Objectives To investigate the effects of military stress and psychological resilience on job burnout and mental health in military personnel and construct the relationship among resilience,job burnout and mental health during military stress.Methods By cluster random sampling,520 personnel in army taking part in the war-game were selected as the experimental group,and another group of 520 who not taking part in the wargame were selected as the control group.After one week of the war-game,the experimental group and control group were investigated by Military Personnel Mental Disorder Prediction Scale,Military Job Burnout Scale and Military Personnel Resilience Scale.The acquired datum were analyzed by t-test,correlation analysis,regression analysis and structural equation modeling analysis.Results (1) The total scores of mental disorder prediction and factor scores of psychosis,depression,mania,neurosis,personality disorder were((15.85±9.30),(0.36±0.91),(1.10±1.53),(2.66±1.78),(1.16± 1.57),(2.04± 1.83)) and the total scores of job burnout and its all factor scores were((23.05±9.40),(5.13±2.47),(3.19±2.18),(5.16±3.01),(1.71 ± 1.66),(3.29±2.21)) of experimental group were significantly higher than control group((11.20±6.24),(0.11 ±0.53),(0.55± 1.10),(1.89± 1.50),(0.51± 1.02),(1.10±1.13),(17.92±9.64),(4.28±2.92),(2.64±2.06),(3.84±2.46),(1.26± 1.37),(2.77±2.43),P=0.000).(2)Psychological resilience negatively correlated with job burnout and mental health(r=-0.52～-0.09,P＜0.05),and job burnout positively correlated with mental health (r=0.12 ～ 0.57,P＜0.01).(3) Under the military stress,psychological resilience was the accommodation to effect the mental health and job burnout of military personnel.(4)The analysis of structural equation modeling showed that psychological resilience had a direct effect on job burnout(the path coefficient was-0.56,P＜0.01),but it had no significant effect on mental health (the path coefficient was-0.06,P=0.302).Job burnout had a direct effect on mental health (the path coefficient was 0.73,P＜0.01),and the structural equation modeling fitted the data very well(x2/ df =3.138,GFI =0.943,AGFI =0.911,NFI =0.930,RFI =0.905,IFI =0.952,TLI =0.933,CFI =0.951,RMSEA =0.065).Conclusion Military stress can lead to job burnout and mental disorders that could be moderated by psychological resilience.Job burnout can fully mediate the relation between psychological resilience and mental health.Psychological resilience effects mental health by job burnout indirectly.

OBJECTIVE To analyze the caloric test findings of the unilateral primary horizontal and posterior semicircular canal benign paroxysmal positional vertigo(HSC-BPPV and PSC-BPPV).METHODS Caloric test were tested in 152 PSC-BPPV patients and 25 HSC-BPPV patients after Dix-Hallpike test and Roll test.RESULTS Of 152 PSC-BPPV patients 64 canal paresis(CP)were found in the abnormal side and 44 in the normal side;Of 25 HSC-BPPV patients 16 canal paresis were found in the abnormal side and 9 in the normal side.The incidence of CP in PSC-BPPV is 30.3% and the incidence of CP in HSC-BPPV is 52%.13 Patients with PSC-BPPV were found abnormal Directional Preponderance(DP)and 10 Patients with PSC-BPPV were found abnormal Directional Preponderance.CONCLUSION The incidence of CP in the abnormal side of HSC-BPPV and PSC-BPPV is more than that of the normal side.The incidence of CP in abnormal side of the HSC-BPPV is more than that of PSC-BPPV.The incidence of abnormal DP in HSC-BPPV is more than that of PSC-BPPV.

Objective To investigate the relationship between the anti-earthquake military rescuers' psychosomatic health and social support, and observe the effect of intervention to the army men who suffered troubles.Methods By cluster random sampling, 152 military rescuers and 139 army men not taking part in the rescues were investigated by Facility Psychosomatic Health Scale and Social Support Rating Scale. Mental intervention or medication was performed to those produced psychosomatic health. Results The scores of somatic symptoms,mental status,psychosomatic health and social support of military rescuers and the control group were (4.09±4.70) ,(2.18 ±3.16) ,(6.27 ±7.08) ,(6.14 ±4.20) and (2.11 ±4.16) ,(1.37 ±3.09),(3.47 ±6.55),(4.57 ± 4.17 )respectively, the difference was significant(P＜0.05). The somatic symptoms had significantly positive correlation with mental status in military rescuers (r=0.17～0.52, P＜ 0.05 or 0.01 ). Failure of social support had positive correlation with mental disorders (r=0.18～0.40, P＜0.05 or 0.01). The degree of social support was the main factor which had affected on the psychosomatic health of military rescuers. The somatic symptoms of military rescuers were apparently higher than their mental symptoms. Mental and pharmaceutical intervention showed good effect on them. Conclusion There is an apparent effect for military rescuers injured seriously psychosomatic health through medication or mental intervention.

