Abstract:Objective To investigate the clinical efficacy of autologous osteochondral transplantation for treating large osteochondral lesions of the talus(OLT)in pilots and the principles of aeromedical assessment.Methods The clinical data of 6 pilots with Hepple type Ⅴ OLT treated at the Air Force Medical Center between May 2016 and May 2022 was retrospectively analyzed.All these pilots underwent exposure of the talar osteochondral injury lesion through an internal malleolar osteotomy approach,and multi-column mosaic-style transplantation repair was performed using autologous osteochondral transplantation devices to harvest non-weight-bearing articular surface osteochondral columns from the lateral condyle of the ipsilateral femur.Anteroposterior X-ray of the ankle joint,CT,and MRI were used to assess the severity of talar osteochondral injury and the healing of the cartilage transplantation area.The Lysholm knee joint score,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,and Visual Analog Scale(VAS)were used to evaluate the knee joint function,ankle joint activity,and pain conditions of the pilots before surgery and during follow-up(3 months and 6 months postoperatively).Results Radiographs(anteroposterior/lateral),CT,and MRI at 3 and 6 months postoperatively confirmed healing of the medial malleolar osteotomy site and excellent integration of the osteochondral grafts with a smooth articular surface.No complications,such as wound infection or nonunion of the osteotomy,occurred during follow-up.Knee joint function at 3 and 6 months postoperatively was not significantly different from the preoperative levels(F=0.294,P=0.611).VAS scores significantly improved at both 3 and 6 months postoperatively(both P＜0.001).AOFAS ankle-hindfoot scores also significantly improved during the two follow-ups(both P＜0.001).The AOFAS score at 6 months postoperatively was significantly higher than at 3 months postoperatively(P=0.004).All the pilots were assessed as eligible for flight at 6 months postoperatively.Conclusion Autologous osteochondral transplantation for treating Hepple V-type talar osteochondral injuries in pilots can significantly relieve pain and improve ankle joint function without affecting the function of the knee joint in the area where the osteochondral graft is taken.It is more appropriate for pilots with talar osteochondral injuries to be permitted to return to duty at 6 months postoperatively.

Abstract:Objective To compare the results of vestibular function tests conducted on pilots before and after the COVID-19 pandemic and analyze the possible causes of vestibular dysfunction in order to provide data for aeromedical assessment.Methods The medical records of 60 pilots who underwent vestibular function tests at the Air Force Medical Center between 2016 and 2023 were reviewed.The data of pilots diagnosed with unilateral vestibular dysfunction for the first time was selected.January 1,2020 was taken as the day the COVID-19 pandemic broke out.Among the 60 cases,51 were diagnosed after this date and assigned to the study group,and 9 were diagnosed before this date and served as the control group.Clinical features of these cases were statistically analyzed.Results The proportion of the study group in all pilots tested during the same period was significantly higher than that of the control group(χ2=4.284,P=0.038).In the study group,47 had no vestibular-related symptoms,but 4 did.In the control group,3 had no vestibular-related symptoms,but6did.The proportion of cases without vestibular-related symptoms was significantly higherin the study group(χ2=15.059,P＜0.001).There was no statisticallysignificant difference between the two groups in the distribution of the abnormal tests.When diagnosed for the first time,41(80%)were assessed as qualified for flight and 6(12%)were temporarily grounded in the study group,compared with 3(33%)and 5(56%)in the control group.The qualified rate of the study group was significantly higher than that of the control group(χ2=6.424,P=0.011),while the proportion of temporarily grounded pilotsin the study group was significantly lower(χ2=7.092,P=0.008).Conclusion The increase of asymptomatic cases of unilateral vestibular dysfunction in pilots may be related to infections with low-virulent strain of SARS-CoV-2 or vaccination.The damage to vestibular function is mild,and detailed classification and aeromedical assessment can be carried out according to vestibular receptor diseases(VRDs).

