抗生素相关性腹泻（antibiotic-associated diarrhea，AAD）指各种原因应用抗生素后出现腹泻等症状，是抗生素应用后最常见的并发症之一。AAD与诸多危险因素相关，并呈现出临床异质性。随着医学技术的不断进步，医学领域对AAD的认识不断加深，相关研究取得较大进展。笔者拟就AAD的相关进展进行综述，为其诊治和预防提供一定参考。

Objective To analyze the disease spectrum of grounded fighter pilots in terms of types of disease, patterns of change over time, and influencing factors so as to provide data for disease prevention, treatment, and health maintenance of fighter pilots in China. Methods The literature on disease spectrums of grounded fighter pilots was retrieved from the Chinese and English databases as of June 2022. After screening, the included literature was selected. The combination rate and publication bias of different components of disease were calculated using STATA 17 software before an appropriate effect model was chosen based on the heterogeneity test results. Subgroup analysis was made according to the time investigation was conducted to study the change of the disease spectrum, and Chi-squared test was performed using SPSS 26 software to find out whether the difference was statistically significant. Results Thirteen articles were included, involving 2 519 grounded pilots. Meta analysis results showed that the top ten diseases were occupational aviation diseases（18%）, nervous system diseases（14%）, motor system diseases（12%）, cardiovascular diseases（12%）, digestive system diseases（11%）, psychosocial diseases（8%）, respiratory system diseases（6%）, ophthalmic diseases（5%）, urinary system diseases（3%）and metabolic diseases（3%）. After 2010, the prevalence of occupational aviation diseases（χ²=88.40, P<0.001）, nervous system diseases（χ²=5.98, P=0.014）and digestive system diseases（χ²=23.87, P<0.001）among grounded fighter pilots decreased while the incidence of motor system diseases（χ²=12.32, P<0.001）, cardiovascular diseases（χ²=18.46, P<0.001） and respiratory diseases（χ²=34.77, P<0.001）increased. The difference was of statistical significance. Conclusion In the spectrum of diseases among grounded fighter pilots, the top two are occupational aviation diseases and nervous system diseases. The prevalence of motor system diseases, cardiovascular diseases and respiratory diseases has been on the rise in recent years. Related institutions need to take precautions to keep fighter pilots healthy in China and reduce the medical grounding rate.

目的 综述国内外空降兵训练伤流行现状及其分类、致病机制和防护措施，以期达到防止或减少空降兵跳伞造成的生理心理损伤，降低空降兵跳伞训练伤发病率。资料来源与选择 国内外公开发表的空降兵训练伤相关文献及防护技术标准。资料引用 引用文献资料64篇。资料综合 伴随军事实战化训练强度的提高，空降兵因跳伞训练导致的训练伤发病率也呈现上升趋势。各国针对空降兵训练伤的流行病学调查显示空降兵跳伞训练伤的发生受个体特征、环境因素和跳伞条件的影响。良好的体能基础、过硬的心理素质以及适宜的防护装备均可有效预防空降兵训练伤。结论 我军须进一步研制适宜的空降兵防护装备，以减少跳伞训练伤的发生，提高空降兵部队战斗力。

Objective To conduct cluster analysis of 12 anthropometric indicators and to explore the relationships between fasting insulin（FINS）, annual flight time and obesity among civil aviation pilots. Methods A total of 1,250 male pilots in East China who underwent physical examinations and auxiliary examinations in Shanghai Hospital between September 2021 and February 2022 were selected to have their height, weight, waist circumference, hip circumference and body fat percentage（PBF）determined using an Inbody body composition analyzer. The data on their aircraft types and duration of flight in 2021 was obtained via a questionnaire survey. Twelve anthropometric indicators were used for cluster analysis using principal component analysis, and the relationships between fasting insulin（FINS）, annual flight time of civil aviation and anthropometric indicators were analyzed using multiple linear regression models to validate the cluster analysis of anthropometric indicators. Results After suitability testing of the 12 anthropometric variables, factor analysis was conducted, and three common factors were extracted using the principal component method, with a cumulative variance contribution rate of 95.29%. Linear regression was used to calculate standardized score coefficients. Multiple linear regression analysis revealed that fasting insulin was related to annual flight time and the three common factors（partial regression coefficients of three common factors were 12.37, 8.90 and 6.78, all P<0.001）, with central obesity making the greatest difference to elevated fasting insulin levels. Conclusion All the three common factors are found to be related to elevated fasting insulin levels, especially the central obesity factor, suggesting the clinical predictive value of anthropocentric indicators.

Objective To accomplish simulated design of experiments for detection of impulse noise from explosive cutting during aircraft escape in order to protect against hearing damage. Methods The relationship between the proportional distance of the overpressure estimation of the impulse noise from explosion cutting during aircraft escape and the point of measurement of bombing in the cockpit of the aircraft was analyzed according to the overpressure evaluation standard stipulated in the safety threshold of auditory damage by impulse noise. Then, simulated design was initiated based on the spatial and temporal characteristics of the instantaneous ejection of the pilot and on the ejection design of the aircraft cockpit and seat. The instantaneous scenario of explosion cutting during aircraft escape was analyzed and simulated. An experimental platform was built with adjustable points of explosion and measurement that were accurately simulated in each posture of the seat. Finally, ground experiments for detection of explosion cutting were carried out and data was collected and analyzed. Results The simulated design was completed based on the cockpit scenario of explosive cutting during aircraft escape. The values of impulse noise overpressure calculated by the two experiments were 165.9 dB and 165.2 dB, respectively. The results of simulated experiments were consistent with the peak value of impulse noise of the measurement curve. In the experiment, the sound insulation value of the helmet was 21.8 dB and the actual value of sound insulation of the helmet was 22 dB. Conclusion The simulated design of experiments for detection of impulse noise from explosion cutting during aircraft escape can provide data for pilots' protection against hearing damage and other research.

