长新冠是一种与感染相关的慢性疾病，个体化、多学科协作的综合康复是长新冠的重要治疗方法。为促进长新冠的康复，由中国康复医学会居家康复专委会发起，空军特色医学中心具体承担制定任务，依据《世界卫生组织制订手册》、采用GRADE方法，组建了多学科指南工作组，遴选出长新冠诊断、康复评价与治疗的16个相关问题，并提出相应建议。

日益复杂的作战环境和任务要求让飞行人员承受着更大的身心压力，心理应激已成为影响飞行安全和任务执行的重要因素。每个应激源都会引发不同的身心反应，飞行人员个体的特殊性决定了应激外在表现形式、持续时间和强度方面的不同，因此针对性的干预措施非常重要。笔者梳理总结了飞行人员心理应激的影响因素、心理干预的介入时机和干预措施，并对未来的研究方向提出建议。

Objective To investigate the incidence of asthenopia among operators of medium and large-sized unmanned aerial vehicles（UAVs）in the Air Force and analyze its influencing factors. Methods A cross-sectional study was carried out. The Asthenopia Survey Scale（ASS）were used to survey 78 operators of medium and large-sized UAVs from the Air Force Units stationed in plateau areas in 2024. Based on the ASS scores, the subjects were divided into 2 groups: the asthenopia group（total score ≥15 points）and the non-asthenopia group（total score <15 points）. The occurrence of asthenopia was analyzed, and univariate analysis and multivariate Logistic regression were used to identify the influencing factors of asthenopia. Results A total of 76 valid questionnaires were collected. Among the subjects, 22 operators had asthenopia（total score ≥15 points）, resulting in an asthenopia incidence rate of 28.95%. Among all items in the scale, 8 items had a detection rate of ≥80%, which were as follows: Item A: "Do you have symptoms of asthenopia"（90.90%）; Item B: "Does asthenopia affect your study, work, or life"（81.82%）; Item 1: "Do you feel discomfort around the eyes"（95.45%）; Item 2: "Do you have dry eyes"（95.45%）; Item 3: "Do you have eye pain such as stabbing pain or distending pain"（86.36%）; Item 5: "Do you have sore eyes"（86.36%）; Item 6: "Do you feel tightness in the eyes"（81.82%）; Item 8: "When using electronic devices such as mobile phones or computers, does the screen brightness cause eye discomfort"（81.82%）. The results of multivariate Logistic regression analysis indicated that two factors were identified as risk factors for asthenopia: "Dry eyes"（OR=6.101, 95%CI: 1.549-24.031）; "Reduced reading speed due to eye symptoms"（OR=12.741, 95%CI: 1.990-81.569）. Conclusion Asthenopia symptoms are relatively prevalent among medium and large-sized UAV operators in the Air Force, primarily manifested as dry eyes and reduced reading speed due to eye symptoms. Dry eyes are the lead contributing factor to asthenopia.

自噬是亚细胞膜结构发生动态变化，经溶酶体介导后对细胞内蛋白质和细胞器降解的过程，是一种调节细胞稳态的机制，其功能异常常与多种重大疾病的发生发展密切相关。本研究综述了基于动物模型开展自噬调控的研究，重点探讨其在肿瘤、神经退行性疾病、心脑血管疾病、代谢性疾病和骨骼疾病中的作用机制及干预进展，以期为后续临床研究和疾病防治提供新思路和潜在靶点。

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.

Objective To explore the effects of sleep deprivation on functional brain connectivity in simulated extended-duration flights using a graph-theoretic approach in order to provide data for formulating precautions and ensuring flight safety. Methods Forty-four young and middle-aged subjects were enrolled in this study. Resting-state functional magnetic resonance（rs-fMRI）examinations were performed before and after 24 hours of sleep deprivation. Time series and functional connectivity matrices were extracted from rs-fMRI and visualized via graph theory metrics and computation of brain network metrics. The degrees, local efficiencies, clustering coefficients, and bridging connections in each brain region were computed while the global network characteristics of each subject were compared before and after sleep deprivation to assess its effects on functional brain connectivity. Results After sleep deprivation, the local efficiency in the right middle frontal gyrus and left inferior occipital gyrus increased（Z/t=2.026, 3.532, P_FDR=0.049, <0.001）, so did clustering coefficients（t=2.377, 3.146, P_FDR=0.022, 0.003）. The degree of the right middle occipital gyrus was also elevated（t=2.096, P_FDR=0.042）. In contrast, the degrees of the left superior temporal gyrus, right Heschl's gyrus, and left insula as well as the local efficiency of the right Heschl's gyrus decreased（Z/t=－2.026, 2.177, 2.959, 2.177, P_FDR=0.049, 0.035, 0.005, 0.033）. In addition, both average local efficiency and bridging connections increased（t=2.090, 2.310, P_FDR=0.042, 0.025）. Conclusion Sleep deprivation impacts the cognitive function of subjects in a simulated extended-duration flight, particularly in terms of attention and delayed memory. The brain may make adaptive responses to sleep deprivation at the local network level, but the global network efficiency may decline.

