Abstract:Objective To analyze the low-dose chest CT examination results of fighter pilots and provide data for related aeromedical assessments.Methods A retrospective analysis was conducted of the results of low-dose chest CT scan and of the data on aeromedical assessments of fighter pilots who underwent health checkups between April 2023 and December 2024 at the 983rd Hospital of the Joint Logistic Support Force.These pilots were divided into a group ages 20 to 29,a group ages 30 to 39 and a third group ages 40-49.The differences in examination results between different age groups were analyzed before critical considerations were identified for aeromedical assessments.Results The results of low dose chest CT screening of 385 fighter pilots revealed no obvious abnormalities in 294 cases(76.36％),pulmonary nodules in 50 cases(12.99％),pulmonary bullae in 34 cases(8.83％),tracheal diverticula in 9 cases(2.34％),mediastinal nodule in 5 cases(1.30％),and esophageal dilatation with food retention in 2 cases(0.52％).There were statistically significant differences in the detection rates of no obvious abnormalities,pulmonary nodules,and pulmonary bullae between these age groups(x2=14.674,9.193,7.868,P＜0.001,=0.010,=0.020).Fewer significant abnormalities were observed in the 30-39-year-old group than in the 40-49-year-old group(P＜0.05).More pulmonary nodules and pulmonary bullae were detected in the group ages 40 to 49 than in the other two age groups(all P＜0.05).However,there was no statistically significant difference in the detection rates of tracheal diverticulum,esophageal dilation or mediastinal nodules between these groups(all P＞0.05).Three cases were temporarily grounded due to pulmonary nodules,and another 4 cases due to pulmonary bullae,accounting for 7.69％(7/91)of the abnormal results.Conclusion The application of low dose chest CT examination in health checkups of fighter pilots can help detect chest diseases early,treat them quickly,and draw more convincing conclusions about aeromedical assessments.

Abstract:Objective To explore the changes and significance of exercise cardiopulmonary indexes of pilots with reduced left ventricular diastolic function.Methods Thirty pilots with reduced left ventricular diastolic function were selected as the study group while another 30 healthy pilots served as the control group.Both groups underwent exercise cardiopulmonary function tests.The indexes of echocardiography in the resting state as well as the maximum exercise power,respiratory reserve,stroke output,post-exercise recovery heart rate,maximum kilogram oxygen uptake,estimated maximum oxygen uptake,metabolic equivalent,peak heart rate and oxygen pulse in exercise cardiopulmonary function tests were recorded.Results There were statistically significant differences in maximum motion power,respiratory reserve,stroke volume,rates of heart rate recovery two minutes and three minutes after exercise between the two groups(t=2.019～3.740,all P＜0.05).The maximum kilogram oxygen uptake was positively correlated with the rate of heart rate recovery two minutes and three minutes after exercise(r=0.558,0.457,P=0.001,0.011).The case was the same with the left ventricular end diastolic diameter,left atrial anterior posterior diameter,left ventricular ejection fraction,and Tei index(t=3.179～9.617,P=0.002 or＜0.001).Conclusion Pilots with reduced left ventricular diastolic function may be vulnerable to changes in exercise cardiopulmonary function and to abnormal regulation of the autonomic nervous system in the early stage.The rate of heart rate recovery two and three minutes after exercise can reflect the ability of autonomic nerves for regulation and aerobic exercise,which can be used to serve pilots'physical training and prescriptions for exercise.

