Objective To design a multimodal real-time cockpit monitoring and early warning system in order to address potential health risks and operational hazards caused by abnormal behaviors of long-duration sedentary fighter pilots. Methods Real-time data on hand movements, posture changes（head tilt, torso displacement）, and seat pressure distribution was collected. Deep learning algorithms were used for spatiotemporal alignment and feature fusion of multimodal data before a dynamic warning model was established via temporal analysis. Deployed on flight simulators, this system was subjected to stability and effectiveness testing. Results An adaptive threshold-based warning mechanism that aligned with stages of flight missions was developed. Simulation tests found that this system could operate stably for over 4 hours, with an average accuracy of 97.21% for detection of abnormal behaviors, which significantly outperformed unimodal approaches. Conclusion This system offers an efficient, low-interference monitoring solution to abnormal behaviors of pilots in cockpits, which is highly applicable to human-machine ergonomic optimization and to the healthcare of pilots.
Objective To investigate the characteristics of dynamic evolution of sedentary fatigue by integrating subjective and objective indicators in order to design an effective monitoring framework. Methods A 180-minute continuous sedentary experiment was designed based on a multi-attribute task battery（MATB）platform. A portable ECG recorder was used to collect high-frequency ECG data. Data on the Karolinska Sleepiness Scale（KSS）and NASA-TLX was synchronously collected at 18 time points. Heart rate variability（HRV）parameters were recorded, including the time-domain index（standard deviation of NN intervals, SDNN, proportion of NN20, pNN20）, frequency domain index（low frequency/high frequency ratio, LF/HF）, and Poincaré plot index（ratio of short-to long-term variability, SD1/SD2）. The temporal evolution of physiological and subjective fatigue measures was analyzed using change point detection and segmented regression methods. Results HRV parameters and subjective fatigue measures showed stage-specific temporal variations. Friedman tests indicated significant time effects for pNN20（χ2=41.940, P=0.007）and KSS（χ2=35.315, P=0.006）. PELT-based change point detection revealed that SDNN and pNN20 kept changing after 60 min. Segmented linear regression and Kendall's τ trend analysis further demonstrated that pNN20 increased during the 40-100 min window [B=0.119, 95%CI: 0.100~0.139, OLS P<0.001, R2=0.981, τ=1.000, Padj=0.004], suggesting high sensitivity to early fatigue evolution. NASA-TLX scores showed weak positive correlations with HR and LF（rs=0.143 and 0.113, P=0.010 and 0.043, respectively）, and weak negative correlations with SD1/SD2（rs=－0.119, P=0.032）. No significant correlations were found between KSS scores and HRV indicators（all P>0.05）. Conclusion The study has validated the utility of HRV features in sedentary fatigue monitoring and proposed a dynamic evaluation framework that combines subjective and objective indicators, which is expected to facilitate the development of personalized early warning models and intelligent monitoring systems.
Objective To establish a model for objective and quantitative evaluation of pilots' operational comfort. Methods The discrete trajectory of pilots' hands was refactored using a motion regeneration model based on anthropometric parameters and via coordinate transforming relations between human joints. Continuous curves were drawn through Gaussian fitting, Fourier fitting and Sine fitting. An evaluation model of pilots' operational comfort was established based on Jerk-cost motion parameters. Results Among the 48 movements in 16 experimental sessions, 12, 19, and 17 movements fell into three levels: relatively comfortable, moderately comfortable, and relatively uncomfortable, respectively. Errors between the classification results of pilots' operational comfort by this evaluation model and results of subjective evaluation of comfort were within 3 movements.Conclusion Based on anthropometric parameters and coordinate transformation relations, the spatial motion trajectories can be reconstructed. The Jerk-cost motion parameter from the spatial motion trajectories can serve as an index for objective evaluation of operational comfort of pilots.