Abstract:Objective To explore the heart rate(HR),moods and changes of indicators of heart rate variability(HRV)of fighter pilots during simulated training for ejection survival in order to provide data for well-designed and effective training.Methods The changes in electrocardiograms(ECGs),moods,and blood pressure before and after training among 36 fighter pilots were recorded during two sessions of simulated training for ejection escape and across three phases of ejection(pre-ejection,during ejection,and post-ejection).For ECG data,HRV was recorded,including the standard deviation of normal R-R intervals(SDRR),total power(TP),low frequency(LF),high frequency(HF)and HR.The results of the questionnaire were analyzed.Results In the first session of ejection escape training,only 13.89%of the pilots were rated as excellent,and one pilot failed the training.In the second session,the excellent rate was 83.33%,and the results of training evaluation were all good or better.Analysis of changes in HR and moods before,during and after the two ejection escape training sessions suggested that in the second ejection survival training session,72.22%of the subjects scored lower than 3 points in terms of stress while 91.67%scored 4 points or higher in confidence.The difference was not statistically significant(P＞0.05).The results of repeated measures analysis of variance of the changes of HRV before,during and after the two sessions showed that there were statistically significant differences in the subjects'HRV,including SDRR(H=41.016,P＜0.001),TP(H=50.265,P＜0.001),and LF(H=6.316,P=0.006)across training stages.Conclusion Simulated training for ejection escape is effective in improving pilots'emergency response and increasing their confidence during ejection escape.

Abstract:Objective To analyze the clinical effects of pelvic floor muscle training combined with regular schedule guidance in patients with urinary incontinence after prostatic hyperplasia surgery.Methods A total of 150 patients with urinary incontinence after transurethral prostatectomy treated in our hospital between December 2022 and December 2024 were selected and divided into a control group(n=75)and a study group(n=75)using the random sampling method.The control group was subjected to bladder function training while the study group underwent pelvic floor muscle training combined with guidance on regular schedules.The efficacy,scores of the International Consultation Incontinence Questionnaire-Short Form(ICIQ SF),number of times of urine leakage,negative emotions,Chronic Prostatitis Symptom Index(NIH-CPSI),scores of the Visual Analogue Scale(VAS)and Pain Perception Index(PPI)were compared between the two groups.Results The effective rate of treatment in the study group was higher than in the control group(χ2=8.963,P=0.003).After treatment,the ICIQ-SF score and the number of times of urine leakage were lower in the study group than in the control group(t=14.208,9.319,both P＜0.001),so were the scores of the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)(t=3.060,3.570,P=0.003,0.001).The scores of NIH-CPSI,VAS and PPI in the study group were also lower(t=6.408,2.684,9.826,P＜0.001,=0.008,＜0.001).Conclusion The application of pelvic floor muscle training combined with regular schedule guidance in patients with urinary incontinence after transurethral prostatectomy can help reduce the number of times of urine leakage,improve negative emotions and alleviate pain.

Abstract:Objective To explore the applicability of three types of irrigations in the root canal therapy of pulpitis.Methods Ninety-three patients with pulpitis treated in the Department of Stomatology,North District of the First Affiliated Hospital of Anhui Medical University,between January 2021 and June 2023 were selected as the subjects,who were randomized into the observation group A(n=31),observation group B(n=31)and control group(n=31)using the random number table method.During root canal preparation,patients in group A were given 3%sodium hypochlorite irrigation,those in group B 1%sodium hypochlorite irrigation,and those in group C 3%hydrogen peroxide irrigation.The number of root canal bacterial colonies and the endotoxin contentin the affected teethbefore and after root canal preparationusingt heirrigationsolutions,the levels of matrix metalloproteinase(MMP)-2,MMP-8 and MMP-9 levels in root canal exudates.Inflammatory cytokines(IL-8,TNF-α)in gingival crevicular fluidbefore using theirrigationsolutionsandat 1-weekafter using theirrigationsolutions.Occlusal pain(VAS scores)before using the irrigationsolutions and at 24 h,48 h,and 1-week after using the irrigationsolutions.Treatment success rates were assessed after 1-year follow-up.Results After using the flushing solution,the bacterial count and endotoxin content in the root canal of Group A were lower than those of Group B and Group C.The levels of MMP-2 and MMP-8 in Group A were lower than those in Group B and Group C.The levels of MMP-9 in Group A were lower than those in Group B and Group C,and the differences were statistically significant(all P＜0.001);After using the flushing solution for one week,the IL-8 level in group A was lower than that in group C(P=0.007),and the TNF-α level was lower in group A than in group B than in group C,with statistically significant differences(P＜0.05);After using the flushing solution for 24 hours,48 hours,and 1 week,Group A＜Group B＜Group C,and the differences were statistically significant(P＜0.01).After a one-year follow-up,the success rates of Group A,Group B,and Group C were 96.55%(28/29),76.92%(20/26),and 75.00%(18/24),respectively,with no statistically significant difference between the groups(P=0.079).Conclusion In root canal therapy of pulpitis,sodium hypochlorite irrigations can more effectively reduce the number of root canal bacterial colonies and lower the endotoxin content.Meanwhile,3%sodium hypochlorite irrigation can inhibit the expressions of matrix metalloproteinases and inflammatory factors,relieve pain after treatment and enhance the success rate of treatment,making it the preferred option for root canal irrigations.The overall curative effect can help optimize the treatment process of pulpitis.Future research can explore the concentration gradient effect and the association with long-term prognosis.