Objective To find out whether the equipment training and high-intensity interval training（HIIT） methods can resist heat stress effectively by monitoring the physiological indicators of the human body during training. Methods Twenty-four male volunteers were assigned randomly to the equipment group（EQUIP）, high-intensity interval training group（HIIT）; and the non-acclimated control group（CON）, respectively. The equipment group completed nine（training for 10 minutes on each equipment）equipment training sessions（90 minutes, 35 ℃ and 70% RH）while the HIIT group accomplished eight（8 exercises, triplicate training for each exercise）HIIT training sessions（40 minutes, 35 ℃ and 70% RH）for ten consecutive days. Both groups rested on the sixth day and all participants completed heat stress tests（HST）at 35 ℃ and 70% RH before（HST1）and after（HST2）training sessions. Throughout training sessions and HST, the rectal temperature（Tre）, skin temperature（Tsk）and heart rate（HR）were recorded. Results It was found that the Tre, average Tsk and average HR of the equipment group and the HIIT group at HST2 were significantly lower than those at CON and HST1（P<0.05）. During the training sessions, the Tre of the equipment group began to decrease significantly on the 3rd day and remained unchanged from the 5th to the 10th day（38.1 ℃~38.2 ℃）. However, the Tre of the HIIT group decreased significantly on the 8th day, and remained between 38.4℃~38.5 ℃ from the 8th to 10th day. The HIIT group had a higher rate of perspiration than the equipment group（t=2.289~4.795, P≤0.001~0.038）, but there was no difference in this rate within the group（P>0.05）. Analysis led to the mathematical equation：T₂ = 0.301 + 0.984 T₁ + 0.01 HRmax（R²=0.578, P<0.001）. Conclusion Equipment training can effectively improve the tolerance of the human body to heat stress, and provide feasible measures for improving heat tolerance of pilots.

氯胺酮相关性膀胱炎（ketamine-related cystitis，KC）是因患者长期或短期吸食氯胺酮引起的临床综合征，以尿频、尿急、尿痛、夜尿增多、每次排尿量减少、排尿困难及膀胱区疼痛不适为主要表现。KC缺乏特异性症状及体征，临床诊断主要依赖于病史采集及尿液检测出氯胺酮或其代谢产物，辅助检查排除其他疾病，可诊断为KC。笔者就氯胺酮、KC流行病学、发病机制、临床表现、诊断与辅助检查及治疗方法等方面进行综述，增强对KC的认识，为其临床诊疗工作提供参考。

Objective To explore and discover the current research status, hotspots, and future trends in the field of mental health of recruits in China. Methods Retrieve 681 published documents in CNKI in the field of mental health of recruits and visualize and analyze the number of articles issued, authors and institutions, and the co-occurrence and mutability of keywords in this field with the help of the scientific metrology software. Results In terms of the number of publications, the research in this field is divided into three stages: slow start（1992-2002）, rapid development（2003-2015）, and gradual retreat（2016-2023）; In terms of authors and institutions, there was a great lack of communication and cooperation between authors and institutions; In terms of the research hotspots, it mainly includes four aspects, namely, the subject group, the mental health-related manifestations, the factors affecting the mental health, and the psychological interventions. In terms of research frontiers, subject to the development of the discipline and the influence of policies, different research frontiers are presented at different time stages, and the recent keywords of psychological resilience, perceptual stress, and sleep quality are still the research hotspots. Conclusion Future research is interdisciplinary to introduce emerging research methods and techniques and to enhance author-institutional collaboration to better serve the mental health of recruits.

Objective To investigate the current competence and expectations of 2 047 flight cadets who were born after 2 000 and 86 instructors in aviation schools in China. Methods A total of 2 047 flight cadets and 86 instructors were investigated. The revised competence questionnaire was used to evaluate their competence. Paired analysis was used to reveal the differences between their current competence and expected levels. Results The current competence of the cadets exceeded the theoretical average. The cadets' evaluation of current factors of competence was lower than that of expected competence（Z=-37.918, -37.383, -36.925, -37.721, -37.008, all P<0.001）. The same was true of instructors（Z=-7.428, -7.062, -7.406, -7.278, -7.235, all P<0.001）, but the cadets' evaluation of current factors of competency was higher than that of instructors（Z=2.47, 3.34, 3.35, 3.39, 2.98, P=0.014, 0.001, 0.001, 0.001, 0.003）, so was their evaluation of the expected factors of competence（Z=8.71, 10.05, 8.92, 11.04, 9.30, all P<0.001）. In addition, ideological competence was considered the most important by cadets and instructors alike. Conclusion The cadets' competence remains to be improved. Ideological competence is considered the most important competence among cadets and instructors. There is a need to synchronize the expectations of competence as well as the importance of different competence factors among cadets and instructors.

Objective To study the effect of flight height of medical rescue aircraft on the efficacy of sputum suction on board. Methods The internal environment of medical rescue aircraft at flying heights of 0 m, 1 000 m, 2 350 m, 3 350 m, and 4 300 m above sea level was simulated using low-pressure chambers. Artificial sputum of the same viscosity was used as the sample for experimentation. The same sputum suction equipment and procedures were adopted during the sputum suction test for the injured. The time taken by sputum suction was recorded separately. Results Under simulated conditions of a medical rescue helicopter flying at five different altitudes from the ground, the time required to suction 5 ml of simulated sputum gradually increased as the simulated flight altitude increased. The suction time at a height of 0, 1 000, 2 350, 3 350 m and 4 300 m respectively was（4.26±1.13）, （5.09±0.30）, （9.37±1.00）, （11.75±0.78）s and（15.54±0.92）s. The results of the analysis of variance showed that there was no statistically significant difference（P=0.27）between the sputum suction time at a flight altitude of 1 000 m and 0 m, while the differences in sputum suction time at flight altitudes of 2 350, 3 350, 4 300 m and 0 m were all statistically significant（all P<0.001）. The pairwise comparison results showed that there were statistically significant differences in the suction time at heights of 2 350 m and 1 000 m（P<0.001）, 3 350 m and 2 350 m（P<0.001）, and 4 300 m and 3 350 m（P<0.001）. Conclusion The increase in flight altitude of medical rescue aircraft will increase the time required for each sputum suction, reducing the efficiency of sputum suction and increasing the risk of suffocation for patients. As flight altitude increases, effective measures such as increasing negative pressure and humidifying the airway should be taken to ensure the effectiveness of sputum suction on board.