Objective:To investigate the relationship between the changes of default network topology properties of brain function and cognitive function in patients with end-stage renal disease (ESRD).Methods:A total of 31 patients with ESRD were enrolled in the Department of Nephrology, Changzhou Second Hospital Affiliated to Nanjing Medical University from January 2019 to December 2020, and 18 healthy persons were included in the same period as the control group.The cognitive function was evaluated with the Montreal cognitive assessment (MoCA) and trail making tests, and then the subjects were examined by resting-state functional magnetic resonance imaging (rs-fMRI). After preprocessing, the brain functional network was constructed and the topology properities of the network were calculated.The SPSS 20.0 software was used for statistical analysis.Independent sample t-test, chi square test and Pearson correlation analysis were used for data statistics. Results:(1) The score of MoCA in the ESRD group(23.37±1.77) was significantly lower than that in the healthy control group(27.94±1.13)( t=9.537, P<0.001). (2) The levels of Eglobal, Elocal, Cp and Sigma in ESRD group ((0.129±0.025), (0.148±0.040), (0.188±0.046), (1.593±0.650)) were significantly lower than those in healthy control group ((0.160±0.040), (0.212±0.024), (0.276±0.049), (2.004±0.864))( t=3.591, 7.474, 7.058, 2.034, all P<0.05). The Lp value of the ESRD group (8.131±1.905) was significantly higher than that of the control group (6.777±2.150)( t=2.583, P< 0.05). The node efficiency values of bilateral dorsolateral superior frontal gyrus, left middle frontal gyrus, bilateral posterior cingulate gyrus, right hippocampus, left superior marginal gyrus, bilateral angular gyrus and bilateral cuneate anterior lobe in ESRD group ((0.133±0.071), (0.201±0.047), (0.211±0.106), (0.175±0.066), (0.276±0.113), (0.122±0.146), (0.042±0.075), (0.171±0.027), (0.154±0.078), (0.240±0.095), (0.161±0.056))were lower than those in the healthy control group((0.312±0.075), (0.289±0.091), (0.277±0.132), (0.284±0.053), (0.368±0.063), (0.231±0.227), (0.120±0.162), (0.296±0.064), (0.310±0.186), (0.318±0.066), (0.286±0.103))( t=2.107-9.436, all P<0.05). (3)Pearson correlation analysis showed that the node efficiency values of bilateral posterior cingulate gyrus and right hippocampus in ESRD group were positively correlated with the score of MoCA( r=0.36, 0.49, 0.53, all P<0.05). Conclusion:The topological structure of brain functional network is abnormal in ESRD patients, which can affect the cognitive function of patients.

The contents recorded in the rotation registration manual is not only the quantitative indicators for evaluating the quality of residency training, but also the important basis for training assessment and issuance of training certificates. In order to solve the problems of data authenticity, information delay, and repeated entry in the rotation registration manual for residency training, Shanghai East Hospital, Tongji University, launched a project to dock the electronic rotation registration manual with the hospital information system. Through the establishment of the project team, the development of working mechanisms, and the implementation of the project, data analysis was used for process reformation and system optimization, so as to continuously improve management efficiency and medical safety while solving problems and form a set of implementation system with reference significance in practice.

Objective:To investigate the effect of pressurized pedicled rectus abdominis flap for breast reconstruction.Methods:A retrospective study was conducted to include 37 female patients with breast cancer who underwent immediate breast reconstruction using a pressurized pedicle rectus abdominis skin flap transplantation after surgery at the Department of Plastic and Reconstructive Surgery, Hunan Provincial Cancer Hospital from March 2019 to December 2022. The patients were aged 29-61 years, with an average age of (37.7±3.5) years. According to the preoperative imaging and ultrasound data, 17 patients were planned to complete immediate breast reconstruction with free inferior abdominal artery perforator flap transplantation, and the operation was adjusted to directly prepare a pedicled rectus abdominis flap with long inferior abdominal vessel pedicle according to the actual situation. In addition, 20 patients were scheduled to use pedicled rectus abdominis flap alone, and the operation was changed according to the actual situation. The flap was trimmed according to the condition of the affected area and immediate intraoperative fluorgraphy. After cutting off the vascular pedicle, the recipient area was placed, and the recipient blood vessels were selected for vascular anastomosis. After shaping, the donor and recipient areas were sutured. The survival of the skin flap was observed.Results:Intraoperative fluorescein angiography was used to determine the blood supply of the flap. It was found that 37 cases of pedicled rectus abdominis flaps had different degrees of blood supply disorders. The affected vessels in the specific anastomosis comprised the intrathoracic vessels (19 cases, 51.4%), the lateral thoracic arterial vein (10 cases, 27.0%), and anterior branches of the thoracic and dorsal vessels (8 cases, 21.6%). In 37 cases, the lateral abdominal wall vein was carried in the flap, 20 of which carried the lateral abdominal wall shallow vein, 17 cases carried the lateral abdominal wall shallow vein, six of which were extra anastomosed and superficial vein, and the actual utilization rate was 16.2%. The follow-up was 47 months, averaging 22.7 months. 37 patients had fair reconstructed breast appearance, good elasticity, and no flap contracture deformation. Only linear scar was left in the flap donor area with no effect on abdominal wall function.Conclusions:Pressurized rectus flap can improve the survival rate and surgical safety.