Objective To investigate the impact of varying ambient light intensity and display brightness on pilots' visual behavior using eye-tracking technology. Methods Nineteen military pilots were selected as the subjects between July 2024 and December 2024. Under three levels of ambient light intensity（dim light, medium-intensity light, and strong light）, the subjects adjusted the display brightness to the three levels（minimum, moderate, and maximum）. Data on their pupil diameter, saccade duration, blink duration, and gaze trajectory was collected by eye-tracking system. Results In the dim light environment, the pupil diameter was larger when the display brightness was at the minimum level compared to the moderate and maximum levels（P=0.010, <0.001）, and it was also larger at the moderate level than at the maximum level（P<0.001）. Under any of the display brightness levels, the pupil diameter in the dim light environment was significantly larger than in either the medium-intensity or strong light environment（all P<0.001）. Under the maximum display brightness, the pupil diameter in the medium-intensity light environment was larger than in the strong light environment（P=0.012）. The effects of ambient light intensity and display brightness on the saccade duration were insignificant（all P>0.05）. In the medium-intensity light environment, the blink duration was significantly shorter than in the strong light environment（P=0.019）. The gaze trajectories varied with ambient light intensity. Paths were more tortuous with more fixation points in the dim and the strong light environments, whereas they were more direct in the medium-intensity light environment. Conclusion The results suggest that both ambient light intensity and display brightness impact the pupil diameter rather than on the saccade duration. Ambient light intensity influences the blink duration, while display brightness has little effect. Gaze trajectories also vary widely under varying ambient light intensities. These findings can provide a reference for the optimized design of light environments and display brightness.

Objective To find out more about the differences in gut microbiota between aircrews with hyperlipidemia（HL）, hyperuricemia（HA）or both（HA+HL）and healthy aircrews（NC）. Methods A total of 40 aircrews who underwent physical examinations at our hospital between September 2022 and September 2023 were enrolled and divided into four groups: a normal control group（NC group, 10 participants）, a hyperlipidemia group（HL group, 10 participants）, a hyperuricemia group（HA group, 10 participants）, and a hyperlipidemia combined with hyperuricemia group（HA+HL group, 10 participants）. The basic demographic information, important data and metabolic indicators（including blood lipid parameters and serum uric acid levels）were collected. Fecal samples were obtained and subjected to 16S rDNA amplicon sequencing to analyze gut microbiota composition. Differential bacterial communities were identified before their functional characteristics were investigated. Results Based on the Bray-Curtis distance matrix, weighted differences between samples were calculated and analyzed using principal coordinate analysis（PCoA）. The results showed that the microbial structures of the HA group, HA+HL group, and HL group were significantly different from those of the NC group（F=1.625, 1.654, 1.400, all P<0.05）. At the phylum level, the top five bacterial phyla across all four groups were Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, and Desulfobacterota. The relative abundance of Firmicutes in the HA+HL group was significantly higher than in the NC group（P<0.001）, and that of Bacteroidetes and the Bacteroidetes-to-Firmicutes ratio in the HA, HL, and HA+HL groups were all significantly higher than in the NC group（all P<0.001）. At the genus level, the top eight gut bacterial genera across the four groups were Megamonas, Bacteroides, Faecalibacterium, Bifidobacteriaceae, Prevotella-9, Streptococcus, Agathobacter, and Escherichia-Shigella. Significant differences were observed in the abundance of Escherichia-Shigella between the four groups（H=9.000, P=0.029）, with the relative abundance of the HA+HL group significantly lower than in the NC group（P<0.05）. Conclusion Aircrews with HA, HL or both（HA+HL）are vulnerable to gut microbiota dysbiosis. Alterations in the abundance of fermentative carbohydrate-related bacterial genera may serve as significant biomarkers for metabolic abnormalities.

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.