Abstract:Objective To investigate the effects of serum total bilirubin(STB)and alanine aminotransferase(ALT)on blood lipids and the incidence of fatty liver among aviators.Methods A total of 1,318 flight personnel who underwent medical evaluation at Guilin Rehabilitation and Recuperation Center between January 2021 and January 2024 were selected and divided into three groups based on types of aircraft:the fighter jet group(581 cases),transport aircraft group(376 cases),and helicopter group(361 cases).The detection rates of related diseases and abnormal indicators were analyzed under different levels of STB and ALT across the three groups.Results Significant differences were observed in the detection rates of fatty liver between the three groups(χ2=7.820,P=0.021),with a notable difference between the fighter jet group and the helicopter group(χ2=7.424,P=0.006).The detection rates of elevated HDL-C also differed significantly(χ2=9.208,P=0.010),particularly between the fighter jet group and the other two groups(χ2=6.050,6.029,P=0.014,0.014).Total cholesterol(TC)levels were significantly different between the three groups(F=6.307,P=0.002),with a marked difference between the fighter jet group and the helicopter group(P=0.002).There were significant differences in HDL-C levels between these groups(F=3.987,P=0.019),especially between the fighter jet group and the transport aircraft group(P=0.025).A comparison of incidences of lipid metabolism disorders between elevated STB levels and normal ones suggested that the detection rates of high levels of TG were significantly different between the transporter aircraft group and the helicopter group(χ2=4.704,11.446,P=0.030,0.001),and that the detection rates of fatty liver(χ2=4.762,P=0.031)and abnormalities of low-density lipoprotein cholesterol(LDL-C)(χ2=14.23,P=0.001)were significantly different in the fighter jet group.The comparison of incidences of lipid metabolism disorders between elevated and normal ALT levels showed that the levels of TG differed significantly between the three groups(Z=3.638,2.509,5.515,P=0.001,0.012,0.001).The differences in TC levels of the fighter jet and helicopter groups,HDL-C levels of the transport aircraft group,LDL-C levels of the helicopter group were of statistical significance(t=2.850,3.297,2.107,2.617,P=0.005,0.001,0.036,0.009).Conclusion Fighter crews have better lipid profiles than transport and helicopter crews.Moderate SSTB levels may reduce hypertriglyceridemia and fatty liver risks while elevated ALT levels are associated with increased risks.

Abstract:Objective To find out about cerebrovascular diseases in aircrews/flight cadets and clinical imaging characteristics.Methods A study was conducted on 13 aircrews admitted to a medical center between December 2020 and April 2024 for diagnosis and treatment of cerebrovascular diseases.Descriptive statistical analysis was conducted of their clinical data,types of aircraft,head MRI data,treatments and follow-up.Results Among the 13 cases,there were 9 flight cadets,3 pilots,and 1 air combat service personnel.All were diagnosed with cerebrovascular diseases through 3.0 T cranial MRI,including 7 cases of microaneurysms,4 cases of cavernous hemangiomas,and 2 cases of other vascular abnormity.Two cases underwent surgical treatment,while the rest showed stable conditions through medical follow-up.After discussion,the Medical Appraisal Committee has decided:One air combat personnel resumed flight after surgery.Two pilots converted to dual-seat fighter jets,two pilots to transport planes,three pilots to helicopters and one pilot to air combat personnel.Four cases were deemed unqualified for flight.Conclusion The medical identification requirements for cerebrovascular diseases in flight cadet selection and single-seat aircraft pilots should be strictly controlled.For pilots who are asymptomatic and have a low probability of bleeding,they can be transferred to multi-seat aircraft with lower loads,and relevant cranial MRI examination items should be strengthened during medical follow-up.The high-resolution magnetic resonance imaging(MRI)screening of the head of pilots can help detect and treat cerebrovascular diseases early,thereby contributing to flight safety.