Objective To find out about the mental health status and related changes among military personnel in scattered and remote troops in the past ten years, and to provide data for mental health assessment and interventions. Methods The literature that met the criteria for assessment was retrieved from CNKI, VIP and Wanfang databases using SCL-90 before meta-analysis was conducted using meta-package in R software. Results Sixteen studies were included after data screening, involving 5 375 subjects, whose scores of depression, interpersonal sensitivity, somatization, and anxiety factors were significantly higher than the military norm（2016 version）（WMD = 0.29, 0.26, 0.26, and 0.24, respectively while P values were<0.001）. The subgroup test showed that scores of interpersonal sensitivity and obsessive-compulsive factors were different between geographical groups（Q=12.8, 5.83, P<0.01, =0.05）. Meta-regression analysis showed that score of interpersonal sensitivity was influenced by the year the study was conducted and by the sample size of the experimental group, the score of depression factors was affected by the sample size of the experimental group while the score of hostility factors varied according to the age of the subjects. Conclusion The psychological health status of military personnel in scattered and remote troops is significantly lower than the military norm（the 2016 version）. The problems involve depression, interpersonal sensitivity, somatization and anxiety.

Objective To explore the effects of simultaneous physical activities on subjective load perception, work performance and heart rate variability（HRV）in the process of accomplishing cognitive tasks. Methods Thirty-three eligible male subjects completed 2-back cognitive tasks under three isotonic physical load conditions（0, 3, 5 Kg）of the left upper limb（with one week interval between conditions）, and their ECG signals were collected during the whole process. After the task, the National Aeronautics and Space Administration-Task load index（NASA-TLX）scale was used to evaluate the subjective task load of the subjects, and their cognitive performance（mean reaction time, correct rate, etc.）was recorded. Results Compared with none physical activity, moderate physical and high physical activities significantly increased subjects' subjective load during cognitive tasks（t=2.235~14.841, all P<0.05）, average reaction time（t=－2.263, －3.284, P=0.031, 0.002）and the wrong responsing rate of cognitive tasks（Z=－2.978, P=0.003）. At the same time, the physical load also significantly increased the operator's heart rate（Z=－4.899, P<0.001）and the low-frequency power value of heart rate variability（Z=－2.253, P=0.024）, while high frequency components were significantly decreased（Z=－2.010, P=0.044）. However, there was no statistical difference in functional status between medium and high physical load（P>0.05）. Conclusion During cognitive tasks, the physical load of the operator will further intensify the perception of task load, reduce execution ability, and cause the increase of sympathetic nerve tension. The results of this research provide a theoretical basis for the real-time evaluation of pilots' mental load in flight.

随着空军战训模式的转变，飞行员面临跨昼夜、长航时飞行等挑战，身心负荷加重，飞行疲劳问题突出。因此，及时有效地检测飞行员的疲劳程度，合理安排作息，对于预防人为事故、保障飞行安全具有重要意义。笔者阐述飞行疲劳的概念与产生原因，总结分析国内外疲劳检测方法及其在飞行领域的应用，展望飞行疲劳检测技术的发展前景，旨在为相关研究工作提供参考。

现代战争中，随着爆炸性武器的大量使用，创伤导致的肺挫伤、爆震性肺损伤及吸入性损伤发生率日益增高，病理上最终都会发展为急性肺损伤和急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS），治疗困难，病死率较高。空运后送能够帮助ARDS伤病员在负伤后几小时内从战术区撤离，在成功转运与快速救治中发挥重要作用。笔者综述美军ARDS伤病员空运后送现况、处置经验与策略，为我军重症伤病员的空运后送配套建设及人才培养提供借鉴。

Objective To explore the therapeutic effect of acupuncture and moxibustion combined with rehabilitation training on patients with peripheral facial paralysis in the acute stage. Methods A study was conducted on 80 patients with acute facial paralysis who were treated in the Physical Rehabilitation Department of Xiamen Special Service Sanatorium of the Army between January 2023 and September 2023. These patients were randomly divided into the control group and the observation group, with 40 patients in each. The control group was treated with acupuncture and moxibustion while the observation group received rehabilitation training plus acupuncture and moxibustion. The clinical efficacy of the two approaches was observed. Results The total effective rate and Portmann score of the observation group after treatment were significantly different from those of the control group（χ²=13.867, t=2.81, 3.98, 3.38, P<0.001, =0.007, <0.001, =0.001）. Conclusion Acupuncture and moxibustion combined with rehabilitation training can facilitate rehabilitation of patients with peripheral facial paralysis in the acute stage, improve the quality of life of patients and proves to be of clinical value.

Objective To analyze the prevalence of hyperlipidemia and related influencing factors in military aircrews, and to provide reference for aviation and health support for pilots. Methods A retrospective survey was used to collect health care data on hospitalized military aircrews in the Air Force Characteristic Medical Center between 2020 and 2021. The prevalence of hyperlipidemia was compared between these patients grouped according to aircraft types, length of flight, jobs, BMI, history of alcohol consumption, history of smoking, blood pressure, age and uric acid levels, respectively. Results The prevalence of hyperlipidemia among the 926 military aircrews was as high as 17.7%. There was no significant difference in the prevalence of hyperlipidemia between aircrews for different aircraft types and jobs, But there was significant difference between aircrews with different lengths of flight（χ²=32.61, P=0.001）. The prevalence of hyperlipidemia was significantly higher among aircrews with hypertension, high uric acid levels and high body mass index than in the normal group（χ²=10.13, 18.82, 33.59, all P=0.001）. Hyperlipidemia was more common among aircrews who smoked cigarettes, and the difference was statistically significant（χ²=20.58, P=0.001）. Multifactorial logistic regression analysis showed that smoking status, body mass index, blood pressure, and uric acid levels were influencing factors of hyperlipidemia（OR=3.080, 1.489, 3.760, 1.629, P<0.001、=0.025、<0.001、=0.026）. Conclusion The prevalence of hyperlipidemia is high among aircrews. Smoking, body mass index, blood pressure and uric acid levels are the influencing factors of hyperlipidemia. Aviation health support should focus on the development of healthy lifestyles among aircrews.