Objective To study the role of a stepwise electric rotary chair training protocol in enhancing the vestibular function stability of airsickness-prone individuals in order to provide evidence for screening and managing these individuals. Methods Forty-four volunteers underwent airsickness susceptibility screening using an electric rotary chair that rotated at 180°/s for 120 s. Failures of the screening received 1 to 4 days of training, with daily sessions lasting for a minimum of 25 minutes, plus psychological guidance and relaxation. Pre and post-training tolerance time and pass rates of screening in different genders were compared to analyze the contributing factors. Results Of these participants, 15 were identified as susceptible to airsickness. After training, their mean tolerance time significantly improved（t=24.100,P<0.001）. The detection rate of susceptibility was 66.67%（6/9）among females, compared with 25.71%（9/35）among males（P=0.044）. There was no statistically significant difference in susceptibility between different age groups（all P>0.05）. Moreover, 93.33%（14/15）of the susceptible individuals met the training standard within three days. Conclusion The stepwise rotary chair training protocol can rapidly and effectively improve vestibular stability and reduce adaptation time. A 120-second screening duration seems feasible.

Objective To analyze pilots' behavior related to visual information acquisition and cognitive processing during turning and landing of simulated flights. Methods Forty-two male pilots performed the designated flight mission in the same simulator. Data on their eye movement was recorded using an SMI eye tracker, and the fixation durations in each area of interest（AOI）across different stages were statistically analyzed. Results During turning, there was a statistically significant difference in the median fixation duration of the subjects on graphic and digital AOIs（Z=－2.737, P=0.006）. Participants' fixation durations on lower AOIs were longer than on upper AOIs（P=0.043）and on right AOIs（P<0.001）, and fixation durations on central AOIs were longer than on right ones（P=0.015）. However, there was no significant difference in durations between the subjects' fixation on the external runway and on the first fixation point when shifting back to the instrument panel（both P>0.05）. Besides, there was statistically significant difference in the median fixation duration between the first fixation point when the subjects shifted back to the instrument panel and other AOIs of the instrument（Z=－3.036, P=0.002）. During landing, participants exhibited longer fixation durations on the runway centerline than on the instrument panel（P=0.008）. Conclusion Pilots pay more attention to graphic AOIs, lower AOIs, central AOIs, and the first fixation point when shifting back to the instrument panel during turning, but they focus their attention on aligning with the runway during landing, suggesting that the design of human-machine interaction interfaces can be optimized by taking actual flights into consideration.

Objective To explore the effects of quadriceps relaxation training combined with Zhoulin spectrum therapeutic apparatus on knee joint pain and functions as well as inflammatory factors in military personnel with post-exercise knee pain. Methods A total of 80 military personnel with knee pain caused by high-intensity training between February 2024 and January 2025 were selected as subjects and randomly divided into a control group（Zhoulin spectrum therapeutic apparatus alone, n=40）and an observation group（quadriceps relaxation training combined with Zhoulin spectrum therapeutic apparatus, n=40）. The course lasted 4 weeks, with both groups receiving guided therapy and relaxation training under medical supervision. Clinical efficacy, scores of the Lysholm Knee Scoring Scale（LKSS）, scores of the Visual Analog Scale（VAS）, and rates of recurrence were compared between the two groups before and after 4 weeks of treatment. Levels of interleukin（IL）-6 and IL-10 were compared at 1 day before treatment, 1 day after treatment, and 3 days after treatment. Results The clinical efficacy in the observation group was much better than that of the control group（Z=－1.993, P=0.046）. Both groups had their VAS scores reduced and Lysholm knee scores increased after 4 weeks of treatment（t=12.079, 9.038, 20.574, 13.148, all P<0.001）. The recurrence rate in the observation group was lower than that of the control group at 4 weeks post-treatment（χ²=6.667, P=0.010）. Simple effect analysis by group found that IL-6 levels were higher（P=0.005, <0.001）while IL-10 levels were lower（P=0.011, <0.001）in the control group than in the observation group at 1 and 3 days post-intervention. Time-based simple effect analysis showed that IL-6 levels peaked at 1 day post-treatment and declined after 3 days of treatment in both groups（both P<0.001）. IL-10 levels kept increasing in the observation group（all P<0.05）, and were elevated in the control group at 1 and 3 days post-treatment compared with baseline（both P<0.001）. Conclusion Combining quadriceps relaxation training with Zhoulin spectrum therapeutic apparatus can yield better outcomes in military personnel with post-exercise knee pain, improve their clinical symptoms, enhance knee function, mitigate pain intensity, lower recurrence rates, and regulate inflammatory cytokine levels.

目的 调查某部雷达站部队训练伤的损伤部位及损伤类型分布情况，为科学制定官兵训练伤的防控措施提供参考依据。方法 对2024年4—5月就诊的188例雷达站官兵进行现场调查，统计其训练伤的伤病部位及损伤类型的分布情况。结果 雷达站官兵训练伤伤病部位占比前3为膝关节及小腿23.40%（44/188）、腰背部15.96%（30/188）和踝关节及足部13.30%（25/188）；损伤类型占比前3为韧带损伤19.15%（36/188）、腰椎间盘突出12.76%（24/188）和肌肉损伤10.64%（20/188）。结论 雷达站官兵训练伤中膝关节及小腿、腰背部损伤发生率较高，损伤类型大多为韧带损伤和腰椎间盘突出，因此需加强其下肢稳定性和灵活性的训练和指导，以及腰背部核心训练。

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.

