飞行人员颈动脉粥样硬化的初步随访观察研究

目的 探讨飞行人员颈动脉粥样硬化（carotidatherosclerosis,CAS）随访的临床意义及进展的相关危险因素。方法 对2016年1月—2019年12月在空军特色医学中心诊断为CAS且伴有至少1项动脉粥样硬化危险因素的飞行人员进行飞行情况和CAS进展的随访。比较CAS进展组和无进展组的动脉粥样硬化危险因素和飞行因素的差异。结果 35例CAS飞行人员的平均年龄为（49.43±5.57）岁,其中含14例（40%）内中膜增厚者,21例（60%）斑块形成者。随访时间为6～55个月。部分飞行人员因合并冠状动脉和颅内动脉狭窄而停飞。22例（63%）CAS无进展,13例（37%）CAS有进展。进展组飞行人员的飞行时间显著长于无进展组[5 000(4 330,9 550)h vs 3 657(2 575,5 400)h,P=0.018],高血压及高脂血症的患病比例明显高于无进展组[8(61.5%)vs 4(18.2%),P=0.024;12(92.3%)vs 12(54.5%),P=0.027]。多因素Logistic回归分析提示年龄（P=0.026,OR=26.496）和高血压病（P=0...     

无症状性脑动脉狭窄飞行人员的初步随访研究

目的 观察无症状性脑动脉狭窄飞行人员的预后。方法 随访诊断为无症状性脑动脉狭窄的3例飞行人员,观察其脑血管事件、脑动脉狭窄的进展程度、脑灌注情况及飞行状况。结果 3例无症状性脑动脉狭窄飞行人员,随访3～72个月,均未发生急性症状性脑血管事件。其中1例为左侧颈内动脉狭窄,狭窄程度及灌注均无变化,航空医学鉴定结论：特许飞行合格,放飞后截止投稿日已飞行1 600 h。其余2例分别为左侧大脑中动脉狭窄和左侧大脑前动脉狭窄,脑血管造影及脑灌注提示侧支循环好,航空医学鉴定结论：特许飞行合格,放飞后截止投稿日飞行时间分别为500 h和150 h。结论 部分无症状性脑动脉狭窄飞行人员经过全面详细评估与严密监测后是可能安全飞行的,但其对飞行的影响仍需进一步研究。     

飞行人员强直性脊柱炎治疗后特许飞行的临床研究

目的 探讨飞行人员强直性脊柱炎（ankylosing spondylitis,AS）治疗后特许飞行的可行性。方法 选取2010年1月—2019年8月空军特色医学中心（原空军总医院）确诊的飞行人员AS患者,根据航空医学鉴定结果分为飞行合格组及飞行不合格组（包括停飞及地面观察超过6个月）,比较2组在年龄、飞行时间、病程、炎性指标及治疗方案的差异。结果 共纳入飞行人员AS患者20例,飞行合格组14例,飞行不合格组6例,飞行不合格组C反应蛋白水平高于飞行合格组（t=-2.95,P<0.05）,差异具有统计学意义;飞行不合格组中5例（83.3%）应用生物制剂,飞行合格组中2例（14.3%）应用生物制剂,2组比较差异具有统计学意义（83.3%vs 14.3%,P<0.01）;2组在年龄、飞行时间及病程方面比较差异无统计学意义;飞行合格组在飞行期间未发生安全事故;1例患者特许飞行合格后21个月病情复发。结论 部分飞行人员AS患者治疗后给予特许飞行具有可行性,飞行期间应定期进行病情评估。     

飞行人员无症状脑梗死的研究现状与进展

目的 综述国内外飞行人员无症状脑梗死（asymptomatic cerebral infarcts,ACI）的研究现状和进展. 资料来源与选择 国内外公开发表的相关文献. 资料引用 引用文献资料36篇. 资料综合 ACI在飞行人员中具有较高的发生率.除了一般血管危险因素,飞行高度和机型等飞行因素也与ACI相关.低压、高G值载荷、飞行中滞动及右向左分流等是造成ACI的主要原因.由于缺乏ACI的航空医学鉴定标准,飞行人员ACI的医学鉴定通常参照症状性脑血管病的标准.结论 飞行人员ACI不仅与常见血管危险因素有关,还受诸多飞行因素的影响.解决飞行人员ACI的治疗、预防和飞行适应性评价等问题,需要开展ACI预后观察、综合防治及飞行适应性评价研究.     