Objective: The purpose of this study was to observe the clinical characteristics of two types of geotropic direction-changing positional nystagmus, the transient(nystagmus time <1 min) and the persistent(nystagmus time > 1 min), and to evaluate the efficacy of the barbecue roll maneuver. Methods: A total of 105 cases diagnosed by supine roll test were studied, which including 35 males and 70 females and the average age was (56.9±14.6)years. There were 70 transient geotropic DCPN and 35 persistent geotropic DCPN. The clinical characteristics and the immediate and one-week efficacy of the barbecue roll maneuver were discussed. Results: The nystagmus disappeared at the null-point position and the nystagmus in supine position were opposite to the bowing (90° nose-down) position in persistent geotropic DCPN cases. While to the transient geotropic DCPN cases, there were no NP and no nystagmus in prone position. The ratio of the first onset of the two groups was 28.6% (persistent) and 72.9% (transient) respectively, and the difference was statistically significant (P<0.05). The immediate and one-week efficacy after barbecue roll maneuver were 91.4% and 80.0% in transient geotropic DCPN cases, and 0% and 42.9% in persistent geotropic DCPN cases, which were statistically significant different(P<0.05). Conclusions The light cupula hypothesis can mainly explain the clinical features of persistent geotropic DCPN cases; the barbecue roll maneuver is invalid to persistent geotropic DCPN cases which can be self-healing.

Objective:To investigate the clinical effects of combined tissue flap transplantation in repairing giant chest wall defects.Methods:This study was a retrospective observational study. From August 2013 to December 2020, 31 patients with chest wall tumor or radiation ulcer after radical resection of chest wall tumor and conformed to the inclusion criteria were admitted to the Department of Breast Oncoplastic Surgery of Hunan Cancer Hospital, including 12 males and 19 females, aged 25-71 years. After resection of tumor or ulcer and wound debridement, the area of secondary chest wall defect was 300-600 cm 2 with length of 16-35 cm and width of 16-32 cm. According to the actual situation of the patients and the preoperative design, the chest wall defects were repaired with the flexible combination of perforator flaps and myocutaneous flaps from different donor sites, and the area of the combined tissue flap was 260-540 cm 2 with length of 20-30 cm and width of 13-20 cm. Free posteromedial thigh perforator flap+free anterolateral thigh myocutaneous flap were used in 2 patients, free deep inferior epigastric artery perforator flap+free anterolateral thigh myocutaneous flap were used in 5 patients, free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+free anterolateral thigh myocutaneous flap were used in 7 patients, free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+pedicled latissimus dorsi myocutaneous flap were used in 2 patients, and bilateral free anterolateral thigh myocutaneous flaps were used in 15 patients. For the remaining small area of superficial tissue defect after being repaired by combined tissue flaps, skin graft was used to repair or delayed local flap transfering was performed after the tissue flaps survived and edema subsided. The appropriate blood vessels in the donor and recipient sites were selected for anastomosis to reconstruct the blood supply of tissue flaps. The wounds in the donor sites of tissue flaps that can be directly sutured were sutured directly; for those that cannot be sutured directly, the skin grafting or delayed suture was performed. The anastomosis of blood vessels in the recipient sites, operation length, and postoperative hospital stay were recorded. The survivals of tissue flaps and skin grafts, the shape and texture of reconstructed chest wall, the wound healing, scar formation, and function of donor sites of tissue flaps, and the scar formation of the donor sites of skin grafts were observed after operation. Tumor recurrence and death of recurrent patients were followed up after operation. Results:The blood vessels in the recipient sites were anastomosed as follows: proximal internal thoracic vessels for 24 times, distal internal thoracic vessels for 12 times, trunk of thoracodorsal vessels for 4 times, anterior serratus branches of thoracodorsal vessels for 8 times, and thoracoacromial vessels for 12 times. The operation length was 6.0 to 8.5 hours, and the postoperative hospital stay was 9 to 21 days. Necrosis at the edge of partial tissue flaps occurred in 4 patients after operation, which healed after dressing change, and the tissue flaps and skin grafts of the other patients survived completely. The shape and texture of the reconstructed chest wall were good. Four patients had poor wound healing in the donor sites of abdominal tissue flaps, which healed after dressing change and local drainage. Only linear scar was left in the donor sites of all tissue flaps, and there was no obvious dysfunction in the donor sites of tissue flaps. Mild hypertrophic scar was left in the donor sites of skin grafts. During follow-up of 9 to 36 months after operation, 6 patients had tumor recurrence, and the recurrence time was 5 to 20 months after operation. After comprehensive treatment for patients with tumor recurrence, 3 patients died.Conclusions:Transplantation of combined tissue flaps in repairing the giant chest wall defects can shorten the time of total operation and hospital stay, and avoid multiple operations. After operation, patients had good chest wall appearance, with reduced tumor recurrence in patients with chest wall tumor.