目的 针对高原高海拔地区边防官兵眼部健康管理分散化的问题，构建基于循证医学的“环境适配-技术赋能-制度创新”三级防控体系，并验证其实际应用效果。方法 采用前瞻性队列研究设计，整合世界卫生组织健康促进理论与《高原战伤救治实用手册》《军队卫勤保障条例》为依据，通过环境适配、技术赋能和制度优化建立眼健康三级防控体系。选取2023年10月—2024年9月西南某海拔>4 500 m边防连队126名官兵为研究对象，采用随机数字表法将其分为观察组（n=63）和对照组（n=63）。观察组实施三级防控体系，对照组维持常规卫勤保障。对比观察组和对照组官兵的眼外伤发生率、干眼症发病率、后送时间、护目镜佩戴依从性、筛查覆盖率及满意度评分。结果 本研究实施三级防控体系，观察组官兵的眼外伤发生率和干眼症发病率均低于对照组，差异均有统计学意义（χ²=5.896、5.642，P=0.015、0.018）；观察组后送时间短于对照组，差异有统计学意义（t=24.260，P<0.001）。观察组官兵的护目镜佩戴依从性和筛查覆盖率均高于对照组（χ²=18.106、62.745，P均<0.001）。观察组官兵总体满意度评分高于对照组（t=11.310，P<0.001），各维度评分均高于对照组（t=9.371~12.795，P均<0.001），差异均有统计学意义。结论 高原高海拔边防连队官兵眼健康保障实施“环境改良、技术创新与制度保障”多维度干预有效降低高海拔官兵眼部风险，为我国高原边防官兵眼部健康卫勤管理提供了科学的保障方案。

腰痛指肋骨下缘至臀部下缘之间的疼痛或不适，伴或不伴一侧或双侧下肢疼痛。依据病因和病理，腰痛分为伤害感受性、神经性和伤害可塑性腰痛。腰痛是飞行人员最常见疾病之一，针对目前军事飞行人员腰痛缺乏系统康复治疗规范的现状，全军航空航天医学专业委员会依据军事飞行人员腰痛特征及全军重点课题研究成果，参照美国物理治疗协会骨科分会制定的基于国际健康、功能分类的腰痛康复指南，组织相关专家制定《军事飞行人员腰痛康复操作指南（2025）》，以规范军事飞行人员腰痛的康复评价、分类、分期及康复治疗方法。

Objective To analyze the results of training and respiratory rates of aircrews of different ages during anti-G breathing maneuvers under load conditions in order to provide data for anti-G breathing maneuvers training. Methods Three hundred and thirty-nine aircrews were collected from the Air Force Medical Center who participated in manned centrifuge training in 2019-2022. The differences in the respiratory rate, pass rate, visual field or changes in states of consciousness during high load training between the group ages 20 to 25（n=69）, group ages 26 to 30（n=110）, group ages 31 to 34（n=83）, and the group ages 35 and older（n=77）were analyzed. Results A total of 339 aircrews participated in the high load training in this study（212 passed the test, and 127 did not pass）. The results showed that there were statistically significant differences in the pass rate between the four age groups（χ²=13.294, P=0.004）. Pairwise comparisons indicated that the pass rate in the group ages 20 to 25（55.07%, 38/69） was lower than in the group ages 31 to 34（74.70%, 62/83）, and lower in the group ages 26 to 30（52.73%, 58/110） than in the group ages 31 to 34（74.70%, 62/83）and the group ages 35 and older（70.13%, 54/77）（all P<0.05）.The respiratory frequency results showed that there were statistically significant differences during the 8 G and 9 G plateaus across age groups（F=3.476, P=0.016）, and the respiratory frequency in the group ages 20-25 was significantly lower than in the other three groups（P=0.002, 0.028, 0.011）. The results of the visual field or states of consciousness showed statistically significant differences in the percentage of aircrews rated as "GOOD" and "A-LOC" or "G-LOC"（χ²=8.619, 8.491, P=0.035, 0.037）between the four groups. Pairwise comparisons showed that the incidence of A-LOC or G-LOC in the group ages 26 to 30 was significantly higher than that in the group ages 31 to 34（P<0.05）. Conclusion The pass rates for high-load training vary among aircrews in different age groups, which may be related to increased accumulated experience in countering high-G forces, pointing to the need to strengthen the load resistance of young aircrews. In addition, the anti-G breathing rate of aircrews under high load conditions is relatively fast, so the training on action of breathing should be improved to ensure flight safety.

