grade Ⅱ:10 cases,Grade Ⅲ:6 cases)and the valsalva maneuver state(Grade Ⅰ:9 cases,Grade Ⅱ:6 cases,Grade Ⅲ:18 cases)(Z=-4.756,P＜0.001).Among the 17 follow-up observers with small to moderate shunts,1 case who refused PFO closure was assessed as original aircraft qualified-unsuitable for modification,1 case who choos was assessed as atrial septal defect,and 15 cases were comprehensively evaluated as flying qualified as the shunt was deemed to have no significant clinical significance.16 cases with large shunts underwent interventional closure.The distribution of RLS grades on cTTE differed significantly immediately post-procedure(Grade 0:8 cases,Grade Ⅰ:7 cases,Grade Ⅱ:1 case),at 6 months(Grade 0:10 cases,Grade Ⅰ:6 cases),and at 12 months(Grade 0:16 cases)(Friedman x2=13.040,P=0.001).No recurrent shunt was observed in any flyinig personnel following successful closure.Based on review results,14 cases were certified as flying qualified,and 2 cases were assessed as flying not qualified.Conclusions A stepwise ultrasound examination protocol,stratified assessment of shunt severity,and close follow-up are crucial for aircrews with abnormal atrial septal structure.Corresponding safe and effective clinical management strategies should be implemented.

Abstract:Objective To explore the MRI manifestations of pseudomyomatous uterine contractions in the myometrium during pregnancy,advance our understanding of related signs,and help prevent misdiagnosis and mistreatment.Methods A retrospective analysis was conducted of 106 patients with pseudomyxomatous uterine contractions during pregnancy at Cangzhou Central Hospital between January 2018 and June 2022.The site of placental attachment,incidences of cesarean scar pregnancy,placental implantation,placental hypoplasia,placenta praevia,and the site,size and signals of pseudomyxomatous uterine contractions were recorded.Results The percentage of mid-term pregnancies was the highest(79.24％).Ninety-six cases(90.57％)had a second pregnancy or more.88 cases whose sites of placental attachment were purely anterior or close to the anterior wall was the largest(83.02％),and the percentage of scar pregnancies and non-scar ones was similar.There were 70(66.04％)cases of non-placental implantation.Contractions were located at the site or on the edge of placental attachment in 90 cases(84.91％).The pseudomyomatous uterine contractions in the myometrium mostly occurred as dome-shaped and spindle-shaped changes on imaging in 92 cases(86.79％).A statistically significant difference was observed in myometrial pseudomyomatous uterine contractions between the first and second trimesters of pregnancy.(x2=9.113,P=0.003).The incidence of pseudomyomatous uterine contractions in the myometrium was significantly higher in early pregnancy than in mid-term pregnancy among cases complicated with placental hypoplasia or placenta previa(x2=3.962,P=0.047).No statistically significant differences were observed in myometrial pseudomyomatous uterine contractions between the first and second trimesters(all P＞0.05).Conclusion In the course of early and mid-term pregnancy,the possibility of uterine pseudomyomatous uterine contractions should be taken into consideration if the myometrium shows spindle-shaped or myometrial verrucous contractions parallel to the long axis of the placenta,with or without scarred uterus and placenta implantation so as to avoid misdiagnosis of uterine myometrial pathology such as uterine fibroids or uterine adenomyosis.

Abstract:Objective To study the incidence of neck and waist diseases among military aircrews flying different types of aircraft and of different ages so as to provide a reference for the precise prevention and treatment of neck and waist diseases among aircrews.Methods By retrospectively analyzing the clinical data of 9 126 aircrews in Lintong Rehabilitation and Convalescent Center,according to different aircraft types,the aircraft(bombers and ptransport aircraft)group consisted of 2 593 aircrews,the aircraft(fighters)group consisted of 1 851 aircrews,and the aircraft(helicopters)group consisted of 4 682 aircrews,the prevalence of neck and waist diseases among these aircrews and the relationships with aircraft types and age of aircrews were studied.Results The incidence rates of neck,waist and concurrent neck and waist diseases in 9 126 aircrews were 6.99％(638/9 126),12.92％(1 179/9 126)and 2.55％(233/9 126)respectively.The top three neck diseases were neck muscle strain(276/9 126),accounting for 3.02％,cervical spondylosis(203/9 126),accounting for 2.22％,and cervical disc herniation(154/9 126),accounting for 1.69％.The top three waist diseases were lumbar disc herniation(647/9 126),accounting for 7.09％,lumbar muscle strain(441/9 126),accounting for 4.83％,and lumbar spondylolysis(42/9 126),accounting for 0.46％.In the aircraft(bombers and ptransport aircraft)groups,the prevalence of neck disease in the group of aircrews ages 30 and younger was lower than in the group ages 41 to 50(P＜0.05),and waist disease was not so prevalent in the group ages 30 and younge as in the other three age groups(all P＜0.05).In the aircraft(fighters)groups,the incidence of neck disease in the group aged 30 and younger was lower than in the other three age groups(all P＜0.05),and that of waist disease in the group ages 30 and younger was lower than in the group between the ages of 41 and 50(P＜0.05).The incidence of neck and waist disease in the group ages 30 and younger was lower than in the groups ages 31 to 40 and 41 to 50(both P＜0.05).In the aircraft(helicopters)group,the prevalence of neck,waist,and concurrent neck and waist diseases in aircrews aged 30 and younger was lower than in the other age groups(all P＜0.05).Neck disease was more common in the aircraft(fighters)group than in the aircraft(bombers and ptransport aircraft)groupand aircraft(helicopters)group(both P＜0.05).There was no significant difference in the incidence of waist disease between aircrews of different aircraft types(all P＞0.05).The incidence of neck and waist disease in the aircraft(fighters)group was higher than that in the aircraft(bombers and ptransport aircraft)group and the aircraft(helicopters)group(both P＜0.05).Conclusion The incidence of neck,waist and concurrent neck and waist diseases in aircrews of the same type of aircraft in the group ages 30 and younger is lower than in the other age groups.After the age of 30,these diseases become more common with the increase of flight time.Aviation security personnel should take precautions according to age and types of aircraft and get treated as early as possible to keep their necks and waists healthy.