Platelet elevation is a rare manifestation in the peripheral blood of patients with chronic myeloid leukemia (CML). In this paper, we report for the first time a case of CML combined with cerebral hemorrhage manifested by abnormally elevated platelets. The patient had elevated platelets in the peripheral blood, showed normal coagulation function, and underwent intracranial hematoma removal due to cerebral hemorrhage. After the operation, bleeding from the operated area and other systems occurred, and the patient was diagnosed as having accelerated CML after combining bone marrow biopsy and genetic testing. His condition was controlled after administration of flumatinib through a jejunal tube. Based on this patient's experience, the feasibility ofadministering flumatinib via a jejunostomy tube was determined, which is the first report of its kind in China and abroad.This article summarizes the diagnosis and treatment process of this patient, with the aim of providing a warning and reference for clinicians.

Objective To retrospectively investigate and analyze the specially permitted aeromedical evaluation results of overage military flying personnel,in order to provide references for health management and related evaluation methods improvement.Methods The clinical data and evaluation results of overage flying personnel were collected from 2012 to 2023.Disease spectrum was analyzed,and qualified rates among different airplane types and aviation duties were compared.Results 79.57%of the 509 flying personnel were detected with diseases,and the top ten were hyperlipidemia,fatty liver,thyroid nodule,renal cyst,hepatic cyst,gallbladder polyps,hyperuricemia,carotid artery arteriosclerosis,hypertension and hepatic hemangioma.96.08%of the personnel were qualified to continue flying,1.96%were disqualified and 1.96%were temporarily disqualified.The qualified rates among different airplane types and aviation duties were not significantly different(P?>?0.05).Conclusion Overage military flying personnel could apply for specially permitted aeromedical evaluation to extend their flying lifespan.Attention should be paid to metabolic and cardiovascular diseases in aeromedical support and evaluation for these experienced flying personnel.

Objective:To investigate the diagnosis, treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations (CCM).Methods:The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad.Results:A total of 10 flying personnel, all male, 20-41 years old, with an average age of 28.3 years, including 8 pilots, 2 air combat/technical personnel, with the flying hours of 110-4 000 h and the average flying hours of 1 102.0 h. The sizes of lesions were 3-12 mm, including 2 cases were smaller than 5 mm, 6 cases were 5-10 mm and 2 cases were bigger than 10 mm. All lesions were located under the cortex, including a case of occipital lobe, 4 cases of frontal lobe, 2 cases of temporal lobe and 3 cases of cerebellar hemisphere. Among the 10 flying personnel, only a case presented intracranial haemorrhage (right cerebellar hemisphere) as first symptom and was treated surgically. Three cases were temporarily grounded due to they were under the grounding observation. Other 7 flying personnel had been followed up for more than 6 months. Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities. Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot, and 2 dual-seat fighter pilots were qualified (limited to dual-seat fighter) and flight-qualified respectively. Two fighter pilots were qualified for lower performance aircraft (limited to bomber, transporter or helicopter).Conclusions:For CCM military flying personnel, the aeromedical assessment conclusion should be made according to the symptoms, lesion location and size, inflight incapacitation possibility assessment, treatment effect, ground observation and follow-up results, as well as the aircraft type and occupation.

Objective:To investigate the diagnosis, treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations (CCM).Methods:The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad.Results:A total of 10 flying personnel, all male, 20-41 years old, with an average age of 28.3 years, including 8 pilots, 2 air combat/technical personnel, with the flying hours of 110-4 000 h and the average flying hours of 1 102.0 h. The sizes of lesions were 3-12 mm, including 2 cases were smaller than 5 mm, 6 cases were 5-10 mm and 2 cases were bigger than 10 mm. All lesions were located under the cortex, including a case of occipital lobe, 4 cases of frontal lobe, 2 cases of temporal lobe and 3 cases of cerebellar hemisphere. Among the 10 flying personnel, only a case presented intracranial haemorrhage (right cerebellar hemisphere) as first symptom and was treated surgically. Three cases were temporarily grounded due to they were under the grounding observation. Other 7 flying personnel had been followed up for more than 6 months. Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities. Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot, and 2 dual-seat fighter pilots were qualified (limited to dual-seat fighter) and flight-qualified respectively. Two fighter pilots were qualified for lower performance aircraft (limited to bomber, transporter or helicopter).Conclusions:For CCM military flying personnel, the aeromedical assessment conclusion should be made according to the symptoms, lesion location and size, inflight incapacitation possibility assessment, treatment effect, ground observation and follow-up results, as well as the aircraft type and occupation.