笔者通过回顾医院空中机动医疗队参加全军基地化训练的任务经历，分析训练质效和下一步医院医疗队建设重点，系统阐述基地化训练对于提升医院机动卫勤分队卫勤保障能力的关键性与必要性，并对下个阶段训练基地建设提出意见建议。基地化训练的逐步实施有助于促进机动卫勤分队实战化卫勤保障水平的提高，规范机动卫勤分队展开救治流程，推动机动卫勤分队训练向实战化的目标方向迈进，但因空中机动站卫勤保障理念起步较晚，仍有部分问题亟待解决。空中机动站是空运医疗后送的关键环节，进行空中机动医疗队基地化训练是空军今后实施基地化卫勤训练发展的趋势和方向，是提高空军医院遂行实战化卫勤保障任务，强化向战为战、为战练兵和标准化、体系化、集成化空军卫勤系统演习演训卫勤保障能力生成的重要途径。

Objective To explore the characteristics of balance and gait of patients after lateral ankle ligament reconstruction and compare them with healthy individuals in order to help develop precise and personalized postoperative rehabilitation programs. Methods Thirty male patients undergoing ankle ligament reconstruction surgery at the Fourth Medical Center of Chinese PLA General Hospital between October 1, 2023 and August 1, 2024 were selected as the study group, while another thirty healthy male peers served as the control group. The balance platform was used to collect data on the two groups of subjects regarding the area and perimeter of their motion trajectories, anterior-posterior and lateral standard deviations, average movement distance of the center of foot pressure on the X and Y axes, and their stability limit values under both eyes-open and eyes-closed conditions. A three-dimensional gait analysis system was employed to collect gait parameters and assess gait characteristics, including the double support phase, foot angle, step uniformity, support phase, swing phase, gait cycle, ankle dorsiflexion-plantarflexion, inversion-eversion, step frequency, step speed, and step width. Results In the eyes-open state, the motion trajectory area, motion trajectory perimeter, lateral standard deviation of the trajectory, and anterior-posterior standard deviation of the trajectory of patients in the ankle ligament reconstruction group were all greater than those of the control group（Z=－3.504 to －2.454, all P<0.05）. In the eyes-closed state, the motion trajectory area, motion trajectory perimeter, lateral standard deviation of the trajectory, anterior-posterior standard deviation of the trajectory, and the average movement distance of the center of pressure on the Y-axis in the ankle ligament reconstruction group exceeded those of the control group（Z=－3.755 to －2.247, all P<0.05）. The stability limit value of the ankle ligament reconstruction group was lower than that of the control group（Z=2.292, P=0.022）. During walking, compared with the control group, there was a decrease in step frequency and step speed in the reconstruction group（Z=－2.434, －3.756, P=0.015, <0.001）, but a significant increase in the double support phase（Z=－4.132, P<0.001）and swing phase（Z=－2.432, P=0.015）in the affected side of the reconstruction group, the support phase（Z=－2.225, P=0.024）, step length（Z=－2.561, P=0.010）, while the ankle dorsiflexion/plantar flexion range of motion（Z=－3.297, P=0.001） was significantly reduced. The healthy side also showed a significant increase in the double support phase（Z=－2.366, P=0.018）. Compared with the healthy side, patients in the reconstruction group had a significant increase in the double support phase（Z=－2.513, P=0.012）and swing phase（Z=－3.962, P<0.001）in the affected side, while the support phase（Z=－4.007, P<0.001）and ankle dorsiflexion/plantar flexion range of motion（Z=－2.188, P=0.029）were significantly reduced. Conclusion Eight weeks after lateral ankle ligament reconstruction, patients' balance stability remains impaired under both eyes-open and eyes-closed conditions, with more pronounced anterior-posterior instability when eyes are closed. Abnormal gait patterns persist during walking.

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.

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.

Objective To explore the applicability of virtual endoscopic reconstruction technology in the treatment of pilot kidney stones using ureteral flexible ureteroscopy. Methods A total of 32 pilots who underwent ureteral flexible ureteroscopy for kidney stones at the Urology Department between January 2021 and February 2024 were selected for this study, who were randomly divided into two groups using a random number table method: the control group（16 cases）and the experimental group（16 cases）. The control group underwent traditional CT imaging for stone localization and subsequent ureteral flexible ureteroscopy while the experimental group used virtual endoscopy reconstruction technology for preoperative stone localization and intraluminal surgical path planning. During surgery, the planned path was followed for ureteral flexible ureteroscopy. The age, stone length, stone location, intraoperative stone localization time, surgical durations, and postoperative complications were compared between the two groups. Results There were no statistically significant differences between the two groups in terms of age, stone location, stone length or the incidence of surgical complications（all P>0.05）. The experimental group had a shorter stone localization time and a shorter surgical duration than the control group, with statistically significant differences（Z/t=－2.488, 2.643, P=0.013, 0.014）. Conclusion The application of virtual endoscopy reconstruction technology in preoperative stone localization, surgical path planning, and intraoperative navigation can shorten stone localization time and surgical durations in ureteral flexible ureteroscopy, thereby improving surgical efficiency.