C反应蛋白与白细胞介素-6对急性脑梗死复发风险预测价值

目的 探讨炎症因子C反应蛋白（CRP）与白细胞介素（IL）-6对急性脑梗死（ACI）复发风险的预测价值。方法 选取铜陵市立医院自2020年3月至2021年12月收治的115例ACI患者为研究对象。根据患者随访90 d的结果对患者进行分组,脑梗死复发28例纳入复发组,87例未复发者纳入未复发组。比较复发组和未复发组患者的性别、年龄、体质量指数、吸烟史、饮酒史、既往病史、发病至入院时间、入院时美国国立卫生研究院卒中量表（NIHSS）评分、常规血液学检测结果及90 d复发风险评估量表（RRE-90）评分等。将单因素比较中差异具有统计学意义的变量作为自变量进行多因素Logistic回归分析,确定ACI复发的影响因素;绘制受试者工作特征曲线分析血清CRP、IL-6对ACI复发的预测价值。结果 复发组年龄、入院时NIHSS评分、CRP、IL-6、纤维蛋白原、同型半胱氨酸及RRE-90评分明显高于未复发组,差异有统计学意义（P<0.05）。CRP、IL-6、纤维蛋白原及RRE-90评分是ACI患者随访90 d复发的影响因素（P<0.05）。单一RRE-90评分预测ACI患者复发的曲线下面...     

军事飞行人员高血压病诊治4例及航空医学鉴定

目的 总结军队飞行人员高血压病的临床诊治、随访观察及航空医学鉴定体会.方法 对4例高血压病直升机和预警机飞行人员,按2010年中国高血压病防治指南确定心血管危险因素、靶器官损害,进行心血管风险分层,并以此为依据进行治疗,血压达标后进行临床生理学检查及飞行能力评估,并进行带药飞行的临床探索和跟踪观察.结果 4例飞行人员的心血管风险分层分别为高血压病2级(高危)2例和高血压病3级(很高危)2例.在改善生活方式的基础上选用降压药物治疗.地面观察3～6个月,血压控制达标,临床生理学检查正常,飞行能力评估良好,下飞行合格结论,并严密跟踪观察达飞行最高年限.随访时间为400～3000 h.均飞行耐力良好.结论 对直升机和预警机高血压病飞行人员运用降压药参加飞行具有可行性.     

无症状性脑梗死飞行人员头颈部动脉狭窄与停飞情况的研究CSCD

目的观察36例无症状脑梗死（silentbraininfarction,SBI）飞行人员头颈部动脉狭窄情况及飞行适应性。方法回顾空军总医院近10年收治的SBI飞行人员的临床资料,根据检查结果分为头颈部动脉狭窄组和非狭窄组,比较两组的脑血管危险因素。观察在检出SBI后2年内的飞行情况。结果共纳入36例SBI飞行人员,均为男性,其中头颈部动脉狭窄10例（动脉狭窄组）,非头颈部动脉狭窄26例（非狭窄组）。高血压病12例（33．33％）;糖尿病2例（5．56％）;血脂异常5例（13．89％）;吸烟史16例（44．44％）。两组飞行人员的年龄、飞行时间及高血压病患病情况差异有统计学意义（P〈0．05）。36例SBI飞行人员中在观察期内无一例发展为症状性卒中。有6名在观察期内复查MRI时发现SBI病灶增多,但均未出现神经系统功能缺损症状。停飞20例,其中动脉狭窄组停飞6人,非狭窄组停飞14人,停飞与否和头颈部动脉狭窄无明显相关性（P=1．00）。停飞的20名飞行人员中5名因SBI合并中重度血管狭窄（包括头颈部动脉和冠状动脉）,7名伴随反复头晕、头痛症状,2名在地面或飞行训练中出现晕厥,4名伴随焦虑抑郁状态,2名合并其他疾病;无一例因单独的SBI而停飞。结论头颈部血管狭窄的飞行人员2年内的停飞比率未显著高于非狭窄组,SBI不是停飞的直接原因。但由于SBI存在影响飞行安全的潜在风险,应定期进行复查评估。     