脓毒症是一种由感染引起的全身炎症反应综合征，通常会导致器官功能障碍危及生命。脓毒症治疗的关键步骤包括病原微生物的清除和炎症反应的控制。纳米颗粒是目前治疗脓毒症最有前景的材料之一，不仅可以搭载抗生素与抗菌肽，且一些金属纳米颗粒本身就具有天然抗菌活性，能够加速感染的控制及病原菌的清除，减少抗生素使用量，提升抗感染疗效。此外，纳米颗粒还可以减少炎性介质的产生、加速炎性介质的清除，从而改善脓毒症患者的预后。这些研究为纳米颗粒在脓毒症的临床应用中提供新策略和新视角。

高尿酸血症（hyperuricaemia，HUA）和痛风发病率增高已成为全球问题。目前，国内外有关HUA的危险因素分析的研究颇多，但对于军事飞行员这一特殊群体HUA的流行病学研究分析尚少。笔者就军事飞行员HUA流行病学研究作一综述，以期为军事飞行员制定和实施更为科学合理的预防策略，更好地维护及促进军事飞行员的健康。

Objective To evaluate the effects of corona virus disease 2019（COVID-19）infection on cardiopulmonary function of military aircrews, and to explore methods for aeromedical assessment of post-infection military aircrews. Methods The twenty military aircrews infected with COVID-19 who were hospitalized and underwent physical examination in the 900th Hospital of the Joint Logistic Team were selected as the experimental group while another twenty military aircrews without COVID-19 infection that matched in gender, age, BMI and hours of flight were selected as the matched group. Resting pulmonary function test and cardiopulmonary exercise test were performed to evaluate cardiopulmonary function. According to the results of health checkups, the post-infection aeromedical assessment of the military aircrews was carried out in combination with the types of aircraft and jobs. Results The comparison of resting pulmonary function between the two groups showed that there was no significant difference in forced vital capacity（FVC）, peak expiratory flow（PEF）, forced expiratory volume in one second（FEV1）, forced expiratory volume in one second/forced vital capacity（FEV1/FVC）, maximal expiratory flow at 50% of forced vital capacity（MEF50）, maximal expiratory flow at 75% of forced vital capacity（MEF75）, maximal voluntary ventilation（MVV）or the corresponding measured value/predicted value percentage（all P>0.05）. Results of cardiopulmonary exercise tests in both groups showed that the pea exercise power（LOAD）, peak oxygen uptake（VO₂peak）, peak oxygen uptake/kilogram（VO₂peak/kg）, anaerobic threshold（AT）, anaerobic threshold/kilogram（AT/kg）, peak metabolic equivalents（METS）, peak oxygen pulse（O₂pulse max）, peak ventilation volume（VE）and the corresponding percentage of measured value/predicted value in the experimental group were significantly lower than those in the matched group（t=2.611~6.114, all P<0.05）. There was no significant difference in heart rate recovery（HRR）, maximum heart rate（HRmax）, or respiratory exchange ratio（RER）between the two groups（all P>0.05）. The aeromedical assessment of twenty military aircrews infected with COVID-19 showed that eighteen of them were qualified for flying（two of them were confined to flying observation）and two military aircrews were temporarily grounded. Conclusion COVID-19 infection can significantly reduce the cardiopulmonary function of military aircrews, which poses a threat to flight safety. For the purpose of more effective aeromedical assessment, it is recommended that military aircrews within 2 months of COVID-19 infection be required to undergo cardiopulmonary exercise tests（CPET）prior to resumption of flight.

Objective To investigate the risk factors of cerebral small vessel disease（CSVD）in pilots. Methods The clinical data of pilots who were hospitalized at the Air Force Characteristic Medical Center between January 2019 and December 2022 was retrospectively analyzed. The case group consisted of 72 pilots who were diagnosed with CSVD by MRI（n=72）, while the control group was composed of 72 pilots who were selected randomly at the ratio of 1:1 and showed no abnormality as confirmed by MRI（n=72）. The differences in risk factors of CSVD and in flight factors between the two groups were studied. Logistic regression analysis was used to explore the risk factors of small cerebral vascular disease in pilots. Results White matter hypertensity（WMH）and enlarged perivascular space（EPVS）were more common in the CSVD group of pilots. There was a combination of multiple imaging subtypes, and there were far more risk factors in the CSVD group than in the control group. Single factor analysis showed that the total flight time and annual flight time in the CSVD group were longer than in the control group [1 875.00（517.50, 2 975.00）h vs 1 000.00（368.50, 2 200.00）h, P=0.027], [126.83（104.55, 153.35）h vs 115.77（90.50, 136.46）h, P=0.021]. The proportion of smoking pilots and those of high-performance fighters in the CSVD group was higher than in the control group [22% vs 5.6%（χ²=8.36, P=0.004）], [29.2% vs 13.9%（χ²=7.05, P=0.029）]. Binary logistic regression analysis showed that smoking（OR=3.304, 95%CI: 1.172~9.317, P=0.024）, types of aircraft（OR=4.607, 95%CI: 1.596~13.298, P=0.005）and annual flight time（OR=2.699, 95%CI: 1.085~6.716, P=0.033）were risk factors for CSVD. Conclusion Smoking, types of high performance fighters and average annual flight time can impact the occurrence of CSVD in pilots.