Abstract:Objective To evaluate the effects of butylphthalide combined with tenecteplase on levels of serum sST2 and other cytokines as well as on neurological functional outcomes in patients with acute ischemic stroke.Methods A prospective study was conducted on 108 acute ischemic stroke(AIS)patients eligible for intravenous thrombolysis treated between June 2023 and June 2024 at the Third Department of Critical Care Medicine.Using a random number table method,these patients were assigned to two groups:the butylphthalide group(n=54,tenecteplase+butylphthalide)and the control group(n=54,tenecteplase alone).Serum levels of soluble suppression of tumorigenicity 2(sST2),matrix metalloproteinase-9(MMP-9),interleukin-6(IL-6)and high-sensitivity C-reactive protein(hs-CRP)were measured before treatment(post-thrombolysis)and 14 days after treatment.Neurological function was assessed using the National Institutes of Health Stroke Scale(NIHSS),functional prognosis was assessed by the Modified Rankin Scale(mRS)and such complications as intracranial hemorrhage were recorded.Results The NIHSS scores of both groups kept decreasing at 24 hours,7 days,and 14 days after treatment(all P＜0.001).At 14 days post-treatment,neurological recovery in the butylphthalide group was better than in the control group(P=0.011).In addition,more patients in the butylphthalide group had favorable short-term(14-day)neurological outcomes(mRS≤2)than in the control group(χ2=4.123,P=0.042).During the long-term follow-up(90 days),the rate of favorable functional outcomes(mRS≤2)was higher in the butylphthalide group than in the control group(χ2=4.160,P=0.041).No statistically significant difference was observed in the incidence of hemorrhagic transformation between the two groups(P＞0.05).At 14 days post-treatment,the levels of the cytokines sST2,MMP-9,IL-6,and hs-CRP in the butylphthalide group were significantly lower than in the control group(Z=2.173～3.160,all P＜0.05).Conclusion Butylphthalide combined with tenecteplase can effectively mitigate inflammatory responses in AIS patients,significantly reduce serum levels of sST2 and related pro-inflammatory factors while promoting neurological recovery without increasing hemorrhagic risk.

Abstract:Objective To investigate the effect of doses of radioactive iodine-131(131I)therapy on survival and quality of life of patients with differentiated thyroid cancer(DTC).Methods The clinical data of 126 DTC patients who received 131I treatment after total thyroidectomy between 2017 and 2020 at Quanzhou First Hospital was retrospectively analyzed.The patients were divided into group A(53 patients,1.1 GBq),group B(45 patients,3.7 GBq),and group C(28 patients,5.5 GBq)according to the dose of 131I treatment before the clearance rate of residual thyroid tissue,the incidence of tumor recurrence or metastasis,adverse reactions,overall survival(OS),disease-free survival(DFS)and scores of quality of life were compared.Results There were no statistically significant differences in the clearance rate of thyroid residual tissue or the incidence of tumor recurrence or metastasis between the three groups(P＞0.05).The incidence of hematologic adverse reactions in Group C was higher than in Groups A and B(all P＜0.05).Multivariate analysis showed that the 131I dose(HR=1.989,95%CI=1.029～3.845)and age(HR=1.080,95%CI=1.008～1.157)were risk factors for the survival curve.Postoperative complications(HR=0.066,95%CI=0.014～0.301)was protective factor for the survival curve.The SF-36 scores of group A were higher than those of groups B and C(P=0.046,P＜0.001),and higher in group B than in group C(P=0.020).EQ-5D scores were higher in Group A than in Group C(P=0.002).The levels of thyroglobulin(Tg),thyroglobulin antibody(TgAb),thyroid stimulating hormone(TSH),and parathyroid hormone(PTH)in Group B were lower than in Groups A and C(P＜0.001 or P＜0.05).Conclusion In patients with DTC,the dose of 131I therapy should be chosen based on the individual patient's condition.Too high a dose may increase the risk of adverse effects,lower the patient's quality of life,and impact the patient's physical,psychological,and social functioning.