战伤救治时效性决定战场急救的成功率，受救护人员素质、战场态势和地形地势等限制因素影响，高新技术的快速发展给军事领域带来了革命性改变，传统卫勤保障模式的困境有望被无人机和增强现实（augmented reality，AR）等新技术打破。笔者通过综述无人机和AR技术在当前军事卫勤领域的应用现状，探讨无人机和AR技术在战场急救领域的优势，为我军发展无人机和AR技术提供思路，以提高战场急救成功率，减少部队战斗减员，进而达到提升卫勤保障能力的目的。

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）.

目的 深入探讨肺腺癌转化为小细胞肺癌（small cell lung cancer，SCLC）的临床病理特征、基因改变与诊疗模式，为优化该类患者的临床管理提供依据。方法 回顾性分析2例肺腺癌转化为SCLC患者的临床资料，详细梳理其诊疗经过、病理、基因检测结果、治疗方案与生存结局，并系统复习国内外相关文献进行综合分析。结果 2例患者均为男性非吸烟者，初始病理诊断均为肺腺癌，发生SCLC转化时均处于广泛期。基因检测显示，病例1存在少见的EGFR基因18外显子G719S、20外显子S768I突变及TP53突变，在3次动态检测中，EGFR与TP53突变频率于SCLC转化后升高；病例2为EGFR 19 外显子E746_A750del突变，2019年7月—2021年6月的3次检测均提示EGFR突变频率持续升高，与肺部病灶缓慢进展趋势一致。2例长期生存患者均在接受表皮生长因子受体-酪氨酸激酶抑制剂治疗后发生SCLC转化，经化疗、放射治疗联合长疗程免疫治疗后，总生存时间均超过50个月。结论 肺腺癌转化为 SCLC 患者具有特定的临床及分子特征，免疫联合化疗方案可能为此类患者提供有效的治疗选择，其长期疗效和分子机制有待进一步研究验证。

Objective To study the differences in brain functions between pilots of different aircraft types when performing selective tasks, and to analyze the correlations between related indicators and cardiopulmonary exercise testing so as to provide data for daily training and selection of pilots. Methods Fourteen pilots（8 fighter pilots and 6 transport pilots）and 9 healthy subjects underwent functional magnetic resonance imaging（fMRI）scan and cardiopulmonary exercise testing（CPET）during selective tasks. The activated brain regions were located, while the relationships between the degree of activation of brain regions and the cardiopulmonary exercise testing were analyzed. Results The response of the left middle frontal gyrus, anaerobic threshold, relative anaerobic threshold and maximum oxygen pulse level of cardiopulmonary function of the pilot group were higher than those of healthy controls（t=4.215, 3.898, 4.231, 2.386, all P<0.05）. There was no difference in the extent to which the left middle frontal gyrus was activated between pilots of different aircraft（P>0.05）, and the anaerobic threshold of the transport pilots was higher than that of fighter pilots（t=－2.611, P=0.023）. The response of the left middle frontal gyrus was negatively correlated with the anaerobic threshold（r=－0.242, P=0.043）. Conclusion The left middle frontal gyrus may be a key brain area for selective attention among pilots, and anti-load training may help fighter pilots keep the left middle frontal gyrus highly activated.

Objective To study the changes in physiological indicators of the human body in hypoxic environments and explore the physiological indicators that can be quantified to assess the degree of hypoxia. Methods In October 2023, 16 male staff members from the Air Force Medical Center were selected as the subjects and were randomly divided into a sedentary group and a mental workload group. Hypoxia tests were conducted at simulated altitudes of 1 500, 2 500, 3 000, 4 000, 5 000, 6 000, 7 000, and 7 500 m in the hypobaric chamber. Results The results of multiple linear regression analysis showed that levels of blood oxygen saturation impacted the duration of hypoxia（B=3.283, 95%CI: 1.896－4.670）. The curves for changes in levels of blood oxygen saturation with the duration of hypoxia at different altitudes were fitted, and the duration of hypoxia at which levels of blood oxygen saturation decreased to the target critical value at each altitude was determined. Conclusion During acute high-altitude hypoxia, the levels of blood oxygen saturation can make a difference in the duration of hypoxia. This study is expected to contribute to related identification, early warning and interventions.