Objective To study the weight distribution of key contributors to respiratory fatigue caused by aviation oxygen masks and provide data for optimization of masks. Methods The control variable method was adopted to investigate the effects of four leading factors-inspiratory resistance, expiratory resistance, weight of masks and sealing of masks-on respiratory fatigue. Meanwhile, a detailed system for evaluation of respiratory fatigue was constructed by combining two objective physiological indicators（heart rate and respiratory rate）with subjective perception evaluation. The factor analysis method was used to conduct quantitative analysis of weight of the experimental data using SPSS software.Results According to the changes in heart rate, respiratory rate and Borg Dyspnea Scale, the biggest contributor to respiratory fatigue was inspiratory resistance, followed by expiratory resistance, sealing of mask and mask weight. Further quantitative analysis via factor analysis found that the weight proportion of each of these factors was 38%, 32%, 22% and 8% respectively. Conclusion Inspiratory resistance, expiratory resistance, sealing of masks and mask weight are the main factors affecting respiratory fatigue induced by aviation oxygen masks. Therefore, in the design of aviation oxygen masks, priority should be given to optimizing the structures related to inspiratory resistance and expiratory resistance so as to reduce the respiratory fatigue of wearers and improve the comfort and safety of masks.
Objective To design a system for dynamic performance evaluation of wearable physiological monitoring devices under complex motion simulation. Methods Based on a simulated platform for dynamic performance, the heart rate, respiratory rate and blood oxygen saturation generated by aircrews performing different movements were simulated as simulation signals. The wearable physiological monitoring device was fixed on a simulated dummy and moved along with the platform to generate the measured signals. Both the simulated signals and measured signals were input into the software for accuracy assessment. Results A dynamic performance evaluation system for wearable physiological monitoring devices was developed, which was capable of accurate analysis of performance of measured signals from such devices. Scores between 0.9 and 1.0 were considered excellent, those between 0.7 and 0.9 average, and those between 0 and 0.7 poor. Conclusion This system for evaluation of dynamic performance of wearable physiological monitoring devices can help determine the accuracy of electrocardiograms, respiratory rate and blood oxygen saturation when used in monitoring, which serves as a standardized evaluation system for the research and development, performance evaluation and improvement of wearable physiological monitoring devices.
Objective To enhance the effectiveness of training for marine aviation flight missions by recommending ways to overcome such challenges as the high demands of marine aviation tasks, rapid changes in marine environments, and the complexity of marine flight missions. Methods A technical support framework for marine aviation flight missions was developed. A simulated system based on virtual reality（VR）was designed to facilitate marine human-machine-environment interactions. Key elements of the system design were analyzed in terms of demands. Such factors as waves, sea surfaces, islands, reefs, ships, aircraft, and weather conditions were simulated. Flight missions, marine environments, and cockpits were digitally simulated, along with the information exchange framework between human-machine environments and tasks. Results A VR-based marine human-machine-environment simulation system was established, which adopted a service-oriented architecture（SOA）with a hierarchical modular structure. All modular functions were accessible to users in the form of services, facilitating compatibility, reuse, and expansion. This system could be deployed in laboratories and training rooms via wireless routing and was equipped with a firewall to enhance security. Conclusion This VR-based marine human-machine-environment simulation system makes it possible for marine aviation tasks to be rehearsed in a simple, low-cost, and totally-simulated manner, which can serve as a brand new tool for simulation training and research support. Pilots can complete missions directly and easily. The information flow collected by the system can provide data for integrated evaluation, data mining and digital development.