Objective:To provide references for standardizing the post-operative aeromedical assessment of heart valve disease of flying personnel by analyzing the pathogenesis characteristics and treatment.Methods:The case data of flying personnel with heart valve disease hospitalized in Air Force Medical Center from November of 2010 to December of 2021 were collected, which was called the clinical group; the relevant cases of heart valve disease in domestic flying personnel reported in the literature were retrieved, which was called the literature group. The retrospective study was carried out and the data was analyzed according to the aircraft type, lesion location, treatment method and identification results.Results:There were 20 cases in the clinical group. According to the number of detected cases, the valve positions order was the aortic valve (12 cases), the mitral valve (7 cases), the tricuspid valve (4 cases, all concomitant), and the pulmonary valve (1 case). The literature group had 11 cases, mainly were aortic valve disease (10 cases) and tricuspid valve (1 case). Most of these aortic valve lesions were based on the pathology of bicuspid aortic valve (BAV). Among the cases of aortic valve disease, 12 cases were flight-qualified, 1 case was restricted flight, 1 case of fighter aircraft was transferred to fly transporter, 3 cases were temporary unqualified for flight, 3 cases were unqualified for flight, and 2 cases were waivered. Among the cases of mitral valve disease, 3 cases were flight-qualified, 4 cases were temporary unqualified for flight, 1 case of tricuspid valve and 1 case of pulmonary valve were qualified for flight.Conclusions:The lesion site of valve is the main factor influencing the aeromedical assessment result. The aortic valve is the most common site of valve disease among flying personnel, and BAV is the most common pathologic type. It should be strengthened physical examination identification and prevention.

Objective:To provide references for standardizing the post-operative aeromedical assessment of heart valve disease of flying personnel by analyzing the pathogenesis characteristics and treatment.Methods:The case data of flying personnel with heart valve disease hospitalized in Air Force Medical Center from November of 2010 to December of 2021 were collected, which was called the clinical group; the relevant cases of heart valve disease in domestic flying personnel reported in the literature were retrieved, which was called the literature group. The retrospective study was carried out and the data was analyzed according to the aircraft type, lesion location, treatment method and identification results.Results:There were 20 cases in the clinical group. According to the number of detected cases, the valve positions order was the aortic valve (12 cases), the mitral valve (7 cases), the tricuspid valve (4 cases, all concomitant), and the pulmonary valve (1 case). The literature group had 11 cases, mainly were aortic valve disease (10 cases) and tricuspid valve (1 case). Most of these aortic valve lesions were based on the pathology of bicuspid aortic valve (BAV). Among the cases of aortic valve disease, 12 cases were flight-qualified, 1 case was restricted flight, 1 case of fighter aircraft was transferred to fly transporter, 3 cases were temporary unqualified for flight, 3 cases were unqualified for flight, and 2 cases were waivered. Among the cases of mitral valve disease, 3 cases were flight-qualified, 4 cases were temporary unqualified for flight, 1 case of tricuspid valve and 1 case of pulmonary valve were qualified for flight.Conclusions:The lesion site of valve is the main factor influencing the aeromedical assessment result. The aortic valve is the most common site of valve disease among flying personnel, and BAV is the most common pathologic type. It should be strengthened physical examination identification and prevention.