Objective To investigate the common psychosomatic diseases and causes among hospitalized military aircrews and those under physical examination, and to provide reference for the prevention and treatment of these diseases. Methods One thousand military aircrews who were hospitalized and underwent physical examination in the 900th Hospital of Joint Logistic Support Force between 2009 and 2023 were randomly selected and divided into the psychosomatic diseases group and non-psychosomatic diseases group. The medical data of these patients was collected to analyze the incidence of common psychosomatic diseases and risk factors. Results Among these military aircrews, there were 311 cases of psychosomatic diseases, including chronic back pain, chronic gastritis, essential hypertension, tension headache, arrhythmia, sleep disorders, oral ulcer, allergic rhinitis, diabetes mellitus and peptic ulcer. The total score of the Symptom Check List-90, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, and psychogenic factor scores of military aircrews were lower than the norm of Chinese soldiers（t=2.961~11.220, all P<0.01）. The total score of the Symptom Check List-90 of military aircrews with psychosomatic diseases and the scores of anxiety, somatization, paranoia, interpersonal sensitivity, depression and hostility were significantly higher than those of aircrews without（t=1.964~4.042, all P<0.05）. Regular Exercise was a protective factor for the common psychosomatic diseases in military aircrews（OR=0.52, P<0.001）. Overweight/obesity, smoking, hyperlipidemia and hyperuricemia were independent risk factors（OR=3.81, 5.11, 1.65, 1.59, P<0.001, <0.001, =0.001, =0.027）. Conclusion The prevalence of psychosomatic diseases in military aircrews is high. While taking psychological interventions seriously, we should work harder to correct unhealthy lifestyles and reduce the incidence of psychosomatic diseases in military aircrews.

心力衰竭是各种病因所致心脏疾病的终末阶段，在老年人群中患病率高达10%~20%，其典型症状与中枢、外周或全身液体过载有关。目前临床上虽有记出入量、临床评分等常规方法指导患者的诊疗，但易因存在部分客观因素影响而产生误差。人体成分分析技术能为心力衰竭的评估及诊疗提供更有价值的数据，从而改善老年心衰患者的预后。笔者就老年心衰患者与人体成分分析技术研究进展进行分析，提出人体成分分析仪针对老年心衰患者的应用价值，为老年心衰患者的诊疗提供新方向。

Objective To bring more artificial intelligence into the design of fighter cockpits based on the pilot-centered concept and by finding out about the specific requirements on the part of fighter pilots. Methods A targeted "Questionnaire on the Intelligent Use of Aircraft Cockpits in the Basic Flight Stage" was designed for a survey. Two hundred and ninety-six male pilots were randomly selected as respondents who were required to recall what they needed to manually observe, judge, and calculate in various flight tasks. The results of the survey were analyzed and expert opinions were solicited before the intelligent design of a new fighter cockpit was proposed. Results A total of 3 182 suggestions were collected, 2 997 of which were related to intelligentization of the cockpit, accounting for 94.19%. A total of 52 requirements on AI of the cockpit were identified, 34 of which were prioritized by pilots. In particular, there were four items that pilots attached importance to in all the five task stages, namely autonomous driving, intelligent voice（including warnings）, intelligent collision avoidance, and voice control. Conclusion The survey results mentioned in this article can provide important reference for optimizing the human-machine adaptability design of control interfaces of fighter cockpits, enhancing the intelligence level of future new fighter cockpits, and reducing the workload of pilots.

Objective To investigate the efficacy and safety of a self-heating Tengfu TCM package. Methods SD rats were divided into the normal control group, model control group, self-heating Tengfu TCM（3.06 g/kg）low, medium, and high dose groups（0.5 h, 3 h, 6 h），traditional Tengfu TCM package group（12.42 g/kg, 0.5 h）, and diclofenac diethylamine emulsion group（0.125 g）according to body weight. An acetic acid-induced pain model and a cotton ball granuloma hyperplasia model in rats were used respectively, and the number of twists, latency and cotton ball granuloma hyperplasia in rats were determined to reveal the differences between the self-heating Tengfu TCM low-, medium-, and high-groups on one hand and the traditional Tengfu TCM group and the diclofenac diethylamine emulsifier group on the other hand. The skin irritation and skin sensitization of self-heating Tengfu TCM packages were investigated via skin irritation tests in experimental rabbits and patch tests in guinea pigs. Results The medium-and high-dose self-heating Tengfu TCM packages Compared with the model control group, The difference was statistically significant（P=0.016, P=0.007）; traditional Tengfu TCM group Compared with low-dose self-heating Tengfu TCM packages The difference was statistically significant（P=0.029）. Comparison of latency in diclofenac diethylamide group with model control group, The difference was statistically significant（P=0.008）, high-dose self-heating Tengfu TCM packages Granuloma weight Compared with the model control group The difference was statistically significant（P=0.016）. The self-heating Tengfu TCM package caused no irritation or sensitization to the skin. Conclusion The self-heating Tengfu TCM package has properties of analgesia and anti-inflammation, and it is safe for transdermal administration.

Objective To investigate the efficacy of Vitapex paste and calcium hydroxide paste against apical periodontitis with sinus tract in flight personnel. Methods Sixty pilots with periapical periodontitis admitted to our hospital between 2019 and 2022 were selected as the subjects and randomly divided into two groups with 30 cases in each. The 30 patients treated with calcium hydroxide paste served as the control group while those treated with Vitapex paste combined with minocycline and ornidazole were assigned to the observation group. The therapeutic effect, levels of factors of inflammation and adverse reactions of the two groups were observed. Results The total effective rate was 100.00% in the observation group, compared with 76.67% in the control group, so the difference was statistically significant（χ²=5.822, P=0.016）. There was no significant difference in VAS scores between the two groups before treatment（t=0.079, 0.112, 0.261, P=0.938, 0.911, 0.795）, but the VAS score of the observation group was significantly lower than that of the control group 14 days after treatment（t=2.925, 2.516, 9.068, P=0.005, 0.015, <0.001）. Adverse reactions included stomach discomfort, infections and headache. The incidence of adverse reactions was 10.00% in the observation group and 3.33% in the control group, so there was no significant difference between the two groups（χ²=0.268, P=0.605）. Conclusion Vitapex paste combined with minocycline and ornidazole is effective in treating periapical periodontitis, which can help control bacterial infections of teeth of the flight personnel and quicken dental diagnosis and treatment during recuperation so that they can return to work sooner.