Objective To explore the problems facing human factors engineering in augmented reality（AR）technology and its applications. Methods Based on literature review, problems with human factors engineering in AR technology were analyzed and ways of improvement were recommended. Results AR technology was widely applied in industrial production and daily lives, but there remained such problems as the wearability of AR devices, which could be addressed by increasing sampling, updating standards for the heads and faces of adults, using soft materials for cushioning and shock absorption, and improving comfort. A second problem lay in the illusions and misjudgment by AR technology, which could be solved by artificially enhancing texture, color features, or marker points in real-world scenarios, increasing contrast between virtual and real environments appropriately and improving the accuracy of tracking and registration. A third problem involved the occlusion between virtual and real elements, which could be reduced using 3D mask occlusion methods, deep computing techniques, and contour tracking processing. A fourth problem was motion sickness and visual fatigue caused by the refresh rates and latency of AR devices, which could be resolved by optimizing display technologies, improving computational and data processing, enhancing system architecture and algorithms, and refining sensor technologies. A fifth problem was the insufficient immersion and realism in AR displays, which could be addressed by combining six-degree-of freedom tracking with feature-based visual simultaneous localization and mapping to achieve independent real-time positioning and high-precision map construction, thereby reducing motion sickness and enhancing immersion and realism. As for the limited field of view, video see-through AR glasses could be adopted, where both real and virtual images were generated by displays, dynamically compressed, and processed digitally to eliminate image distortion and expand the field of view. Conclusion AR technology is increasingly used across industrial production and daily lives, but some problems persist that require more optimization to achieve better user experiences.
Objective To investigate the effects and temporal characteristics of simulated microgravity on auditory function of experimental animals in order to find out more about the biological mechanisms underlying microgravity-induced damage to the auditory system of rats. Methods Thirty-six male Sprague-Dawley（SD）rats were randomly assigned to a simulated microgravity group（SM）and a control group（WT）, with 18 rats in each. Based on exposure duration, each group was divided into three subgroups: 1 week（SM1, WT1）, 4 weeks（SM4, WT4）, and 8 weeks（SM8, WT8）, with 6 rats（12 ears）in each. A tail-suspension model was used to induce simulated microgravity in rats. Auditory brainstem response（ABR）thresholds, threshold shifts, and distortion product otoacoustic emissions（DPOAE）were measured bilaterally immediately before and after exposure for a comparison between the two groups. Results Baseline ABR thresholds did not differ significantly between these groups across frequencies（all P>0.05）. The repeated measures ANOVA results showed that except for the 18 kHz frequency, the ABR threshold of SM4 was higher than WT4 at all frequencies（P=0.001-0.034）; The ABR threshold of SM8 is higher than that of WT8 at all frequencies（all P<0.001）. The generalized estimation equation results show that the ABR threshold offset of SM4 is higher than that of SM4 at click, 6, 12, and 32 kHz frequencies（all P<0.05）; The ABR threshold offset of SM8 is higher than that of WT8 on all frequencies（all P<0.001）. No significant differences in DPOAE response rates were observed（all P>0.05）. Conclusion Simulated microgravity can lead to increased ABR thresholds and threshold shifts in rats. These impairments become pronounced four weeks into exposure and deteriorate by the eighth week.
Objective To analyze the relationships between the cephalometry of craniofacial morphology and obstructive sleep apnea（OSA）in aircrews in order to provide a reference for the graded diagnosis of OSA in aircrews. Methods Cephalometric data from 64 male aircrews suspected of OSA was collected. Based on the apnea-hypopnea index（AHI）from overnight polysomnography（PSG）, the participants were divided into a control group（n=6）, mild OSA group（n=10）, moderate OSA group（n=28）, and severe OSA group（n=20）. Differences in cephalometric parameters between these groups and correlations between cephalometric parameters and AHI were analyzed.Results There were statistically significant differences in age, body mass index（BMI）, oxygen desaturation index（ODI）, respiratory arousal index and AHI between the four groups of aircrews（F/H=3.081-40.163, all P<0.05）. Post-hoc pairwise comparisons revealed that age, BMI, ODI, respiratory arousal index and AHI in the moderate and severe OSA groups were all higher than in the control group（all P<0.05）. BMI was higher in the severe OSA group than in the mild OSA group（P=0.009）. ODI, respiratory arousal index and AHI were higher in moderate and severe OSA groups than in the mild OSA group（all P<0.05）. In addition, ODI and AHI were significantly higher in the severe OSA group than in the moderate OSA group（all P<0.001）. Statistically significant differences were found in the mandibular plane-hyoid bone（MP-H）distance and posterior airway space（PAS）between the four groups（F/H=12.024, 2.262, P=0.007, 0.037）. After pairwise comparison, the results showed that the MP-H levels in the mild, moderate, and severe OSA groups were higher than those in the control group（P=0.046, 0.013, 0.001）, and the MP-H levels in the severe OSA group were higher than those in the moderate OSA group（P=0.049）; The PAS in the severe OSA group was lower than that in the control group（P=0.032）. There was no statistically significant difference in the remaining cephalometric measurement parameters among the four groups（all P>0.05）. AHI was positively correlated with MP-H（rs=0.397, P=0.001）but negatively with PAS（rs=－0.336, P=0.005）.Conclusion The cephalometric parameters MP-H and PAS hold significant clinical importance in the assessment and management of OSA in flight personnel.