Abstract:Objective To analyze the outcomes of surgical treatment and resumption of flight among surgically hospitalized pilots in order to find out about the characteristics of pilots with different re-flight outcomes.Methods A total of 202 pilots who underwent surgical treatment at the Air Force Medical Center between January 1,2012,and May 22,2023 were selected.Based on the results of aeromedical assessments,they were divided into a flight qualified group(186 cases)and an unqualified group(16 cases).The basic information,surgical approaches,and final results of qualification assessments were compared between the two groups.Results In terms of departments where these pilots were hospitalized,the flight qualified group was primarily treated in departments of general surgery,thoracic surgery,and otolaryngology,and the unqualified group in departments of orthopedics and neurosurgery(P=0.009).The median length of hospital stay was 14.50(10.00,22.00)days in the flight qualified group,compared with 23.00(16.25,29.00)days in the unqualified group(Z=-2.817,P=0.005).After surgery,the proportion of patients transferred to the ICU in the unqualified group was higher than in the flight qualified group(P=0.017).The average surgical duration of the unqualified group was 110.00(62.50,195.00)minutes,compared with 60.00(38.50,100.00)minutes in the flight qualified group(Z=-2.413,P=0.016).Conclusion There are significant differences between pilots with different re-flight outcomes.These differences may be indirectly affects their eligibility for re-flight.

Abstract:Objective To analyze the changes in indicators of heart rate variability of pilots and cadets before,during,and after flights in order to provide data for analysis of psychological stress and for safety assurance during flight training.Methods Forty-two male pilots and cadets were selected for collection of physiological data during flights,with electrocardiogram(ECG)parameters recorded.Results The differences in heart rate,low frequency(LF),high frequency(HF),and the ratio of low to high frequency(LF/HF)of pilots during non-training periods and before,during,and after flight training were statistically significant(F=4.791～31.909,P＜0.05).During daily flight training,heart rate,LF,and LF/HF of pilots increased(P＜0.001,=0.001,0.004)while HF decreased(P=0.001).The differences in the standard deviation of normal-to-normal intervals(SDNN)and the root mean square of successive differences of RR intervals(RMSSD)before,during and after flight training between cadets were also of statistical significance(F=6.479,8.005;P=0.005,0.002).During daily flight training,the RMSSD decreased(P=0.008).Conclusion The heart rate and frequency domain indicators of pilots change significantly during flight training,so do the time domain indicators of cadets,which can provide a reference for aviation health and safety assurance of pilots and flight cadets during flight training.

Abstract:Objective To explore the stress changes in cervical disc structures and balance-related components following vertebral displacement in cervical spondylosis patients,and the potential mechanisms underlying symptom relief after manual reduction.Methods A healthy female volunteer underwent thin-slice computed tomography(CT)scanning of the entire cervical spine.From these CT images,a bone model was extracted,and subsequent modeling of soft tissues culminated in the completion of a cervical spine FEA model.The model's validity was rigorously evaluated through comparison with the literature currently available.With the Z-axis rotational degrees of freedom(DOF)of the upper surfaces of C4,C5,and C6 vertebrae fixed,simulation mimicking changes in spinal mechanical environment after vertebral displacement were observed.Specifically,the lower surface of the C7 vertebral body was constrained,and a 73.6 N follower load was applied to the upper surface of the C3 vertebral body.Under leftward rotation conditions,the peak stress and distribution patterns in zygapophysial joint and intervertebral discs were meticulously analyzed.Results A finite element model of the C3-C7 cervical spine was established,incorporating a total of 20 ligament groups across five types:the anterior longitudinal ligament(ALL),posterior longitudinal ligament(PLL),ligamentum flavum(LF),supraspinous ligament(SL),and interspinous ligament(IL).The vertebral bodies were primarily composed primarily of tetrahedral elements,while the intervertebral discs and facet joints were primarily modeled with hexahedral elements.The entire model consisted of 351 188 nodes and 183 241 elements.The average range of motion of each segment of the model was basically consistent with the results of published research data.When the Z-axis rotational degrees of freedom of the upper surfaces of the C6,C5,and C4 vertebrae were fixed successively,the peak stress of the bilateral facet joints and intervertebral discs changed significantly compared with the untreated group.The peak stress of the bilateral facet joints of C3-C4 in the C5 fixation group decreased slightly compared with the untreated group,while the peak stress of the bilateral facet joints of C4-C5 increased significantly.Under other conditions,compared with the untreated group,the overall stress of the facet joints below the fixed segment decreased compared with the untreated group,while the overall stress above the fixed segment increased.The peak stress and distribution characteristics of the bilateral facet cartilage from C3 to C7 were mainly concentrated on the opposite side of rotation,with the right cartilage of C3-C4 as the stress concentration point.The peak stress and distribution characteristics of the intervertebral discs from C3 to C7 were mainly concentrated on C4-C5,but after fixing the Z-axis degree of freedom of the upper surface of C4,the peak stress of the intervertebral discs became C3-C4.Conclusion The reduction in rotational degrees of freedom caused by vertebral displacement can lead to obstruction to of biomechanical transmission throughout the cervical spine.The range of motion in the segments below the affected vertebra decreases,while the segments above the affected vertebra compensate by increasing their range of motion to accomplish the overall coupled movement of the cervical spine.This compensatory mechanism accelerates the degeneration of the segments above the affected vertebra.

