飞行员甲状腺功能亢进症治愈放飞一例

一、临床资料 患者,男性,36岁,运-7飞行员,总飞行时间1400 h.因发作性四肢无力1月余,伴怕热、多汗、心悸、体重下降,于2007年3月27日入院.有甲状腺功能亢进症家族史（家中1姐1妹及1堂姐患本病）.人院查体：心率84次/min,血压120/80 mm Hg.体重59.5 kg.突眼征阴性,甲状腺Ⅰ度肿大,未闻及血管杂音.心肺腹查体无阳性体征,四肢肌力Ⅴ级,双手平举时可见轻微震颤,肌张力正常.     

Analyser les procédures et les modalités d’évaluation du handicap à la lumière de la Convention des Nations unies relative aux droits des personnes handicapées : proposition de guide méthodologique

The implementation of the UN Convention on the Rights of Persons with Disabilities (CRDP) implies that signatory States, among other obligations, take the necessary measures to allow persons with disabilities “to live in the community, with choices equal to others” (art. 19). To undertake support services and provisions, development policies promoting social inclusion and participation of disabled persons, international organisations (UN, World Bank, European Disability Forum…) recommend that State parties develop disability assessment mechanisms and eligibility criteria for services and benefits consistent with the Convention. Many countries, notably developing countries, are in need of guiding tools and methods to analyze and reform their disability assessment systems and procedures in light of the Convention. This article presents the results of a research conducted in 2011–2012. Based on articles of the Convention on one hand, on a review of international literature on the definition of disability and disability assessment mechanisms on the other hand, and continuous consultation of disabled persons organisations in seven low and middle income countries (India, Nepal, Uganda, Philippines, Romania, Rwanda and Tunisia) and two OECD countries (Belgium and France), the study resulted in identifying a number of issues related to disability assessment mechanisms and in developing a methodological guide for private and public stakeholders. This guide allows describing and analyzing disability assessment and eligibility mechanisms in a given country, in order to develop indicators with a view to proposing reforms.     

飞行学员肾下垂两年跟踪随访研究

目的 观察飞行学员肾下垂随时间的变化情况,为招飞体检时肾下垂医学鉴定标准掌握提供参考. 方法 对招飞体检时肋下可触及肾脏的86名飞行学员(观察组)和随机选择的肋下未触及肾脏的51名学员(对照组)进行跟踪随访,并将观察组按照立位深吸气时是否肋缘下可触及右肾一半以上进一步分为肾下移组(63名)和肾下垂组(23名),观察其在基础学习训练期间的健康状况,两年后复查肾脏触诊和超声检查肾脏位置变化情况,以及有无运动后血尿,对检查结果 进行对比分析. 结果 经过两年学习训练,观察组飞行学员体重增加.超声测量右肾脏下极距右髂后上嵴距离显示:对照组学员肾脏位置无明显变化[(6.0±0.7)cm比(5.9±1.0)cm,t=0.668,P＞0.05],肾下移组肾脏位置有所下降[(5.3±1.0)cm比(5.6±0.7)cm,t=2.961,P＜0.01],肾下垂组肾脏位置下降更明显[(3.9±0.6)cm比(5.3±0.4)cm,t=10.451,P＜0.01].肾下垂组有2名飞行学员出现劳累后腰酸、腰痛等临床症状. 结论 通过两年航空大学常规基础体能训练,肾下移和肾下垂飞行学员肾脏位置没有改善,反而进一步下移,建议招飞体检时应进一步重视肾下垂的检查和医学鉴定,必要时结合超声检查进行评定. Abstract： Objective To observe the change of nephroptosis with time in flying cadets and provide references to the evaluation standard of diagnosing nephroptosis in selection of flying cadets.Methods Follow up was taken both for 86 flying cadets with different degree of nephroptosis (observation group) and 51 randomly selected cadets without nephroptosis (control group). The observation group was further divided into kidney descending group ((53 cadets) and nephroptosis group (23 cadets) according to if the half or more kidney could be touched by palpation when cadet was in standing position and holding deep breath. Two years later, kidney palpation and ultrasonic examination were performed again to check the position of kidney and their urine was tested after 3000 m running for inspecting occult blood. All data were compared and analyzed. Results Cadets in observation group showed increased body mass index in two years. The distance between anus perineum of right kidney and right posterior superior iliac spine depended by ultrasound examination was decreased significantly both in kidney descending group [(5. 3 ± 1.0) cm compared to (5. 6 ±0.7) cm, t=2.961, P＜0. 01] and nephroptosis group [(3.9±0.6) cm compared to (5.3±0.4) cm,t=10. 451, P＜0.01] but in control group [(6.0±0.7) cm compared to (5.9±1.0) cm, t=0. 668,P＞0.05]. Two cadets in kidney descending group had a complaint of waist soreness and lumbago after exertion. Conclusions Flying cadets' nephroptosis has not been ameliorated and even more serious in two years of routine exercise in aviation university. The nephroptosis should be paid more attention in selection of flying cadets and diagnosis may be conducted with ultrasonic examination if necessary.     