Objective To analyze the characteristics of lipids in male aircrew members with lumbar disc herniation complicated with hypercuricemia (HUA), investigate the association between metabolic indicators of lipids and HUA, and identify the risk factors. Methods A total of 214 male aviation personnel diagnosed with lumbar intervertebral disc herniation were enrolled before undergoing biochemical tests within 24 hours of admission. Data on HUA, basic information, and related biochemical indicators（including lipid indicators, renal function indicators, and liver function indicators）were collected. Patients were divided into the HUA group（53 cases）and the non-HUA group（161 cases）. Differences in clinical data and biochemical indicators between the two groups were statistically analyzed. Binary logistic regression models were adopted to identify contributors to HUA while ROC curves were used to evaluate the accuracy of each model for predicting HUA. Results The levels of total cholesterol（TC）, triglycerides（TG）, and non-high-density lipoprotein cholesterol（non-HDL-C）in the HUA group were significantly higher than those in the non-HUA group（t/Z=2.475, －4.216, 2.970, P=0.014, <0.001, =0.003）. The detection rates of abnormal TC, TG, and non-HDL-C in the HUA group were also significantly higher than in the non-HUA group（χ2=10.226, 5.125, 8.995, P=0.001, 0.024, 0.003）, with the highest detection rate of abnormal low-density lipoprotein as 41.51% in the HUA group. Univariate logistic analysis showed that TG（OR=1.777, 95%CI: 1.069-2.955）and non-HDL-C（OR=1.845, 95%CI: 1.040-3.271）remained significant factors influencing HUA. The area under the ROC curve（AUC）in Model 2 for predicting HUA was 0.749（95%CI: 0.657-0.840）. Conclusion Elevated TG and non-HDL-C may be important risk factors for HUA in male aircrews complicated with lumbar disc herniation. Clinically, monitoring these lipid indicators can provide references for early identification of and interventions in comorbid lumbar disc herniation complicated with HUA.
Objective To evaluate the synergistic analgesic effect of ultrasound-guided precise localization combined with targeted transdermal drug delivery during the treatment of acute lumbar disc herniation（LDH）. Methods A retrospective analysis was conducted of 50 male soldiers diagnosed with acute LDH between May 2022 and May 2025. These patients were divided into an ultrasound-guided group（n=25）and anatomical localization group（n=25）. Both groups received flurbiprofen gel patch treatment（8 h/patch, bid）. The ultrasound-guided group was additionally given transforminal injection of compound betamethasone under real-time ultrasound guidance while the anatomical localization group received surface landmark-based injection. Visual Analogue Scale（VAS）scores were compared before injection, at 1-day and 7-day post-injection. Results The VAS scores were 5.52±1.08, 3.07±0.75, and 1.60±0.71 at three time points in the ultrasound-guided group, compared with 5.40±1.04, 3.53±0.76, and 2.00±0.65 in the anatomical localization group. Repeated measures ANOVA revealed a significant main effect of time（Ftime=315.470, Ptime<0.001）, and a significant interaction between time and group（Finteraction=8.920, Pinteraction<0.001）. At day 1 and day 7 post-treatment, the VAS scores were significantly lower in the ultrasound-guided group than in the anatomical localization group（P=0.036, 0.043）. On days 1 and 7 after treatment, the VAS scores in both groups were lower than those before treatment. On day 7 after treatment, the VAS scores in both groups were also lower than those on day 1 after treatment（all P<0.001）. Conclusion The combination of ultrasound-guided transforminal injection and flurbiprofen transdermal delivery can more effectively alleviate pain in acute LDH, which should be made more accessible due to the precise targeting and clinical efficacy.