军事训练的难度和强度不断提高，及体育活动的规范性不足等因素，导致前交叉韧带（anterior cruciate ligament，ACL）损伤在军人群体中变得更加常见。这种损伤不仅会限制膝关节的功能，甚至可能提前终止患者的军事生涯，给军队的战备力量造成损失。笔者通过在中国知网、维普、Web of Science、PubMed等数据库查阅77篇相关文献，对ACL损伤的流行病学、危险因素、诊断、治疗和康复训练等方面进行综述，旨在为临床诊疗工作和制定预防措施提供参考。

视觉诱发运动不耐受（visual induced motion sickness，VIMS）是一种主要由视觉系统刺激引起的运动不耐受，典型表现为恶心、眩晕或定向障碍、眼睛疲劳等。VIMS是人体一种正常生理反应，但当其症状严重到产生负面影响时被认为是视觉诱发运动病（visually induced motion sickness disorder，VIMSD）。现代仿真技术发展迅速，已逐渐渗透到人们的医疗、教育、娱乐、工作等多个方面，VIMS对于仿真技术的发展及个体的身心健康有重要影响。本研究从VIMS的易感因素、发病机制、主观和客观评价方法及治疗手段4个方面对VIMS的研究进展进行综述，为VIMS的深入研究提供理论基础。

Objective To establish a rat fracture model to study the regulatory effects of dexmedetomidine on anxiety and hippocampal neuroinflammation caused by fractures in rats. Methods Forty adult male Wistar rats were randomly divided into four groups in a free drinking water mode: the control group（blank control group）, DEX group（dexmedetomidine group）, surgery group （right femur osteotomy）, and surgery +DEX group（intraperitoneally injected with 12μg/ kg DEX after fracture）. At 6 h, 24 h and 7 d after the establishment of the model, the anxiety of the rats was measured via fright response, the expressions of inflammatory factors（TNF-α, IL-1β, IL-6）in the serum and hippocampal tissue of the rats were detected by ELISA, and the apoptotic cells in the hippocampus were quantified by TUNEL staining. Western blot was used to detect the expressions of TNF-α, IL-1β, IL-6, nNOS, NOX2, 4-HNE, Bax and Bcl-2 proteins in the hippocampus. Results Compared with the control group, the serum levels of TNF-α, IL-1β and IL-6 and the mRNA levels of TNF-α, IL-1β and IL-6 in the hippocampus of the operation group were increased（P<0.001）, and the number of apoptotic cells was increased. The expression levels of Bcl-2（P<0.001）and nNOS（P=0.001）in hippocampus were decreased, while the expression levels of Bax（P<0.001）and 4-HNE（P=0.001）, NOX2（P=0.003）and ROS（P=0.009）in hippocampus were increased. The serum levels of TNF-α, IL-1β and IL-6 and the mRNA levels of TNF-α, IL-1β and IL-6 in hippocampal tissue were decreased in the operation +DEX group（P<0.001）, the number of apoptotic cells and the level of Bax protein were significantly decreased（P=0.008）. The levels of 4-HNE（P<0.001）,NOX2（P<0.001）and ROS（P=0.008）in hippocampus were decreased, while the expression levels of Bcl-2（P=0.005）in neurons and nNOS（P<0.001）in hippocampus were increased. Conclusion Dexmedetomidine can significantly improve the anxiety state, reduce neuroinflammation and neuronal apoptosis in rats with fractures.

Objective To measure the daily energy expenditure of aircrews so as to provide data for studies on energy metabolism and to explore a new method to monitor energy expenditure for aircrews. Methods The total daily energy expenditure of 59 aircrews from 4 aviation units was calculated via life observation and actigraphy. The differences and correlations between the two methods were observed. Results The total daily energy expenditure measured by means of life observation and actigraphy was（3 102.1±372.4）kcal and（2 957.8±422.2）kcal, respectively. There was statistically significant difference between the two methods（t=3.170, P=0.002）, but strong correlations were also found between the two methods（r=0.619, P<0.001）. Conclusion The results of measurement by life observation and actigraphy are closely correlated. Actigraphy can replace life observation in measurement of the total energy expenditure of aircrews.

Objective To study intestinal flora changes in patients with ischemic stroke, and to explore their correlations with prognosis and T helper cell type 1/T helper cell type 2（Th1/Th2）immune cell balance. Methods One hundred and six patients with ischemic stroke admitted to our hospital between January 2020 and March 2022 were enrolled and received intravenous thrombolytic therapy. After discharge, the prognosis of patients was evaluated using the Modified Rankin Scale（mRS）after 90-day follow-up. These patients were divided into the good group（mRS score ≤2, n=71）and poor group（3 <mRS score <6, n=35）according to the mRS score. The intestinal flora composition and levels of Th1/Th2 and related cytokines were compared between the two groups. Pearson correlation analysis was conducted to reveal the correlations between the relative abundance of intestinal flora and the levels of Th1/Th2 and related cytokines in these patients. Results Chaol index and Shannon index were lower in the poor group than in the good group（t=7.025, 5.033, all P<0.001）. The abundance of Firmicutes and Prevotella was decreased in the poor group（t=11.475, 6.514, all P<0.001）, while the abundance of Bacteroides and Escherichia was increased compared with the good group（t=19.289, 7.826, all P<0.001）. The poor group had elevated serum levels of interleukin-2（IL-2）and interferon-γ（IFN-γ）（t=12.685, 25.814, all P<0.001）but decreased levels of Th1/Th2, IL-4 and IL-5 compared with the good group（t=5.066, 12.793, 11.476, all P<0.001）. The results of Pearson correlation analysis suggested that Bacteroidetes and Escherichia were negatively correlated with Th1/Th2, IL-4, and IL-5（r=-0.604~-0.376, P<0.05）, but positively with IL-2 and IFN-γ（r=0.439~0.623, all P<0.05）. Firmicutes, Prevotella, Chao1 index, and Shannon index were positively correlated with Th1/Th2, IL-4, and IL-5（r=0.428~0.623, P<0.05）, but negatively with IL-2 and IFN-γ（r=-0.584~-0.397, P<0.05）. Conclusion Changes in intestinal flora in patients with ischemic stroke are associated with poor prognosis and levels of Th1/Th2 and related cytokines.