Abstract:Objective To construct a risk prediction model for central lymph node metastasis(CLNM)in patients with papillary thyroid carcinoma(PTC)based on contrast-enhanced ultrasound(CEUS)parameters.Methods A total of 105 patients with PTC and treated in Tangshan People's Hospital between January 2022 and March 2023 were selected,and the incidence of CLNM was statistically analyzed.The patients were divided into the CLNM group and non-CLNM group.The basic information,indicators of laboratory tests,and CEUS parameters were compared between the two groups.The contributors to CLNM in patients with PTC were analyzed using a Lasso-Logistic regression model.The predictability and utility of the model were evaluated via the receiver operating characteristic curve and decision curve analysis.Results The incidence of CLNM in these PTC patients was 48.57%(51/105).The proportion of female patients,age,proportion of multiple lesions,maximum lesion diameter,scores of the thyroid imaging reporting and data system(TI-RADS),serum thymidine kinase 1(TK1)levels,gene expressions of targeting protein for Xklp2,C-X-C chemokine receptor 4(CXCR4),and those of a disintegrin and metalloproteinase 9(ADAM9)in cancer tissues in the CLNM group were higher than in the non-CLNM group(t/χ2=2.282～12.302,all P＜0.05).The serum levels of microRNA-363(miR-363)and microRNA-1296(miR-1296),gene expressions of microRNA-1243(miR-1243)and protein phosphatase 4 regulatory subunit 1,time to peak(TTP),peak intensity(PI),and mean transit time(MTT)were lower or shorter than in the non-CLNM group(t/χ2=5.914～8.638,all P＜0.001).The score of TI-RADS,TK1,miR-363,miR-1296,miR-1243,CXCR4,ADAM9,TTP,PI and MTT could make a difference in CLNM among PTC patients(OR=0.267～3.124,all P＜0.05).A risk prediction model of CLNM nomograms was constructed,and_Bootstrap internal validation showed that the area under the curve(AUC)of the model forpredicting CLNM in PTC patients was 0.915(95%CI:0.884～0.917);the decision curve(DCA)showed that the model had good clinical utility in predicting the risk of CLNM.The calibrationcurve showed that the coincidence between the observed value and the predicted value of thecalibration curve of the modcl was good.Conclusion The risk prediction model of CLNM nomograms based on CEUS parameters in PTC patients can well predict the risk of CLNM and promises wide clinical applications.