Objective To explore the effect of early pulmonary function rehabilitation training on delirium and respiratory mechanics indexes of patients with chronic obstructive pulmonary disease and on mechanical ventilation in an intensive care unit（ICU）. Methods A total of 140 ICU patients with COPD treated between June 2023 and June 2025 were selected, who were randomly divided into two groups, with 70 in each. Patients in the control group were given routine nursing care while those in the study group were additionally given early lung rehabilitation training guided by respiratory therapists. The duration of mechanical ventilation, length of stay in the ICU, average expenses in the ICU, incidence of delirium and respiratory mechanics were compared between the two groups, so were the acute physiology and chronic health status before and after interventions. Results The duration of mechanical ventilation, ICU stay, and average expenses in the ICU were shorter or lower in the experimental group（t=56.944, 92.662, 96.787, all P<0.001）than in the control group, so was the incidence of delirium（χ2=5.079, P=0.024）. The partial pressure of oxygen was higher in the experimental group than in the control group, but the partial pressure of carbon dioxide was lower（t=5.741, 15.259, both P<0.001）. The platform pressure, peak airway pressure, mean airway pressure, expiratory resistance, and inspiratory resistance were lower in the experimental group than in the control group, but dynamic compliance was higher（t=3.523-38.841, all P<0.05）. The difference in acute physiology and chronic health evaluation Ⅱ scores was statistically significant between the two groups（t=11.821, P<0.001）. Conclusion Early lung function rehabilitation training can effectively improve respiratory mechanics while having a positive effect on mechanical ventilation indexes so that the recovery of lung function of patients is boosted and the incidence of delirium is reduced.
Objective To compare the therapeutic effects of platelet-rich plasma（PRP）injections, dextrose prolotherapy（DPT）, and conventional rehabilitation against meniscus injury. Methods A retrospective analysis was conducted of 45 patients with meniscus injury treated in the Department of Rehabilitation Medicine at the Air Force Medical Center between August 2024 and August 2025. These patients were divided into a PRP group（n=15）, DPT group（n=15）, and control group（conventional rehabilitation, n=15）based on treatment regimens. The Visual Analogue Scale（VAS）score, knee Range of Motion（ROM）, knee extension/flexion muscle strength, International Knee Documentation Committee（IKDC）score, Tampa Scale for Kinesiophobia-17（TSK-17）score, and 12-Item Short Form Health Survey（SF- 12）score were collected before and after treatment. One-way analysis of variance was used to study the differences between the groups. Multiple linear regression analysis was conducted to explore the factors influencing the therapeutic effect in patients with meniscus injury. Results VAS scores, knee extension strength, IKDC scores, and TSK-17 scores improved more significantly in the PRP group than in the DPT group（P<0.001 or =0.022）. Multiple linear regression analysis suggested that treatment regimens were an independent factor influencing the improvement of VAS scores（B=－0.773, 95%CI: －1.394-－0.153）, knee extension strength（B=3.317, 95%CI: 1.857-4.778）, IKDC scores（B=6.627, 95%CI: 4.575-8.680）, and TSK-17 scores（B=－4.751, 95%CI: －6.290-－3.213）. PRP injections reduced VAS pain scores and TSK scores more significantly than DPT therapy while elevating knee extension strength and IKDC functional scores more effectively than DPT therapy. Conclusion Both PRP injection and DPT are effective at alleviating pain and promoting functional recovery. PRP is more effective and may serve as the preferred injectable therapy for meniscus injury repair while DPT, which is user-friendly and cost-effective, can be a viable alternative to PRP.