Objective:To investigate the expression of iron-regulating erythroid factors in different types of erythropoiesis disorders.Methods:From January 2016 to November 2019, the plasma concentrations of iron-regulating erythroid factors were measured by ELISA methods in 47 patients with different types of erythropoiesis disorders. The adaptation orientation of iron-regulating erythroid factor expression with bone marrow erythropoiesis activities (represented by bone marrow-nucleated erythrocytes ratio) was analyzed.Results:The median plasma growth differentiation factor (GDF) 15 levels in patients with polycythemia vera (PV) , pure red cell aplasia (PRCA) , autoimmune hemolytic anemia (AIHA) , and myelodysplastic syndrome (MDS) were 266.01 ng/L (112.40, 452.37) , 110.63 ng/L (81.41, 220.42) , 52.11 ng/L (32.61, 171.66) , and 276.53 (132.16, 525.70) ng/L, respectively, which were significantly higher than those in normal patients with 37.45 (19.65, 57.72) ng/L (all P < 0.01) . The plasma TWSG1 expression levels were not significantly different in patients with PV, PRCA, AIHA, and MDS from those of normal patients (P>0.05) . The median plasma GDF11 level in PV was 74.75 (10.95, 121.32) ng/L, which was significantly higher than 36.90 (3.38, 98.34) ng/L in normal control subjects ( P<0.01) . However, no statistical differences were observed in the other three subjects ( P>0.05) . The median plasma erythroferrone (ERFE) levels in AIHA and PV were 121.76 ng/L (68.12, 343.11) and 129.63 (47.02, 170.03) ng/L, respectively, with the highest level in AIHA in all the studied types of erythropoiesis disorders. The bone marrow-nucleated erythrocytes ratio was significantly and positively correlated with ERFE ( r=0.458, P=0.001) but not with GDF15 ( r=-0.163, P=0.274) , GDF11 ( r=0.120, P=0.421) , and TWSG1 ( r=-0.166, P=0.269) . Conclusion:The expression profile of iron-regulating erythroid factors is not exactly the same in different types of erythropoiesis disorders. ERFE demonstrated the highest correlation with erythropoiesis activities.

Objective:To study the effect of iron deficiency level for oral iron absorption in iron deficient patients.Methods:37 non-pregnant female patients who were diagnosed with iron deficiency and 13 healthy females who completed their physical examination at the outpatient department of the Anemia Center of the Institute of Hematology & Blood Diseases Hospital from July 2018 to June 2020 were included. Hepcidin and C2-C0 of oral iron absorption test were analyzed in different iron deficiency and serum ferritin level.Results:The median of Hepcidin in IDA, ID/IDE and healthy control group were 4.9 (2.17-32.86) , 26.98 (11.02-49.71) and 69.89 (42.23-138.96) μg/L ( P<0.001) , respectively. Hepcidin level of IDA group was lower than that of ID/IDE group (adjusted P=0.005) and healthy control (adjusted P<0.001) . Hepcidin level of ID/IDE group had no significant difference compared with healthy control (adjusted P=0.22) . The mean of C2-C0 in IDA, ID/IDE and healthy control group were (35.30±21.68) , (37.90±14.06) and (23.57±10.14) μmol/L ( P=0.130) , respectively. Multilinear regression analysis showed C0, SF, sTFR and HGB were independent factors for Hepcidin in iron deficient patients, with an equation of Hepcidin=-31.842-0.642*C0+2.239*SF+1.778*sTFR+0.365*HGB-0.274*RET-HB. We didn't find independent factor of C2-C0. Conclusion:The degree of iron deficiency had an effect on oral iron absorption. Patients of ID/IDE group absorbed iron more slowly than patients of IDA group. Iron deficient patients with normal gastrointestinal function absorbed more iron by oral administration when they were in a more serious iron deficient stage. Hepcidin was a better parameter to distinguish iron absorption level among different iron deficient patients than C2-C0 of oral iron absorption test.