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.

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.

目的 制定口腔正畸固定矫治器粘接四手操作技术规范与流程。方法 采用德尔菲法于2022年9月—2023年6月对21名专家进行3轮函询，确定技术规范及流程内容。选取2023年7—11月在空军军医大学口腔医院正畸科接受固定矫治器粘接四手操作技术治疗的120例患者，采用随机数字表法将其分为观察组与对照组，每组60例。观察组实施规范培训后的四手操作，对照组采用常规配合模式，比较2组的椅旁平均操作时间、单个托槽粘接时间、单个托槽树脂使用量和医师、患者对护理工作的满意度。结果 3轮专家函询有效问卷回收率均为100%，专家权威系数为0.95，肯德尔和谐系数分别为0.150（χ²=110.147，P<0.001）、0.165（χ²=121.327，P<0.001）和0.618（χ²=454.006，P<0.001）。构建的口腔正畸固定矫治器粘接四手操作技术规范包含一级条目5项、二级条目19项、三级条目36项，指标变异系数为0.00~0.09。培训后观察组的椅旁平均操作时间、单个托槽粘接时间、单个托槽树脂使用量均低于对照组（t=73.091、30.116、6.603，P均<0.001），医师和患者对护理工作的满意度均高于对照组（t=9.355、13.589，P均<0.001）。结论 构建的口腔正畸固定矫治器粘接四手操作技术规范和流程具有科学性和实用性，可为进一步规范正畸护理诊疗工作提供理论依据和实践方向。

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.

目的 探索应对极限运动科学有效的热习服训练方法。方法 选取2022 年1月—2024年2月海南沿海部队执行作战任务的男性士兵14名，采用随机数字表法将其分为室内训练组（7名，室内热习服训练）和户外训练组（7名，户外热习服训练）。室内训练组于室内环境中训练，环境温度（35.00±0.20）℃，相对湿度（40.00±2.00）%；采用无动力跑步机，坡度5%，阻力7，完成5 km跑步，尽力跑；户外训练组根据实时室外温度调整着装，每日完成6 km跑步（分3次进行，间歇休息10 min）。2组训练周期均为7 d，训练前后均进行热耐力检测。采用生理应激指数（physiological strain index，PSI）评估热习服训练后热耐力的改善情况，设定PSI≤3为热耐力优秀的判定标准。室内训练组每日训练中持续监测直肠温度、心率，训练后计算出汗量，并计算PSI；户外训练组持续监测每日训练中耳蜗温度、心率，训练后计算出汗量，并计算PSI。结果 室内训练组训练后最快心率（P=0.002）、最高核心温度（P=0.003）均较训练前低，PSI改善（P<0.001），训练结束后热耐力检测PSI为2.33±0.35（≤3），达到优秀标准。户外训练组训练结束后热耐力检测最高核心温度（P<0.001）、最快心率（P<0.001）均较训练前低，训练结束后热耐力检测PSI为2.54±0.33（≤3），达到优秀标准。组间比较：室内训练组平均最高核心温度高于户外训练组，而平均出汗量低于户外训练组（P均<0.001）。结论 无论是模拟环境还是户外自然环境，本研究采用的极限运动热习服训练方法均可使参训人员达到PSI≤3的优秀标准，从而增强其对极限运动下热应激反应的适应能力。

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.

目的 探讨经胸超声心动图在中心静脉置管导管尖端定位中的应用价值。方法 选取2023年10月—2024年4月在空军特色医学中心肿瘤科住院拟行静脉化疗并行中心静脉置管的25例患者，置管方式包括经外周静脉穿刺中心静脉置管（peripherally inserted central venous catheter，PICC）和完全植入式静脉输液港（totally implantable venous access port，TIVAP），置管过程中行经胸超声心动图及腔内心电图定位，术后行胸部X线片检查定位导管尖端位置，对导管尖端位置进行对比分析。结果 25例中心静脉置管患者中包括PICC置管14例，TIVAP 11例，经胸超声心动图定位导管尖端准确率96.0%（24/25），腔内心电图和X线片定位导管尖端准确率均为100%（25/25），差异无统计学意义（P均>0.05）。结论 经胸超声心动图可准确判断中心静脉置管导管尖端位置，有临床指导作用，可在临床广泛推广。