颅脑损伤后癫痫发作的航空医学鉴定——附病例报告二例

目的 通过回顾性分析民航飞行员颅脑损伤病例及社区病例相关文献,探讨不同程度的颅脑损伤后不同时间段癫痫的发病率和颅脑损伤后癫痫发作的高危因素,以期指导民用航空人员颅脑损伤的医学鉴定.方法 获取并回顾相关颅脑损伤后癫痫发作的流行病学研究,获得社区颅脑损伤病例共9475例,其中重度605例,中度1955例,轻度6915例;民航飞行员重度颅脑损伤申请特许鉴定病例2例.分析并探讨颅脑损伤后癫痫发作的航空医学鉴定.结果 ①重度颅脑损伤后癫痫发病率高于中度,中度高于轻度.②颅脑损伤后随时间推移癫痫发作可能性逐步降低;轻度颅脑损伤1年后癫痫年发病率小于1%,中度颅脑损伤3年后癫痫年发病率小于1%,重度颅脑损伤8年后癫痫年发病率小于1%.③颅脑损伤后癫痫发作高危因素有:脑挫伤、硬膜下血肿、凹陷性骨折及意识丧失或损伤后遗忘大于24 h.④两名颅脑损伤飞行员经及时有效治疗后恢复良好,各项检查未见异常,密切随访期间未见癫痫发作.其中1名飞行员于伤后第4年特许合格,安全飞行2年(1800 h),未见癫痫发作;另1名于伤后第9年特许合格,安全飞行4年(1600 h),未见癫痫发作.结论 根据1%法则,颅脑损伤治愈后,若各项检查未见异常,轻度颅脑损伤1年后可评定为合格,中度3年后可评定为合格,重度8年后可考虑有或无限制的合格鉴定. Abstract： Objective To investigate the incidence of various grade of posttraumatic epilepsy in different time and risk factors by analyzing cerebral trauma cases of civil pilots and correlative literatures.The conclusion is expected to contribute to the aviation medical assessment for the civil pilot with posttraumatic epilepsy. Methods For analyzing epidemiology studies of posttraumatic epilepsy 9475 cases of civilians' posttraumatic epilepsy (include 605 severe, 1955 moderate and 6915 mild traumatic brain injury cases) were reviewed. Besides, 2 epilepsy cases of civil pilots with severe traumatic brain injury, who were specially applied for assessment, were also analyzed to investigate the application in aeromedical assessment. Results ①The severer traumatic brain injury the higher incidence of posttraumatic epilepsy. ②The possibility of posttraumatic epilepsy seizure was gradully diminished with time. The incidence of posttraumatic epilepsy could reduce to lower than 1% after 1, 3 or 8 years corresponding to the mild,moderate and severe traumatic brain injury. ③ The high risk factors of posttraumatic epilepsy included brain contusion, subdural hematoma, depressed fracture, loss of consciousness or post traumatic amnesia more than 24 h and early seizure. The close follow-up showed that 2 pilots well recovered by timely treatment and no more abnormities and seizure happened. One pilot was permitted for co-piloting at the 4th year of injury and had no epilepsy seizure in his safe flying for 2 years (1800 h). Another pilot returned to his qualified flight at the 9th year and had safely flied as pilot instructor for 4 years ( 1600 h) without seizure.Conclusions By applying 1% rule in aeromedical assessment, the mild traumatic brain injured pilot would be suggested to fit for flying by 1-year recovery and 3-year recovery for the moderate if no more abnormities were diagnosed. For the severe injured pilot, the flying qualification could be considered with or without limitation by 8-year recovery.     