慢性颈痛是常见慢性疾病，具有高患病率、高复发率等特点，有效的自我管理能够改善患者的疼痛程度和生活质量。随着移动设备和信息技术的快速发展，数字健康越来越多地应用于慢性颈痛患者的自我管理中。笔者对慢性颈痛患者的自我管理、数字健康的发展背景和现状以及数字健康在慢性颈痛患者自我管理中的应用进行总结，旨在为慢性颈痛患者自我管理的应用和设计提供借鉴。

Objective To explore the mechanism of action of naringin in the treatment of atherosclerosis based on network pharmacology and vitro cellular assays. Methods The PubChem platform and Pharmmapper online analysis platform were used to obtain targets of naringin, and Genecards, PharmGkb, TTD, Disgenet and Drugbank databases were searched for targets related to atherosclerosis diseases. The protein-protein interaction network was constructed to screen for the core targets while the main pathways and target proteins were screened via GO and KEGG enrichment analyses. Molecular docking was performed to determine the molecular basis of the interactions between naringin and the core targets. In vitro experiments were conducted with human umbilical vein endothelial cells（HUVEC）to verify the predicted results. Results A total of 220 potential targets of naringin were screened, 5 253 targets were related to atherosclerosis, and 94 co-acting targets were identified. GO functional annotation resulted in a total of 281 entries, including 215 biological processes, 25 cellular components, and 41 molecular functions. KEGG enrichment revealed a total of 36 pathways related to therapies for atherosclerosis. The molecular docking results demonstrated that naringin bound well to the five core targets. The results of cellular experiments showed that naringin could significantly reduce the migration and adhesion ability of HUVEC. Conclusion Naringin may inhabit atherosclerosis by regulating lipids, proteoglycan in cancer and MAPK signaling pathways through such key targets as the kinase insert domain receptor, recombinant plasminogen activator inhibitor 1 and tissue inhibitor of matrix metalloproteinase-1 which exert anti-atherosclerosis effects by regulating endothelial cell function, angiogenesis, cell proliferation and apoptosis.

Objective Investigate the situation of neck and back pain in flight pilots and cadets, analyze the relevant risk factors, and provide reference for the early and targeted prevention and treatment of neck and back pain in flight pilots and cadets. Methods A questionnaire was used to investigate the incidence of neck and low back pain among pilots, the questionnaire included basic information, military training, physical training, and neck and back pain. 272 flight personnel divided into the instructor group and cadet group. Both groups were re-divided into a group with neck and low back pain and one without. Univariate analysis was conducted to identify risk factors for neck and low back pain. Results Among the 272 pilots, 75（27.6%）suffered from neck and low back pain, including 15 cadets（9.3%）and 60 instructors（54.5%）, so the difference was statistically significant（χ²=67.279, P<0.001）. Forty-one pilots were afflicted with chronic neck and low back pain（15.1%）, including 4 cadets（2.5%）and 37 instructors（33.6%）, and the difference was statistically significant（χ²=49.714, P<0.001）. The difference in the incidence of neck and back pain between pilots of different age groups, BMI, and flight time was statistically significant（χ²=64.022, 23.585, 73.262, all P<0.001）. The incidence among pilots ages 31 and older, with a BMI of above 24 kg/m²and a flight time over 1 000 h was higher than among those ages 30 and younger, whose BMI was below 24 kg/m² and flight time was 1 000 h or less（all P<0.05）. There were statistically significant differences in military training, physical training, and neck and back pain among flight trainees and instructors with or without neck and back pain in each group（all P<0.05）. The risk factors for neck and low back pain among pilots included a cumulative flight time of over 1 000~2 000 h（OR=14.191, 95%CI: 4.213~47.802, P<0.001）and 2 000 h（OR=18.412, 95%CI: 6.850~49.492, P<0.001）, invasive treatment（OR=13.835, 95%CI: 2.264~84.549, P=0.004）, poor posture（OR=3.937, 95%CI: 1.649~9.398, P=0.002）and improper methods of exercise（OR=2.735, 95%CI: 1.096~6.824, P=0.002）. The risk factors in the instructor group included a flight time of over 1 000~2 000 h（OR=115.580, 95%CI: 3.164~4 221.890, P=0.010）and 2 000 h（OR=197.790, 95%CI: 5.226~7 486.187, P=0.004）, lack of guidance for prevention and treatment of neck and low back pain（OR=20.010, 95%CI: 3.932~101.836, P<0.001）, poor posture at ordinary times（OR=4.586, 95%CI: 1.232~17.075, P=0.023）and too long a single flight（OR=5.346, 95%CI: 1.347~21.212, P=0.017）. Conclusion The prevention and treatment of neck and low back pain require attention to both flight related factors and non-flight factors so as to effectively reduce the prevalence of neck and low back pain among flight personnel.

Objective To find out whether electrodermal activity（EDA）can be used for accurate assessment of motion sickness in order to provide reference for precise medical selection of teenager flying cadets. Methods A total of 350 students were selected randomly from teenager aviation schools who attended the final stage of medical selection. A 90-second Coriolis acceleration endurance test was performed among these students. A wearable monitoring system was used to collect EDA at the same time. The Graybiel method was adopted to evaluate autonomic nerve symptoms. According to the Graybiel score, it is divided into Group A: Graybiel=0 points, Group B: Graybiel score 1~2 points, and Group C: Graybiel ≥ 3 points. The correlation between changes in EDA and Graybiel scores was analyzed. Results With the subjects with incomplete indicators excluded, 301 students were included in this study. It was found that EDA was significantly increased in students with motion sickness, who were divided into three groups according to the total Graybiel scores: 0 point（n=173）, 1~2 points（n=102）, and ≥3 points（n=26）groups. The post-test skin conductance reaction（SCR）and skin conductance level（SCL）were significantly higher in the last two groups than in the first group（H=-5.408, -6.781, -3.002, -2.772, P<0.001, <0.001, =0.008, =0.017）. The pre-test SCL was significantly higher in the second group than in the first group（H=-3.019, P=0.008）. Conclusion Our results indicate that EDA can be a useful index for objective evaluation of motion sickness. Real-time EDA data combined with Graybiel scores can help identify motion sickness during medical selection of Air Force cadets.