Objective To study the clinical efficacy of modified Diyuqingbi cream against psoriasis vulgaris complicated with blood heat syndrome.Methods A total of 60 patients with psoriasis vulgaris admitted to Dongzhimen Hospital between March 2023 and December 2023 were randomly divided into two groups using the random number table method. The treatment group（30 cases）was treated with modified Diyuqingbi cream while the control group（30 cases）was treated with Diyuqingbi cream externally twice/d for 4 weeks. Before and after treatment, skin lesions were scored using Psoriasis Area and Severity Index（PASI）, body surface area（BSA）, Visual Analogue Scale（VAS）and Dermatology Life Quality Index（DLQI）. The potential of hydrogen（pH）, stratum corneum hydration（SCH）and trans-epidermal water loss（TEWL）of the skin at lesion sites were observed to evaluate the skin barrier function. Adverse reactions were recorded during medication to assess the safety of the cream. Recurrence was followed up using the PASI score at 4 weeks after treatment. Results After 4 weeks of treatment, PASI scores, pH, TEWL, BSA scores, VAS scores and DLQI scores decreased in both groups（t/Z=－4.706-13.484, all P<0.05） while SCH increased（t=15.918, 10.534, both P<0.001）. SCH and DLQI scores were improved more significantly in the treatment group than in the control group（t=3.833, 2.414, P<0.001, =0.019）, and the total effective rate was higher（χ2=4.344, P=0.037）. No adverse reactions occurred in either group during the medication. Conclusion Modified Diyuqingbi cream can reduce the size and severity of skin lesions and improve quality of life, itching and skin barrier function of patients with psoriasis vulgaris complicated with blood heat syndrome, and proves to be more effective and safter than Diyuqingbi cream.
Objective To investigate the clinical efficacy of Tongbian scraping combined with proprioceptive training against mixed cervical spondylosis. Methods A total of 92 patients with mixed cervical spondylosis admitted to Anqing 116th Hospital between February 2023 and May 2024 were selected and divided into a control group and observation group according to treatment regimens. The 45 patients in the control group received proprioceptive training plus routine treatment while those in the observation group were additionally treated with Tongbian scraping. The total effective rate, Visual Analogue Scale（VAS）score, Clinical Assessment Scale for Cervical Spondylosis（CASCS）score, hemorheology, inflammatory indexes and adverse reactions were compared between the two groups. Results The overall effective rate was 91.49%（45/47）in the observation group, which was notably higher than 75.56%（34/45）in the control group（χ2=4.277, P=0.039）. After treatment, VAS scores decreased（t=27.492, 19.796, both P<0.05）while CASCS scores increased（t=14.953, 10.876, both P<0.05）in both groups. The plasma viscosity, red blood cell aggregation index, C-reactive protein, and IL-6 levels decreased on average（t=2.235-40.305, all P<0.05）. The erythrocyte sedimentation rate in the observation group decreased compared to before treatment（t=3.144, P=0.002）, and the improvement of the above indicators in the observation group was better than that in the control group（t=2.131-14.764, all P<0.05）; The incidence of adverse events was 2.22%（1/45）in the control group and 6.38%（3/47）in the observation group, with no statistically significant difference between the two groups（χ2=0.957, P=0.328）.Conclusion Tongbian scraping combined with proprioception training can improve the cervical function and pain symptoms of patients with mixed cervical spondylosis by regulating hemorheological parameters and levels of inflammatory factors.