Objective:To explore the relationship between the exercise of cervical and lumbar muscles of military flying personnel and the prevalence of cervical and lumbar spine diseases, and to verify the protective effect of the exercise of cervical and lumbar muscles on cervical and lumbar of flying personnel.Methods:A self-made questionnaire and cluster sampling method were used. Air Force pilots of different aircraft types were selected to survey the situation of physical exercise and the prevalence of cervical and lumbar diseases by a questionnaire. Pilots were grouped by if stretching before flight, if relaxing after flight, and if regularly exercising on the strength of cervical and lumbar muscles. The prevalence of the cervical and lumbar diseases was compared. Influence factors were searched by Logistic regression analysis to investigate the protective effect of cervical and lumbar muscle exercise on the neck and waist.Results:In this study, 779 valid questionnaires out of 923 were obtained. The effective rate of the questionnaires was 84.4%. The prevalence of cervical and lumbar diseases in the flying personnel without cervical and lumbar muscles stretching before flight was 36.2%, while the prevalence of flying personnel with cervical and lumbar muscles stretching before flight was 27.6%. There were significant differences between them (χ 2=6.217, P<0.05). The prevalence rate of cervical and lumbar diseases in the flying personnel without cervical and lumbar muscles relaxation after flight was 37.9%, while the prevalence of flying personnel without cervical and lumbar muscles with relaxation after flight was 23.7%. There were significant differences between them (χ 2=16.30, P<0.01). The prevalence rate of cervical and lumbar diseases in the flying personnel without regular training was 41.1%, while the prevalence of relaxation after flight was 29.8%. There were significant differences between them (χ 2=8.89, P<0.01). Logistic regression analysis showed that age, relaxing after the flight, and regular training of cervical and lumbar muscles were all independent factors that affected cervical and lumbar diseases. Among them, increased age was the risk factor of cervical and lumbar diseases ( OR=1.073, 95 %CI: 1.033-1.114, P<0.01), cervical and lumbar relaxing after the flight ( OR=0.456, 95 %CI: 0.303-0.686, P<0.01) and regular training of cervical and lumbar muscles ( OR=0.656, 95 %CI: 0.463-0.930, P<0.05) were both protective factors for cervical and lumbar diseases. Conclusions:The stretching before flight, relaxing after flight, and regular training of cervical and lumbar muscles can significantly reduce the prevalence of cervical and lumbar diseases in flying personnel.

Objective:To explore the relationship between the exercise of cervical and lumbar muscles of military flying personnel and the prevalence of cervical and lumbar spine diseases, and to verify the protective effect of the exercise of cervical and lumbar muscles on cervical and lumbar of flying personnel.Methods:A self-made questionnaire and cluster sampling method were used. Air Force pilots of different aircraft types were selected to survey the situation of physical exercise and the prevalence of cervical and lumbar diseases by a questionnaire. Pilots were grouped by if stretching before flight, if relaxing after flight, and if regularly exercising on the strength of cervical and lumbar muscles. The prevalence of the cervical and lumbar diseases was compared. Influence factors were searched by Logistic regression analysis to investigate the protective effect of cervical and lumbar muscle exercise on the neck and waist.Results:In this study, 779 valid questionnaires out of 923 were obtained. The effective rate of the questionnaires was 84.4%. The prevalence of cervical and lumbar diseases in the flying personnel without cervical and lumbar muscles stretching before flight was 36.2%, while the prevalence of flying personnel with cervical and lumbar muscles stretching before flight was 27.6%. There were significant differences between them (χ 2=6.217, P<0.05). The prevalence rate of cervical and lumbar diseases in the flying personnel without cervical and lumbar muscles relaxation after flight was 37.9%, while the prevalence of flying personnel without cervical and lumbar muscles with relaxation after flight was 23.7%. There were significant differences between them (χ 2=16.30, P<0.01). The prevalence rate of cervical and lumbar diseases in the flying personnel without regular training was 41.1%, while the prevalence of relaxation after flight was 29.8%. There were significant differences between them (χ 2=8.89, P<0.01). Logistic regression analysis showed that age, relaxing after the flight, and regular training of cervical and lumbar muscles were all independent factors that affected cervical and lumbar diseases. Among them, increased age was the risk factor of cervical and lumbar diseases ( OR=1.073, 95 %CI: 1.033-1.114, P<0.01), cervical and lumbar relaxing after the flight ( OR=0.456, 95 %CI: 0.303-0.686, P<0.01) and regular training of cervical and lumbar muscles ( OR=0.656, 95 %CI: 0.463-0.930, P<0.05) were both protective factors for cervical and lumbar diseases. Conclusions:The stretching before flight, relaxing after flight, and regular training of cervical and lumbar muscles can significantly reduce the prevalence of cervical and lumbar diseases in flying personnel.