Abstract:Objective To observe the effect of tiotropium bromide combined with inhaled glucocorticoids on lung function, FeNO and immune function in patients with asthma-chronic obstructive pulmonary disease (ACOS) overlap syndrome.Methods One hundred and eighteen patients with ACOS were selected as subjects and were equally divided into the observation group and control group by the random number table method. Both groups were treated with budesonide powder inhalation, but the observation group was additionally treated with tiotropium bromide dry powder capsules. The clinical effect, pulmonary function indexes [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the percentage of forced expiratory volume in forced vital capacity (FEV1/FVC), FeNO], serum inflammatory factors [interleukin (IL-6), tumor necrosis factor alpha (TNF-α), immune function indexes (Th1 and Th2 cell subsets) and scores of asthma symptom (ACT) and chronic obstructive pulmonary disease symptoms (CAT) before and after treatment were compared between the two groups.Results The total effective rate in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the improvement of FVC, FEV1, FEV1/FVC and FeNO in the observation group was more significant than that in the control group (t=9.785, 7.537, 11.045 and 3.037, P<0.05). The expression levels of IL-6 and TNF-α in the observation group were significantly lower than those in the control group (t=4.568 and 2.835,P<0.05). The immune indexes (Th1, Th2, Th1/Th2) and improvement of CAT and ACT scores in the observation group were significantly better than those in control (t=14.192, 2.222, 12.692 and 8.565, 7.863, P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.778,P<0.05).Conclusion Tiotropium bromide combined with inhaled glucocorticoids can significantly relieve the clinical symptoms of patients with ACOS and improve lung function and immune function in patients. This approach is more effective than inhalation of glucocorticoids alone, without increasing adverse reactions.

Abstract:Objective To analyze the risk factors for new fractures after vertebroplasty for osteoporotic vertebral compression fractures in the elderly. Methods The clinical data of 88 elderly patients with osteoporotic vertebral compression fractures who had undergone vertebroplasty in our hospital between April 2013 and March 2017 was analyzed retrospectively. According to the presence of new fractures, the patients were divided into the fracture group (33 pepole) and non-fracture group (55 pepole). The demographic data, past history, general information on fractures and operations were collected. The risk factors of new fractures after vertebroplasty for osteoporotic vertebral compression fractures in the elderly were screened by Logistic regression analysis. Results Among the 88 elderly patients with osteoporotic vertebral compression fractures after vertebroplasty, there were 33 cases with non-operative new vertebral fractures, and the incidence was 37.50%. There was significant difference between the fracture group and the non-fracture group in the long-term use of glucocorticoids, bone mineral density, the number of fractured vertebral bodies before surgery, the number of operated vertebral bodies, the fracture compression rate, the recovery rate of vertebral body height, the number of enhanced vertebral bodies and the proportion of bone cement vertebral disc leakage(P<0.05). Long-term use of glucocorticoids, bone mineral density, the number of fractured vertebral bodies before surgery, the number of operated vertebral bodies, the number of enhanced vertebral bodies and bone cement vertebral disc leakage were risk factors for new fractures after vertebroplasty of osteoporotic vertebral compression fractures. Conclusion There is an obvious correlation between new fractures and long-term use of glucocorticoids, the number of fractured vertebral bodies before surgery, the number of enhanced vertebral bodies and bone cement vertebral disc leakage in elderly patients with osteoporotic vertebral compression fractures after percutaneous kyphoplasty(PKP). Positive control of the risk factors can reduce the risk of refracture after surgery.

Abstract:Objective To find out about the physical and mental health of flight personnel with ulcerative colitis and to explore the influence of nursing intervention on the physical and mental health of flight personnel with ulcerative colitis under the guidance of IMCHB.Methods Cornell Medical Index(CMI)was used to investigate the physical and mental health of 47 cases of flight personnel with ulcerative colitis upon admission to and discharge from the hospital. Such interventions as psychological nursing, medication instructions, dietary guidance, close observation and health advice under the guidance of IMCHB. The average scores of each item of CMI, those of physical and psychological items and those of the eighteen factors ranging from A to R were compared.ResultsThe incidence of physical and mental symptoms among these 47 cases detected upon admission declined compared with the time of discharge and the difference was statistically significant. There was significant difference between the scores of Item D (the digestive system), Item L (habits), Item M (inadaptability), Item Q (anger) (P<0.001), Item I (fatigue) (P<0.05), and Item O (anxiety) (P<0.05).Conclusion The flight personnel with ulcerative colitis has different psychological and physical qualities. More attention should be paid to their well-being. The whole-process nursing interventions to the 47 cases of flight personnel with ulcerative colitis under the guidance of IMCHB have a positive effect on their physical and mental health by improving their quality of life and flight stamina.