磁敏感成像在探测早产儿局灶性脑白质损伤中的研究

目的 应用磁敏感成像(susceptibility weighted imaging,SWI)探测早产儿局灶性脑白质损伤(punctate white matter lesions,PWML)中是否含有微出血成分,观察病灶的演变.资料与方法 对27例行头颅常规MRI、扩散加权成像(DWI)表现为PWML的早产儿同期增加SWI扫描.观察PWML在SWI的相应位置上是否表现为低信号,观察随访常规MRI.结果 1例患儿MRI示左侧侧脑室下角旁簇状短T1、短T2信号,DWI示相应病灶高信号,SWI示相应病灶低信号.26例MRI示双侧半卵圆中心、侧脑室旁、后角、前角旁短T1伴或不伴有短T2信号,DWI示相应病灶处高信号,部分病灶范围增大,SWI示相应病灶高信号.其中病灶呈线状者8例,簇状者12例,混合型7例.7～22天后,随访到其中17例患儿.10例(10/17)病灶呈簇状者随访期MRI上病灶吸收、部分消失,7例(7/17)病灶呈线状、混合状者出现脑室旁白质软化灶(periventricular leukomalacia,PVL).结论 绝大多数PWML在SWI上表现为高信号,提示PWML中不含微出血成分.病灶形态呈线状、混合状者,晚期有发展成PVL的可能.     

"治未病"干预下住院飞行人员腰肌劳损的效果观察

目的 以"治未病"促进飞行人员腰肌劳损康复.方法 选择住院飞行人员120例,采用随机数字表法分为对照组和观察组各60例.对照组行腰肌劳损的常规治疗.观察组以"治未病"思想为指导,按照"未病先防""既病防变""瘥后防复"实施健康教育、物理治疗、腰背肌锻炼、健康随访等干预.结果 出院后随访第1、2个月治疗效果比较,2组差异疗有效率无统计学意义(P>0.05);出院后3、6、12个月随访,观察组治疗有效率高于对照组,差异有统计学意义(P<0.05).结论 "治未病"持续指导有利于提高住院飞行人员腰肌劳损的治疗效果.     

扩散加权成像在早期诊断早产儿局灶性脑白质损伤及其预后的价值

目的探讨扩散加权成像(DWI)在早期诊断早产儿局灶性脑白质损伤(punctate white matter damage,PWMD)及其预后的价值。资料与方法搜集PWMD早产儿39例资料。患儿均在生后两周内进行头部MR、DWI(b=1000s/mm2)扫描且被确诊为PWMD。随访患儿头部MRI及生长发育情况。观察患儿早期DWI上病灶的数量、形状、分布;观察随访期病灶演变及对临床预后的影响。结果早期DWI上PWMD病灶数量<3个13例,3～10个10例,>10个16例;早期DWI上病灶呈簇状22例(簇状病灶组),呈线状11例(线状病灶组),呈混合型6例(混合型病灶组)。病灶分布只位于侧脑室旁者9例,只位于侧脑室后角旁者13例,位于半卵圆中心、侧脑室旁、后角、前角旁等部位者17例。随访0.6～22个月后,簇状病灶组22例头部MRI示病灶吸收消失,未见异常信号灶。20例智力发育指数(mental development index,MDI)>80,神经运动发育指数(psychomotor devel-opment index,PDI)>80,2例语言发育障碍,MDI<69,PDI>80;线状病灶组7例头部MRI出现...     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.