Objective To compare the effectiveness of automated cleaning and conventional manual cleaning of gastrointestinal endoscopes using adenosine triphosphate（ATP）bioluminescence assay and membrane filtration concentration bacterial culture method. Methods A total of 240 gastrointestinal endoscopes clinically used at the Endoscopy Center of the First Affiliated Hospital of Nanjing Medical University between October and December 2024 were selected. According to the cleaning method, the endoscopes were divided into an experimental group（automated cleaning）and a control group（conventional manual cleaning）, with 120 endoscopes in each. The ATP bioluminescence assay and membrane filtration concentration bacterial culture method were used to test three sites of the endoscopes in both groups, namely the inner surface of the forceps channel in the insertion section, the outer surface of the insertion section, and the outer surface of the valve in the control section, so as to evaluate the effect of cleaning and disinfection. Receiver operating characteristic（ROC）curve analysis was conducted to find out about the ability of the relative light unit（RLU）values at each site to predict abnormal levels of colony-forming units（CFUs）. Cleaning efficiency and Fatigue Scale 14（FS-14）scores of operators were compared between the two groups. Results The quality of cleaning and disinfection on the inner surface of the forceps channel in the insertion section was significantly higher in the experimental group than in the control group（χ2=5.128 and 3.895, P=0.024 and 0.048, respectively）. ROC curve analysis showed that the areas under the curve of RLU values for predicting abnormal levels of CFUs on the inner surface of the forceps channel in the insertion section, the outer surface of the insertion section, and the outer surface of the valve in the control section were 0.969, 0.955, and 0.977, respectively, with optimal cut-off values of 170.5, 144.5, and 159.5, respectively. The cleaning efficiency and the proportion of operators with an FS-14 score difference of <2 points were significantly higher in the experimental group than in the control group（t/χ2=36.913 and 65.324, all P<0.001.Conclusion Automated cleaning can improve the quality of cleaning and disinfection of gastrointestinal endoscopes, enhance work efficiency, and reduce the fatigue burden of related personnel. The combined application of the ATP bioluminescence assay and membrane filtration concentration bacterial culture method can effectively monitor the quality of cleaning.
Objective To evaluate the efficacy and safety of micropunch elevation combined with fractional CO2 laser followed by autologous epidermal cell transplantation in the treatment of atrophic acne scars. Methods A total of 25 patients with atrophic acne scars admitted to the Department of Dermatology of the First Medical Center, Chinese PLA General Hospital, between June 2024 and January 2025 were enrolled, all of whom completed the follow-up. Both sides of the face were randomly assigned to either the experimental group（micropunch elevation combined with fractional CO2 laser plus autologous epidermal cell transplantation）or the control group（micropunch elevation combined with fractional CO2 laser alone）. Efficacy and safety were accessed at baseline, 1 month, and 4 months post-treatment. Evaluation indicators included ECCA scores, subjective satisfaction scores, VISIA parameters, Visual Analogue Scale（VAS）scores, and incidence of adverse events. Results There was a significant main effect of time（Ftime=185.367, Ptime<0.001）, but not of group（Fgroup=0.771, Pgroup=0.384）, and a significant interaction between time and group（Finteraction=10.645, Pinteraction<0.001）. At 4 months postoperatively, the ECCA score in the experimental group was lower than in the control group（P=0.043）. The difference in scores of subjective satisfaction between the two groups was statistically significant（Z=－4.000, P<0.001）, so was the difference in VISIA parameters（spots and red areas）（t=3.163, 2.696, P=0.004, 0.013）. The incidence of post-inflammatory hyperpigmentation（PIH）, duration of erythema, complete healing times, and VAS score in the experimental group were lower or shorter than those of the control group（χ2/t=4.167, 5.132, 4.525, 3.714, P=0.031, <0.001, <0.001, =0.001）. Conclusion Micropunch elevation combined with fractional CO2 laser followed by autologous epidermal cell transplantation may synergistically enhance clinical outcomes for atrophic acne scars while reducing adverse effects.