Objective To evaluate the applicability of kite flaps in the repair of upper lip defects. Methods A total of 30 patients with upper lip defects repaired with kite flaps were selected from July 2021 to August 2024 at the Dermatoplastic Center of Air Force Medical Center. Their clinical data was retrospectively analyzed. The therapeutic effect of kite flips against upper lip defects was studied. Results The age of these patients ranged from 10 to 69, the median age was 26.00（17.25, 36.50）, and the areas of skin defects ranged from 0.5 cm×0.5 cm to 3.3 cm×2.8 cm. The survival of the flaps at the site of surgery was satisfactory. Healing by first intention occurred in all the incisions and there was no local deformation. After follow-up of 3 months to 1 year, it was found that the surgical scars were not obvious, the lip hair grew normally, and the aesthetic effect was satisfactory. Conclusions Kite flaps have distinct advantages in repairing upper lip defects, such as smaller auxiliary incisions, less damage, quick recovery, well-concealed scars along the nasolabial sulcus, no obvious scars after healing, and no pronounced local deformation.

Objective To analyze the body composition of military aviators. Methods A total of 184 aviators who visited the Aircrew Department of the Air Force Hospital of the Eastern Theater Command between June and December 2024 were enrolled and divided into a fighter pilot group（n=85）and a bomber/transport/helicopter（B/T/H）aircrew group（n=99）. Basic information was collected, and body composition was measured using bioelectrical impedance analysis. Multiple linear regression was employed to analyze the body composition of military aviators. Results Statistically significant differences were observed between the two groups in age and hours of flight（Z=－7.813, －7.185, both P<0.001）. Significant differences were also found in body mass index, InBody scores, body fat percentage, muscle percentage of right and left lower limbs, visceral fat areas, trunk fat percentage, fat percentage of right and left upper limbs, fat percentage of right and left lower limbs, the waist-to hip ratio and the extracellular water ratio（t=2.990－6.667, all P<0.05）. However, no significant differences were observed in smoking status, skeletal muscle mass, skeletal muscle mass indexes, basal metabolic rates, or muscle percentages of the upper limbs and trunk（χ²/t=0.808－1.723, all P>0.05）. Multiple linear regression analysis indicated that the types of aircraft impacted all dependent variables except the muscle percentage of right and left lower limbs（B=－2.977－29.140, all P<0.05）. Age made a huge difference in all dependent variables except for the fat percentage of left lower limbs（B=－0.384－1.923, all P<0.05）. BMI had significant effects on all dependent variables except the extracellular water ratio and muscle percentage of right and left lower limbs（B=0.005－21.720, all P<0.05）. Hours of flight showed no significant association with any of the dependent variables（all P>0.05）. Conclusion Age is a big contributor to muscle loss in aviators. Fighter pilots generally have healthier body composition profiles than B/T/H aircrews. It is recommended that fighter pilots enhance core muscle resistance training, and that B/T/H aircrews focus on visceral fat reduction and dietary modifications.

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.

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.

Objective To compare the clinical effects of manual mechanical hysteroscopic tissue removal（mHTR） and that of hysteroscopic electricity resection（HEC）for the treatment of endometrialpolyps（EMPs）. Methods Sixty patients with EMPs admitted to the Air Force Medical Center between August 2022 and February 2024 were enrolled in this study. According to surgical approaches, 30 patients treated with the manual mHTR were assigned to the observation group while another 30 patients undergoing hysteroscopic resection served as the control group. The perioperative indicators of the two groups were compared, including the time taken to remove the largest polyp, numbers of times instrument entered the uterine cavity, amounts of bleeding, usage of distention solutions, menstrual recovery, endometrial thickness, maximum polyp volume, postoperative complications（patients with infection and intrauterine adhesions）, recurrence（patients with endometrial polyps detected a second time via postoperative ultrasound examination）, and pregnancy（patients with confirmed intrauterine pregnancy by postoperative ultrasound）. Results The time taken to remove the largest polyp in the observation group was shorter than in the control group（Z=－3.691, P<0.001）. The number of times the hysteroscope entered the uterine cavity and the usage of distention solutions were both lower than those in the control group（Z=－7.125, －2.121, P<0.001, =0.034）. There was no statistically significant difference in the amount of intraoperative bleeding, postoperative menstrual recovery time, or endometrial thickness between the two groups（P>0.05）. All patients were followed up for at least 6 months. There was 1 case of recurrence but no occurrence of intrauterine adhesions in the observation group. Among the 17 married but childless subjects, 7 became pregnant. In the control group, there was no recurrence but 1 case of intrauterine adhesion. Among the 14 married and childless individuals, 6 became pregnant. Conclusion Both manual mHTR and HEC are effective in the treatment of endometrial polyps. Manual mHTR has some advantages over HEC in that it is portable, safe, effective and causes no electrical heating damage and fewer postoperative complications. Moreover, it does not affect pregnancy and is suitable for young women with both EMPs and fertility needs.