Abstract:Objective To investigate the factors influencing the efficacy of treatment for unilateral sudden deafness.Methods A total of 304 patients with unilateral sudden deafness admitted to the Department of Otolaryngology,Heze Municipal Hospital,from January 2022 to May 2024 were selected.The treatment efficacy rates were compared under different clinical characteristics.Multivariate logistic regression analysis was used to analyse the impact of clinical characteristics on treatment outcomes in patients with unilateral sudden deafness,and the total scores of the Symptom Checklist 90 were compared before and after treatment.Results There were statistically significant differences in treatment efficacy rates among patients with different disease durations,audiogram types,and the presence or absence of anxiety and depression(χ2=7.293,23.198,10.743,P=0.001,＜0.001,=0.001).The results of the multivariable logistic regression analysis showed that disease duration(OR=3.669,95%CI:1.322～10.177),hearing curve(OR=2.878,95%CI:0.273～30.284),and anxiety/depression(OR=2.846,95%CI:1.177～6.879)were identified as factors influencing treatment efficacy in patients with unilateral sudden sensorineural hearing loss.After 2 weeks of treatment,the total Symptom Checklist 90 score was higher than before treatment,with a statistically significant difference(t=43.504,P＜0.001).Conclusion The factors influencing the efficacy of treatment for unilateral sudden deafness are duration of illness,type of audiometric curve,and anxiety and depression.Therefore,these factors should be prioritised in clinical treatment.

Abstract:Objective To analyze the clinical characteristics of adult onset Still's disease(AOSD)in order to improve the diagnostic accuracy and therapeutic effect and reduce the incidence.Methods The clinical data of 37 inpatients with adult-onset Still's disease admitted to Air Force Medical Center in 2021-2024 was collected and analyzed retrospectively.Results Thirty-four patients received blood cultures while another 30 patients underwent bone marrow puncture to rule out the possibility of infections or tumors.There was fever in 35 cases,rash in 31 cases,arthralgia in 28 cases,muscle pain in 25 cases,pharyngeal pain in 19 cases,itching in 19 cases,swollen lymph nodes in 15 cases and an enlarged spleen in 1 case.According to laboratory indicators,there were 25 cases whose white blood cells exceeded10×109/L,23 cases of liver dysfunction,33 cases of negative rheumatoid factors,and 32 cases of negative antinuclear antibodies.Two cases were not treated symptomatically.Only NSADs were used in 3 cases.while compound glycyrrhizin injection alone was used in 5 cases.Glucocorticoids were used in 27 cases,immunosuppressors combined with glucocorticoids in 4 cases,and IVIG in 2 cases.Two cases were complicated with macrophage activation syndrome,who were treated with high-dose glucocorticoids and IVIG.Conclusion The main manifestations of AOSD are fever,rash,joint pain,muscle pain,sore throat and itching.Specific laboratory indicators for diagnosis of AOSD are still lacking.Glucocorticoids are the first-line treatment of AOSD.In severe cases,immunosuppressants and IVIG can be added for treatment.

Abstract:Objective To simulate the night myopia experience of flight personnel on the ground,analyze the causes of night myopia,evaluate and verify the night myopia experience and the training effect of overcoming night myopia,and provide data basis for further standardizing night myopia experience in night vision training.Methods The new T2/YSX-1 night vision physiological experience training equipment was used to conduct night myopia experience training for flight personnel participating in annual physical examination,and overcome training through blinking and eye saccades.Training data were collected to compare the differences in night myopia simulation training for flight personnel of different ages and flight positions.Results A total of 62 people participated in the night myopia experience and overcoming training,all of them showed night myopia.In the night myopia training,6 people were excellent,5 people were good,and 39 people were qualified,with a pass rate of 80.65%.Fisher exact test was carried out on the results of flight personnel of different ages and different positions to overcome the night close training,and there was no statistical significance.The flight personnel of different ages and different positions showed the same training effect.(Results of night myopia simulation training for flight personnel of different ages:(Results of night myopia simulation training for flight personnel of different ages:P=0.542;Results of night myopia simulation training for flight personnel of different positions:P=0.441).Conclusion This training verifies that providing effective visual stimulation through blinking and eye saccades is an effective method to overcome night myopia,and provides data basis for standardizing night myopia experience and training of flight personnel in night vision training.