空间导航是基于自身位置和外在环境构建复杂的认知地图，从而实现正确导航的过程。人类将同种异体中心和自我中心2种不同的参考系相结合，进行路线规划，导航到正确的目的地。空间导航能力与飞行安全密切相关，近几十年来国内外空军一直在对飞行空间定向障碍进行研究和实践，但至今因飞行空间定向障碍造成的严重飞行事故仍然非常严重，也是A级飞行事故的主要原因。笔者综述不同空间导航参考系相关脑区的激活信息以及空间参考系在导航中的作用，从而探究人类导航与空间参考系之间的关系。基于现有研究，使用合适手段，如静息态功能磁共振等，对脑区激活和信息传导进行进一步研究，可以为选择合适的人群从事飞行等空间导航相关工作提供依据，对为飞行员制定个性化的空间导航能力训练方案具有现实意义。

目的 探究易栓症的诊断、治疗以及对空军飞行员飞行的影响及医学鉴定。方法 对1例军事飞行员易栓症的诊治及航空医学鉴定过程进行分析，并文献复习。结果 该飞行员因左下肢肿痛诊断左下肢静脉血栓，之后又先后出现右下肢静脉血栓、肺动脉分支血栓形成；易栓症检查：蛋白S下降，血管性血友病因子（von willebrand factor，vWF）活性、vWF抗原、Ⅷ因子（factor Ⅷ，FⅧ）活性升高；血栓性疾病相关基因二代测序检测：HABP2突变，c.1518+1G>C突变频率50%，血、口腔黏膜上皮细胞HABP2突变一代测序检查阳性。诊断：易栓症，蛋白S缺陷症。给予利伐沙班口服。航空医学鉴定结论为飞行不合格。结论 飞行人员反复出现静脉血栓、动脉血栓，应查易栓症相关指标，尽早明确诊断，易栓症患者需要长期口服抗凝药物治疗，以预防血栓再发。该类飞行人员在航空环境下，存在再发血栓风险及口服抗凝药物所致的自发出血风险，建议停飞。

Objective To find out about the current incidence of xerophthalmia in military pilots and analyze the causes. Methods A total of 660 military pilots who sought treatment at the 988th Hospital of the Logistic Support Force between March 2021 and January 2023 were selected as the subjects. A survey involving questionnaires about basic information, Ocular Surface Disease Index（OSDI）surveys, and ophthalmological examinations were conducted. Chi-square tests were used to analyze the factors contributing to xerophthalmia in military pilots, and factors with statistically significant differences were analyzed using binary logistic regression analysis. Results The results of OSDI showed that 45.45%（300/660）of the pilots had signs of dry eyes, including mild dry eye signs（81.67%, 245/300）, moderate dry eye signs（10.00%, 30/300）and severe dry eye signs（8.33%, 25/300）. Based on diagnostic criteria for xerophthalmia, pilots diagnosed with xerophthalmia accounted for 8.94%（59/660）. Logistic regression showed that the age ranged from 41 to 50 years（OR=3.089, P=0.010）. Total flight time: >1 500~2 500 h（OR=6.352, P=0.003）, >2 500~3 500 h（OR=4.626, P=0.010）, >3 500~5 000 h（OR=9.210, P<0.001）, >5 000 h or more（OR=26.577, P=0.001）. Frequent dry mouth during flight（OR=5.924, P=0.032）, daily use of video display terminal >4 h（OR=4.631, P=0.005）were the risk factors for dry eyes. And watching video display terminal >1 h without resting eyes（OR=0.143, P<0.001）was the protective factor for dry eyes. Conclusion The prevalence of xerophthalmia among military pilots is relatively high, suggesting the need to exercise more effective control over xerophthalmia as required by pilots in order to prevent the occurrence and progression of xerophthalmia.

Objective To analyze the clinical characteristics and pregnancy outcomes of pregnancy-associated fulminant type-1 diabetes. Methods The clinical data of 43 patients with pregnancy-associated fulminant type-1 diabetes collected from domestic and foreign databases, and of 5 patients from our hospital was included for analysis. Results The majority（62.5%）of patients had onset of symptoms in the third trimester of pregnancy. Gastrointestinal symptoms and hyperglycemic symptoms were common. Eight cases（16.7%）of live birth were reported, There is no statistically significant difference in live birth rates between domestic and international patients. The average interval between onset and treatment was 0.50 for foreign patients, compared with 2.19 for domestic ones with a significant difference（t=2.060, P=0.045）. Meanwhile, no significant difference was observed in results of laboratory tests, such as glucose levels, blood sodium or potassium concentrations（P>0.05）. However, there was significant difference in the onset of gestational age between patients with live birth and those with fetal loss（35.17 weeks vs.32.54 weeks, t=2.076, P=0.047）. There is no statistically significant difference between other clinical features. Conclusion Patients with pregnancy-associated fulminant type-1 diabetes are likely to present with various clinical manifestations, which rapidly progress to critical illness with a high percentage of fetal loss. Obstetricians should be alert to this risk in order to improve maternal and neonatal outcomes through early intervention.

睡眠障碍目前已成为严重影响人们身心健康及工作生活质量的公共卫生问题，高海拔特殊环境下人体睡眠结构及体内激素变化，更易导致睡眠障碍。在此环境下，军事人员发生睡眠障碍的概率增加，影响个体战训效能及部队战斗力，因此，该类人群的睡眠状况更值得关注。寻找一种安全、有效的方式来改善睡眠，提高特殊环境军事人员的战训效能是卫勤保障部门的重要职责。褪黑素以其半衰期短、有效改善睡眠、不影响次日工作效能及增强体能等优点引起人们广泛关注。笔者以高海拔地区军事人员睡眠状况为出发点，将褪黑素改善睡眠的优点和其在特殊作业环境中的应用价值作为重点进行综述，为褪黑素在高海拔特殊环境下军事人员中的应用提供依据。