飞行人员踏板运动试验心电图ST-T改变影响因素分析

活动踏板运动试验是一项评价心肌缺血及协助诊断冠心病常用的无创检查方法,具有简便、安全、实用等特点,临床应用广泛.踏板运动试验在飞行人员疗养大体检心电图鉴别诊断中常可用到[5],笔者对影响阳性结果判断的一些非病理因素做一探讨分析.     

民航飞行员甲状腺癌的临床诊治及医学鉴定——附7例病例报告

甲状腺癌是最常见的甲状腺恶性肿瘤,约占全身恶性肿瘤的1％,甲状腺癌的发病率不断上升,是最常见的内分泌系统恶性肿瘤[1].民用航空飞行员中甲状腺癌的患病率也有所增长.本文报道7例甲状腺癌飞行员病例,并对治疗后的甲状腺癌飞行员的航空医学鉴定进行讨论,以期在航空医学体检保障上加强认识,保障飞行安全.     

Factors Associated with Universal Free School Meal Provision Adoption among US Public Schools

BackgroundThe Community Eligibility Provision (CEP) allows high-poverty schools participating in US Department of Agriculture meal programs to offer universal free school meals. Emerging evidence suggests benefits of CEP for student meal participation, behavior, and academic performance. Although CEP became available nationwide in 2014, in school year 2019–2020, one third of eligible schools were not participating.ObjectiveThis study evaluates which school, district, and state factors are associated with CEP participation.DesignCross-sectional study comparing CEP-participating with eligible nonparticipating schools to assess the relationship between CEP participation and school, district, and state factors.ParticipantsUS public schools eligible for CEP in school year 2017–2018 (n = 42,813).Main Outcome MeasuresCEP participation.Statistical Analyses PerformedPenalized regression variable selection methods to determine which factors contribute information to the model. Generalized logistic regression to predict odds of CEP participation unadjusted and adjusted for each factor in the full sample and in stratified analyses by whether a state was part of the CEP phase-in period (early vs late implementing states).ResultsIn the full sample, adjusted odds of CEP participation were greater in states where CEP had been available longer (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.34, 1.67). In late implementing states, adjusted odds of CEP participation were higher in schools with more students directly certified for free meals (OR in schools with 80%–89% vs 30%–39% directly certified: 19.32; 95% CI, 12.98, 28.76), Title I schools (OR, 1.85; 95% CI, 1.55, 2.21), and urban schools (OR suburban vs urban, 0.46; 95% CI, 0.36, 0.59). Differences by school level, enrollment, district size, student race/ethnicity, and geographic region also existed.ConclusionsFindings may help advocates, state agencies, and policymakers understand potential barriers to adoption and guide research exploring effective strategies to promote uptake. Future research should use qualitative and longitudinal designs to explore barriers to adoption, including cost and state and local policies.     

配方施肥对板蓝根产量和多糖含量的影响

目的：对不同配方施肥处理的板蓝根的产量及多糖含量进行分析,以确定板蓝根的最佳氮磷钾配比。方法：采用L₁₆(4³)正交法设计,研究氮磷钾不同配比对板蓝根产量的影响；采用苯酚-硫酸比色法对多糖含量进行测定。结果：板蓝根产量最大和多糖含量最高的最优施肥配方是A₂B₂C₁,即尿素869.0 kg·hm^-2、过磷酸钙1 428.6 kg·hm^-2、硫酸钾0 kg·hm-2。结论：磷肥能显著影响板蓝根的产量水平,氮肥能显著影响板蓝根多糖的含量。